Rheumatic fever is an acute infection that can cause inflammation of the joints, eyes, nerves, and heart. Most often it is a complication of strep throat, or streptococcal pharyngitis. The usual symptoms are a high fever, rash, and joint and muscle pains that follow or accompany a sore throat. Choreajittery body movements and facial twitches also may develop. At one time, rheumatic fever was a widespread childhood disease in the United States, especially in crowded urban areas, and it was the most common cause of chronic heart disease. The arthritic pain and other aches associated with the disease were often dismissed as growing pains, allowing it to go unchecked until the heart had incurred permanent damage. Due largely to the use of antibiotics to treat strep throat, the incidence of rheumatic fever has dropped by more than 90 percent in the United States over the last SO years. However, there have been recent sporadic outbreaks. These cases have been ascribed to a new strain of streptococcus bacteria that produces a sore throat so mild and brief that it goes unnoticed.
Diagnostic Studies And Procedures
Although not all episodes of strep throat develop into rheumatic fever, any sore throat in a child that lasts for more than a couple of days should be seen by a physician. After inspecting the throat for characteristic inflammation and pus, a doctor will use a swab to collect a sample of secretions for a laboratory culture. If there is no sore throat but other symptoms suggest the presence of rheumatic fever, blood tests will be ordered to look for strep antibodies, and an electrocardiogram done to check for heart damage. Some fluid may be aspirated from swollen joints to rule out other types of infectious arthritis. Years after the initial infection, a cardiac examination may reveal a heart murmur, indicating possible damage to the mitral valve and perhaps other heart structures. Echocardiography, an ultrasound examination of the heart, can identify specific abnormalities.
Antibiotics are prescribed to eliminate any lingering strep organisms, followed by low dose prophylactic antibiotics to prevent recurrent attacks. This preventive regimen varies, but may involve a monthly injection of penicillin or a daily oral dose of a sulfa drug or penicillin. Some doctors advocate life-long prophylaxis with antibiotics, while others prescribe it for the first few years after a bout of rheumatic fever. If prophylactic antibiotics have been stopped, they should be temporarily resumed before and after dental work or surgery. During such procedures, bacteria may enter the bloodstream and travel to the heart where they can multiply and cause endocarditis a serious infection of the heart valves and lining. Other treatments will vary according to symptoms. If mild arthritis is the only problem, aspirin or another painkiller may be all that is needed. More severe arthritis requires higher doses of aspirin or other nonsteroidal anti-inflammatory medications. High doses of aspirin, plus pred nisone or another corticosteroid drug, are prescribed for heart inflammation. Cardiac arrhythmias are treated with antiarrhythmic drugs; other heart medications are prescribed as needed. Surgery to repair or replace damaged heart valves is sometimes necessary, but usually not until many years after the bout of rheumatic fever.
Aromatherapy and Massage
A therapist may gently massage painful joints with eucalyptus, mint, thyme, or rosemary oils. However, the massaging or manipulating of badly inflamed joints should be avoided.
Teas made of fever few or a combination of dandelion and catnip are said to help reduce fever, and garlic and onions are recommended to strengthen the heart. To reduce joint pain and inflammation, herbalists sometimes prescribe white birch capsules, which contain salicylate, the major ingredient in aspirin. A comfrey poultice may also help alleviate pain.
These gentle range of motion exercises are especially suitable for people with arthritis, chorea, and reduced heart function. The routine also fosters a sense of well being, an important factor in recovery.
The high doses of aspirin prescribed to treat the inflammation of rheumatic fever can cause severe stomach irritation. To minimize this effect, take aspirin and similar anti inflammatory drugs with meals. If you still suffer stomach upset, ask your doctor about taking enteric (coated) aspirin, which does not dissolve until the pill reaches the small intestine. When taking aspirin, be alert for other adverse reactions, especially ringing in the ears , loss of hearing, palpitations, or easy bruising and bleeding. Bed rest is imperative during the acute phase of rheumatic fever, when heart and joint inflammation are most severe. In the past, patients were advised to stay in bed for months after symptoms disappeared. Many doctors now believe that prolonged bed rest has no value, and may cause unnecessary psychological problems.
Other Causes of Rheumatic Symptoms
Juvenile rheumatoid arthritis can cause many of the same symptoms as rheumatic fever. Depending upon the patient’s age and symptoms, other disorders that a doctor may consider include Lyme disease, rheumatoid arthritis, drug reactions, and complications of gonorrhea.