25th February 2025

Rheumatic fever

Overview of rheumatic fever

This is a delayed immune response to pharyngeal infection with group-A β-haemolytic Streptococcus. It is uncommon in the UK but the major worldwide cause of valvular heart disease.

Signs and symptoms of rheumatic fever

Arthritis is usually in large joints, with little inflammation and self-limits in 2-3 weeks. Other features can include erythema marginatum (an annular pink rash on the trunk and proximal limbs that can fade and reappear), painless subcutaneous nodules, carditis (with cardiomyopathy and conduction defects), Sydenham’s chorea, and valvular heart disease (of the mitral valve) 10-20 years later.

Investigations in rheumatic fever

Diagnosis is based on clinical features with detection of group-A Streptococcus: throat cultures or antistreptolysin O (ASO) titre. The Jones criteria can be used. CXR and ECG look for cardiac involvement.

Management of rheumatic fever

Treatment is with 10 days of penicillin with NSAIDs. Some patients may receive long-term secondary prophylaxis with phenoxymethylpenicillin (recurrence risk).

Table 2 Overview of key rheumatological manifestations of infection