Rheumatic Fever – When a Sore Throat Affects the Heart

Most sore throats in children are harmless and pass on their own. But when a throat infection caused by Streptococcus bacteria isn’t properly treated, it can sometimes lead to a more serious condition: rheumatic fever.

Though now rare in many countries, rheumatic fever can still occur—and when it does, it may affect the heart, joints, skin, or brain. The good news: with early treatment, most children recover fully and avoid long-term complications.

⚠️ Important: If your child has a sore throat with fever, joint pain, rash, or unusual movements, especially a few weeks after a confirmed or suspected strep infection, seek medical attention. Rheumatic fever needs prompt diagnosis and treatment to prevent heart damage.

What Is Rheumatic Fever?

Rheumatic fever is an inflammatory disease that may develop after an untreated or partially treated streptococcal throat infection (strep throat). It is not the infection itself, but a delayed immune reaction to it. It usually occurs 2–4 weeks after the sore throat.

Though uncommon in industrialized countries, it still poses a risk in many parts of the world, particularly in areas with limited access to antibiotics.

What Are the Symptoms?

Symptoms can vary but often include:

• Painful, swollen joints, especially moving from one joint to another (migratory arthritis)

• Fever

• Fatigue

• Chest pain or shortness of breath (if the heart is affected)

• Skin rash (erythema marginatum) or small skin nodules

• Involuntary movements (chorea or Sydenham’s chorea)

These symptoms are part of what’s known as the Jones criteria, used to help diagnose the disease.

How Is It Diagnosed?

Doctors consider the history of a recent strep infection and look for typical symptoms. Tests may include:

• Throat culture or rapid strep test

• Blood tests for strep antibodies (ASO titers)

• ECG or echocardiogram (to check the heart)

• Blood tests for inflammation

It is important to exclude other possible causes of the symptoms, especially in children with unusual movements or fever.

How Is It Treated?

Treatment focuses on two things: eliminating the strep bacteria and controlling inflammation.

• Antibiotics (usually penicillin) are given to treat or prevent further strep infections

• Anti-inflammatory medications (e.g. aspirin or corticosteroids) help with joint pain and inflammation

• Long-term antibiotic prophylaxis is needed to prevent recurrences—often monthly penicillin injections for several years, depending on heart involvement

Children with heart valve damage (rheumatic heart disease) require long-term cardiology follow-up.

Can It Be Prevented?

Yes—the most effective prevention is treating strep throat early with antibiotics. If your child has symptoms of strep throat (fever, sore throat, swollen tonsils, white patches, or neck lymph nodes), see your doctor. Completing the full antibiotic course is essential.

What’s the Outlook?

With timely treatment, most children recover well. In cases without heart involvement, the long-term outlook is excellent. However, if the heart is affected, follow-up and sometimes surgery may be needed later in life.

Learn More

PRINTO provides a detailed, family-oriented leaflet on rheumatic fever and post-streptococcal arthritis.

🔗 Read more on PRINTO:

Rheumatic Fever – PRINTO Patient Leaflet

All rights and content remain with PRINTO, and the original resources can be found at:

https://www.printo.it/pediatric-rheumatology/GB/info/GB