Symptoms of Rheumatic Fever

The symptoms of rheumatic fever are separated into two groups:

• Major criteria
• Minor criteria

The diagnosis is established when the person has at least two major criteria, or two minor criteria and one major criterion, as well as the evidence of streptococcal infection (rising antistreptolysin O titre). The only exceptions are indolent carditis and chorea, which are directly linked with rheumatic fever.

Major Criteria

• Polyarthritis – inflammation of several joints. Polyarthritis that happens as a result of rheumatic fever usually affects large joints. Typically, it starts in the knees and migrates upwards. What is characteristic about this type of arthritis is that the inflammation doesnot have any lasting effects on the joints.
• Carditis – inflammation of the myocardium. Since inflammation gradually weakens the muscle cells of myocardium, carditis can lead to congestive heart failure Moreover, the inflammation can irreversibly damage the heart valves leading to their stenosis or insufficiency. The patient with rheumatic fever may also develop pericarditis. The classic sign of pericarditis is friction rub that can be heard when using a stethoscope during a cardiovascular examination.
• Subcutaneous nodules – small accumulations of collagen fibers that do not cause any pain and are usually located on the back of the wrists, on elbows and knees.
• Sydenham’s chorea – involuntary rapid movement of the face and arm muscles. This symptom usually appears after a long while (at least three months) after the onset of the disease. Sydenham’s chorea is also often accompanied by outbursts of unusual behavior (e.g. inappropriate laughing, crying, and anger).

Minor Criteria

• Febrile body temperature which usually ranges from 38.2 to 38.9 degrees Celsius.
• Arthralgia – joint pain that isnot accompanied by swelling. This symptom is usually caused by high fever. If the patient has polyarthritis, then this symptom cannot be counted.
• Elevated erythrocyte sedimentation rate (ESR). ESR usually rises as a reaction to an inflammation process within the body. However, it can also rise in women at the start of their period and during pregnancy.
• Leukocytosis – elevates levels of white blood cells. This is a clear sign of an inflammatory process.
• Signs of heart block on ECG. This usually includes a prolonged PR interval (first-degree AV block). This criterion cannot be counted if the patient was diagnosed with carditis.
• Previous history of rheumatic fever

Other Signs and Symptoms

• Preceding streptococcal infection. This is a very important sign although it isnot included in major and minor criteria. Preceding streptococcal infection is diagnosed based on levels on raised levels of antistreptolysin O, streptococcal antibody titre growth, and positive throat culture.
• Abdominal pain and nose bleeds are also common for patients with rheumatic fever.
• Heart murmurs. Heart murmurs can be heard when the rheumatic fever has sufficiently damaged the heart valves.
• Fatigue. People with rheumatic fever often suffer from fatigue either due to toxic effects of substances released due to inflammation or due to heart failure caused by carditis.

Next Chapter: Diagnosis of Rheumatic fever