RHEUMATIC FEVER — THE SILENT PAINFUL INFLAMMATORY DISEASE

streptococcal throat infection wikipedia

Definition

Rheumatic fever is an inflammatory autoimmune disease that develops as a complication of untreated or inadequately treated streptococcal throat infection (usually Group A β-hemolytic Streptococcus). It primarily affects the heart, joints, brain, and skin, and is one of the preventable causes of acquired heart disease in young people.

Aetiology (Cause)

• The main cause is post-streptococcal infection of the upper respiratory tract—pharyngitis or tonsillitis.

• The body’s immune system produces antibodies against the bacteria, but these antibodies mistakenly attack body tissues (especially the heart valves, joints, and connective tissue).

• Genetic susceptibility and poor sanitation also play a role.

Age, Sex & Climate

• Age: Commonly seen between 5–15 years of age.

• Sex: Slightly more common in females.

• Climate: More frequent in cool, humid climates and during winter or early spring when throat infections are common.

• Social Factors: Overcrowding, malnutrition, and poor hygiene increase risk.

Pathology

The disease produces inflammatory lesions in connective tissue, especially around heart valves (endocardium), myocardium, and pericardium, leading to:

• Aschoff bodies (granulomatous nodules in the heart)

• Fibrosis and scarring of valves (chronic rheumatic heart disease)

Clinical Features

The onset usually follows a sore throat by 2–3 weeks.
Common features include:

Symptoms

• Fever with chills and malaise

• Painful and swollen joints (knees, ankles, wrists, elbows)

• Shifting (fleeting) limb pain — one joint improves while another becomes inflamed

• Fatigue and loss of appetite

• Palpitations and chest discomfort (if heart involved)

Signs

• Swollen, warm, tender joints

• Heart murmur (if carditis)

• Erythema marginatum (rash with red edges)

• Subcutaneous nodules over joints or spine

• Chorea (involuntary jerky movements, mostly in girls)

Major Manifestations (Jones Criteria)

According to Revised Jones Criteria (WHO, AHA):

1. Carditis – inflammation of the heart layers

2. Polyarthritis – multiple joint inflammation

3. Chorea (Sydenham’s chorea) – involuntary movements

4. Erythema marginatum – typical rash

5. Subcutaneous nodules

Minor criteria include fever, raised ESR/CRP, prolonged PR interval on ECG, and previous rheumatic fever.

Diagnosis

Based on:

• Recent Group A Streptococcal infection

• ASO titre (Antistreptolysin O antibodies) positive

• Throat culture or rapid antigen test

• ESR and CRP elevated (inflammatory markers)

• Echocardiography for heart valve involvement

Differential Diagnosis

• Septic arthritis

• Juvenile idiopathic arthritis

• Infective endocarditis

• Viral myocarditis

Complications

• Rheumatic carditis → Chronic rheumatic heart disease (RHD)

• Valve deformities (mitral stenosis, aortic regurgitation)

• Heart failure

• Chronic arthritis

• Recurrence with every throat infection

Prognosis

Early diagnosis and complete treatment of streptococcal infection provide an excellent prognosis.
However, recurrent attacks may cause permanent valve damage requiring lifelong medical care or surgery.

Treatment Approaches

1. Allopathic (Modern Medicine)

• Antibiotics: Penicillin (to eradicate streptococcal infection)

• Anti-inflammatory drugs: Aspirin, Naproxen

• Corticosteroids: Prednisolone (for carditis)

• Bed rest: Essential during acute phase

• Secondary prevention: Long-term benzathine penicillin injection every 3–4 weeks to prevent recurrence

2. Homeopathic Remedies

(Used under qualified supervision only)

• Rhus tox: For joint stiffness and pain worse after rest

• Bryonia alba: For dry, hot swelling of joints aggravated by movement

• Ledum palustre: For pain starting in lower joints and moving upward

• Pulsatilla: For wandering pains and mild, emotional temperament
  (Consult a licensed homeopath before using any remedy)

3. Ayurvedic & Age-Old Systems

• Decoctions: Dashamoola, Guggulu, and Shallaki (Boswellia) for inflammation

• Panchakarma therapy: To detoxify body

• Herbal tonics: Ashwagandha, Giloy (Tinospora cordifolia) for immunity and inflammation control

• Diet: Light, anti-inflammatory diet with warm fluids and turmeric milk

Prevention

• Prompt treatment of sore throat or tonsillitis caused by streptococcal bacteria

• Maintain personal hygiene

• Avoid overcrowding and damp environment

• Continue prophylactic antibiotics as advised

Disclaimer

This article is for educational and awareness purposes only.
It should not replace professional medical consultation, diagnosis, or treatment.
Always consult a qualified physician before taking any medication or alternative therapy.

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Citations / References

1. World Health Organization (WHO): Rheumatic Fever and Rheumatic Heart Disease Guidelines (2023).

2. Centers for Disease Control and Prevention (CDC): Group A Streptococcal Diseases Overview, 2024.

3. Indian Council of Medical Research (ICMR): Prevention and Control of Rheumatic Heart Disease in India, 2023.

4. American Heart Association (AHA): Revised Jones Criteria for Diagnosis of Rheumatic Fever, 2020.

Keywords

rheumatic fever, rheumatic heart disease, joint pain fever, streptococcal infection, sore throat complications, homeopathic remedies for rheumatic fever, ayurvedic treatment, WHO rheumatic fever, CDC group A strep, carditis

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