12th March 2024

Clinical manifestations

Signs and symptoms of rheumatic fever include: 

• Fever 
• Erythema marginatum: an annular erythema appearing as macules and papules typically on the trunk, upper arms and legs. As the lesions progress, their outer edges become raised with central clearing. 
• Arthritis: a migratory polyarthritis primarily affecting the large joints is typically seen. Arthralgia may also be present.
• Carditis can affect more than half of patients and may affect all the layers of the cardium (pancarditis) 
• Valvular regurgitation: there is typically involvement of the valvular endothelium progressing to valvular regurgitation. The mitral valve and aortic valve are most commonly affected.
• Chorea: involuntary, irregular jerking movements. Occurs due to immunological reactions affecting parts of the basal ganglia. Chorea can present up to six months after the initial streptococcal infection.
• Subcutaneous nodules: painless lumps over the extensor surfaces of wrists, elbows, knees and ankles.