Rheumatic Fever: Symptoms Beyond Heart, Joints, and Throat

Rheumatic fever is an autoimmune sequela of untreated group A streptococcal pharyngitis. While carditis, arthritis, and chorea are hallmark features, it can affect multiple systems:

Common Manifestations

• Carditis: Murmur, tachycardia, pericardial effusion, heart failure
• Polyarthritis: Migratory, large joints (knees, ankles, elbows, wrists)
• Chorea (Sydenham's): Involuntary, jerky movements, emotional lability
• Erythema marginatum: Serpiginous, non-pruritic rash on trunk/limbs
• Subcutaneous nodules: Firm, painless over bony prominences

Other Possible Features

• Fever, fatigue, malaise
• Chest pain, dyspnea (carditis)
• Hoarseness, dysphagia (rare)
• Lymphadenopathy
• Abdominal pain (mesenteric adenitis)

Pathophysiology

Molecular mimicry between streptococcal M protein and host tissues (heart, joints, brain, skin) triggers cross-reactive antibodies and T-cell responses, causing inflammatory damage.

Importance of Early Treatment

Prompt penicillin treatment of strep throat prevents rheumatic fever. Once established, anti-inflammatory therapy (aspirin, corticosteroids) and long-term penicillin prophylaxis are essential to prevent recurrent attacks and chronic rheumatic heart disease.