Symptoms and Complications
The symptoms of rheumatic fever depend on whether the heart, joints, or nervous system are most affected. Most people with rheumatic fever have a fever and joint pain. The joint pain usually affects large joints such as the knees, elbows, ankles, or wrists, and the pain characteristically migrates from one joint to another, so that one or more joints may be swollen, red, and extremely tender. The arthritis is usually reversible.
Many people who develop rheumatic fever suffer damage to their heart valves (endocarditis, most commonly mitral stenosis), to the heart muscle (myocarditis), to the sac covering the heart (pericarditis), or all three at once. This may cause no symptoms, but some people feel heart palpitations or chest pain. Very occasionally, there is heart failure, though few people in North America die during a rheumatic fever infection.
In severe cases, the valves have to be replaced with artificial ones. People with damaged valves and those with an artificial heart valve are at increased risk of a heart infection later in life (infectious endocarditis).
If the process of infection and inflammation affects the central nervous system, it may produce a symptom known as chorea. This affects about 10% of people with rheumatic fever. It's most likely in children aged 7 to 14 years, especially girls, and almost never occurs after puberty. The onset of chorea is usually gradual, and it often first appears several months after the rheumatic fever has passed. Teachers may be the first to notice it and mistake it for clumsiness or restlessness. Symptoms may include:
- grimacing
- purposeless movements of the arms and legs
- indistinct speech
Occasionally, chorea is the only visible symptom of rheumatic fever. There may also be a rash or pea-sized lumps under the skin.