Rheumatic fever

Rheumatic fever is a serious but preventable illness that can damage your heart. Learn more about what causes it, symptoms to look out for, how it’s treated and how to protect yourself and your whānau.

What is rheumatic fever and what causes it?

Rheumatic fever is a serious illness that can develop after a throat infection    caused by Group A Streptococcus (Strep A)  bacteria. These infections are often called Strep A or strep throat. 

When you get Strep A infection, your immune system – the part of the body that helps fight off sickness – makes antibodies. These are special proteins that help the body fight bacteria. 

In some people, these antibodies become over-active and can attack healthy parts of the body. This usually happens a few weeks after the Strep A infection, and the inflammation can affect the heart valves, joints, brain and skin. Sometimes people get rheumatic fever even if they don’t remember having a sore throat. 

You may also hear this condition being called acute rheumatic fever (ARF).

Scientists don’t yet know why some people have this immune response and others don’t. 

You can catch strep throat from someone else, but you can’t catch rheumatic fever. It’s the body’s rection to strep that causes it.

Who is most at risk?

Anyone can get rheumatic fever, but some people are more at risk than others. 

In New Zealand, Māori and Pacific young people aged 3 to 35 are more likely to get rheumatic fever, particularly those aged 4 to 19. This is often linked to the challenges whānau have finding homes that are warm, dry, well ventilated and big enough for families. Rheumatic fever is also more common in communities where it may be harder to access healthcare or medicine.

You may also be more at risk if you:

• have had rheumatic fever before
• have family members who have had rheumatic fever or rheumatic heart disease (RHD).

People at low risk of rheumatic fever do not usually need swabbing or antibiotics when they get a sore throat.

How does rheumatic fever affect the heart?

Rheumatic fever can cause inflammation (swelling) and damage in the heart, especially the valves that control how blood flows through the heart.

Each time you have rheumatic fever it increases the risk of long-term heart valve damage. 

In some people, this damage can lead to rheumatic heart disease  (RHD), a condition where the inflammation from rheumatic fever causes permanent scarring to the heart valves. 

Over time, rheumatic heart disease can worsen and cause other heart problems, long after rheumatic fever has gone. 

Regular check-ups and treatment help protect the  heart and, if there is valve damage, can stop it getting worse.

Learn more about rheumatic heart disease

How to reduce your risk of getting rheumatic fever

Māori and Pacific people aged 3 to 35 years should get a sore throat checked by a healthcare provider every time they happen.

If the sore throat is caused by Strep A, or if you or your child are at higher risk of rheumatic fever, a 10-day course of antibiotics (medicine that kills bacteria) is needed. 

It’s important to take the antibiotics for the full course, even when your sore throat starts to feel better. This medicine kills the Strep A bacteria, which helps stop rheumatic fever from developing and prevents the infection from spreading to others. 

If you stop taking the antibiotics too soon, some bacteria may survive and grow again. This increases the risk of rheumatic fever.

When and where to get a sore throat checked?

If you or someone in your whānau is at high risk of rheumatic fever (see above), get every sore throat checked as soon as possible. See a doctor or nurse, even if the sore throat seems mild. Some pharmacies offer free throat checks and can provide antibiotics if they’re needed.

Your child’s school may also offer free sore throat checks. Contact their school to find out.

Symptoms of strep throat

Symptoms can include:

• a painful or scratchy throat, especially when you swallow
• difficulty swallowing
• redness at the back of your mouth
• fever (high temperature)
• bad breath
• swollen glands in your neck
• enlarged tonsils covered in white stuff
• headache
• stomach pain
• nausea (feeling sick) and vomiting (being sick).

Sometimes, you may also have a skin rash along with a fever and sore throat.

Māori and Pacific people aged 3 to 35 years should get a sore throat checked by a healthcare provider every time they happen. 

Visit info.health.nz to find out more about where to get sore throats checked.

How is Strep A throat diagnosed?

Strep throat is diagnosed with a throat swab. Your doctor, nurse or pharmacist will gently rub the back of you or your child’s throat with a cotton swab to test for Strep A bacteria.  

If you or your child is at high risk of rheumatic fever, you should be given antibiotics while waiting for the swab result.  

If it is not possible to do a swab, you may be given antibiotics without the swab.

What to do if someone in your whānau has strep throat

Strep throat spreads easily. If someone in your whānau has strep throat, others may also need to be checked. Your doctor or nurse may: 

• offer a throat swab  
• prescribe antibiotics for anyone with a sore throat who is at higher risk of rheumatic fever, including those who have had it before. 

It’s important that everyone with strep takes all the antibiotic medicine they are given, even if they start to feel better. 

If anyone gets a sore throat again, see a healthcare provider as soon as possible for another check.

Signs and symptoms of rheumatic fever

Rheumatic fever can cause joint pain and swelling in the elbows, wrists, knees and ankles. The pain can move from one joint to another and the joint may feel hot, red or sore to touch. Sometimes it can be so painful that it’s hard to walk or move. Sometimes it might be a mild limp. 

Rheumatic fever can also cause fever (high temperature) and skin rashes. Very rarely it can cause jerky movements or changes in how you move (called Sydenham’s chorea). If the heart valves are badly affected, it can cause shortness of breath, chest pain or a fast heartbeat. 

Symptoms usually start a few weeks after a sore throat, but sometimes people with rheumatic fever don’t recall having a throat infection. 

Most people get better over time, but heart damage can be long-term and may get worse, especially if you get rheumatic fever again.

How is rheumatic fever diagnosed?

If your doctor thinks you or your child may have rheumatic fever, you’ll need to go to hospital for tests and treatment. Tests may include the following.   

• Blood tests: to look for signs of inflammation or infection in your body. 
• Throat swab: to see if there’s any Strep A bacteria still in your throat. 
• Electrocardiogram (ECG): a test that checks your heart’s rhythm. 
• Echocardiogram (echo): a scan that uses sound waves   to show if there’s any damage to your heart muscle or valves. 

Rheumatic fever is diagnosed by looking at all of your symptoms and test results. 

There is no one single test that can confirm or exclude a diagnosis of rheumatic fever.  

Sometimes it can take repeated tests over a few weeks for doctors to determine if a person has rheumatic fever or not.

Treatment for rheumatic fever

Treatment for rheumatic fever usually happens in two stages: first in hospital, then at home. 

The main goals are to: 

• kill any strep bacteria still in your body
• reduce joint swelling and pain
• protect your heart from further damage. 

Treatment in hospital

Most people with rheumatic fever need to stay in hospital to confirm the diagnosis, check how the heart is working and start treatment.   

While in hospital you may need: 

• antibiotics to kill any remaining Strep A bacteria 
• education and support 
• preparing for and receiving the first dose of long-term penicillin 
• pain medicine if your joints are sore or swollen
• bed rest until the pain, fever and inflammation settle.

Treatment at home

After leaving hospital, you’ll need ongoing care to prevent you from getting rheumatic fever again. Penicillin injections every 28 days are the most important part of ongoing care. You’ll also need follow-up appointments, so your doctor can check how your heart is recovering and whether there’s any lasting damage.

Rheumatic fever and pregnancy

Pregnancy places extra demands on the heart. Pregnant people with rheumatic heart disease need to be carefully monitored before and during pregnancy, as RHD can place extra strain on the heart.   Inform your lead maternity carer (LMC) if you have had rheumatic fever  or have RHD.

Ongoing care

You or your child will need regular antibiotic injections (penicillin) every 28 days to prevent any new strep infections and reduce the risk of getting rheumatic fever again. These injections kill the strep bacteria, and each one has enough medicine to protect you for 28 days. 

You’ll usually need these injections for at least 10 years, or until the age of 21, whichever is longer. 

It’s very important you don’t miss any injections as this increases your risk of getting strep and/or rheumatic fever again.

People with severe heart damage may need the injections for longer. They may also need heart surgery and other medicines.

Note: the injection may sting a little but it is important because it helps stop rheumatic fever and protects their heart from further damage. If the pain bothers you or your child, talk to your doctor or nurse on ways to make it easier.

Why ongoing treatment matters

You can get rheumatic fever more than once. If you’ve had it before, you’re more at risk of getting it again, and each time it increases your risk of long-term heart damage.

If you’ve had rheumatic fever, you’re also more at risk of infection of the heart valves known as infective endocarditis. You may need extra antibiotics before certain medical or dental procedures to protect your heart. Always tell every doctor, dentist or dental therapist if you or your child have had rheumatic fever.

How to keep your home warm and dry for your whānau

Cold and damp housing increases the risk of strep and rheumatic fever. 

Keeping your home warm and dry helps to protect your whānau from getting sick and makes it easier to recover if someone does get unwell. 

Here are some ideas that can help to keep a home warm and dry. Every home is different, so try what works best for you and your whānau: 

• Open curtains to let in the sun and close them before it gets dark. If you don’t have curtains, some areas have community curtain banks run by groups like Red Cross NZ or Habitat For Humanity.  
• Open windows and doors for a short time each day to let fresh air in and damp air out. 
• Open kitchen and bathroom windows while cooking or showering. 
• Dry wet clothes outside or in a garage. 
• Check for draughts (cold air) around doors and windows and block any gaps. 
• Use heaters safely to keep your home warm. Some create a lot of moisture (e.g. unflued gas heaters), so try to choose one that warms your home without making it damp. 
• Wipe moisture off windows and walls.

You could also contact the Healthy Homes Initiative. It’s a free service that helps eligible families, including those at risk of rheumatic fever, make their homes warm and dry.

Family and community support

Having rheumatic fever can be hard for the person affected and their family. Support from whānau, friends, schools and the wider community can make a big difference to recovery and help reduce the risk of getting rheumatic fever again. 

Whānau can:   

• talk with healthcare providers about how to arrange penicillin injections to see what works best for the whānau  . The nurse may be able to come to your home or school to give the injections. 
• set reminders to make sure your child has their penicillin injection every 28 days. 
• get every sore throat checked as soon as possible
• offer to help with transport to appointments 
• encourage rest when needed, especially after leaving hospital – eventually most kids with rheumatic fever can participate fully in sports and activities 
• look for ways to make your family home warmer and drier. 

Schools and communities can: 

• support young people to get their penicillin injections and encourage early sore throat checks
• work with health and housing services so families can access the support they’re entitled to 
• support tamariki to return to school with a plan that meets their health needs.

Where can I go for help and more information?

Visit pumanawa.org.nz for whānau stories, resources and tips. 

Visit info.health.nz for details on local health services and where you can get sore throats checked.