Rheumatic fever symptoms may vary. Some people may have several symptoms, while others experience only a few. The symptoms may also change during the course of the disease. The onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.
Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin or central nervous system — may include:
- Painful and tender joints — most often the ankles, knees, elbows or wrists; less often the shoulders, hips, hands and feet
- Pain in one joint that migrates to another joint
- Red, hot or swollen joints
- Small, painless nodules beneath the skin
- Chest pain
- Heart murmur
- Flat or slightly raised, painless rash with a ragged edge (erythema marginatum)
- Jerky, uncontrollable body movements (Sydenham chorea or St. Vitus' dance) — most often in the hands, feet and face
- Outbursts of unusual behavior, such as crying or inappropriate laughing, that accompanies Sydenham chorea
When to see a doctor
Your child should see a doctor if he or she has signs or symptoms of strep throat. Proper treatment of strep can prevent rheumatic fever. Call your doctor if your child has any of the following signs or symptoms:
- A sore throat without cold symptoms, such as a runny nose
- A sore throat accompanied by tender, swollen lymph glands (nodes)
- A red rash that starts at the head and neck, then expands to the trunk and extremities
- Difficulty swallowing anything, including saliva
- Thick or bloody discharge from the nose, which is more likely in children under 3 years of age
- A bright red tongue with bumps all over it, known as strawberry tongue
Call your doctor about a fever in the following situations:
- Newborns up to 3 months old with a fever of 100.4 F (38 C) taken rectally
- Children ages 3 to 6 months with a temperature of 102 F (38.9 C) or higher
- Children ages 6 months to 2 years with a fever of 102 F (38.9 C) or higher that doesn't respond to medication or lasts more than one day
- Children ages 2 to 17 years with a fever of 102 F (38.9 C) or higher (taken rectally for children younger than 3 and orally for children older than 3) that doesn't respond to medication or lasts more than three days
Also, see your doctor if your child shows any other signs or symptoms of rheumatic fever.
Feb. 18, 2014
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- Marijon E, et al. Rheumatic heart disease. The Lancet. 2012;379:953.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Aug. 12, 2013.
- Chow AW, et al. Evaluation of acute pharyngitis in adults. http://www.uptodate.com/home. Accessed Aug. 12, 2013.
- Gibofsky A, et al. Epidemiology and pathogenesis of acute rheumatic fever. http://www.uptodate.com/home. Accessed Aug. 12, 2013.
- Schmitt BD. Pediatric Telephone Protocols. 13th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2011:1.
- Mankad R (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 4, 2013.
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