Rheumatic Fever: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Rheumatic Fever?
A pediatrician (a children's doctor) or a primary care doctor often starts care. A cardiologist (a heart doctor) is usually involved when the heart is affected. A rheumatologist (a doctor who treats joint and immune diseases) may also help. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is rheumatic fever?
Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria, such as strep throat or scarlet fever. It can cause severe illness in the heart, joints, skin, and brain. The germ appears to trick the immune system, the body's defense system, into attacking healthy tissues. Strep throat is highly contagious, but rheumatic fever is not contagious.
Rheumatic fever does not often occur in the United States and other developed countries. It is still common in countries that have a lot of poverty and poor health systems.
Symptoms
Symptoms can affect many systems in the body. General symptoms may include:
- Fever, nosebleeds, and pain in the belly.
- Heart problems, which may cause no symptoms or may lead to shortness of breath and chest pain.
- Joint pain, swelling, redness, and warmth, mainly in the knees, elbows, ankles, and wrists. The pain can move from one joint to another.
- A ring-shaped or snake-like skin rash on the trunk and the upper part of the arms or legs.
- Skin lumps, called nodules.
Some people also develop Sydenham chorea, a condition that affects the brain and nervous system. It causes quick, jerky movements that mainly affect the face, feet, and hands.
Rheumatic fever can cause severe heart problems and heart damage. Long-term problems can include damage to the heart valves, which may leak or become narrow.
Causes and who gets it
Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses. The abnormal reaction seems to almost always happen with strep throat or scarlet fever. Strep infections in other parts of the body do not seem to cause rheumatic fever.
How doctors diagnose it
Your provider will examine you and carefully check your heart sounds, skin, and joints. Tests may include a blood test for a past strep infection (such as an ASO test) and a complete blood count. An electrocardiogram (ECG), a heart test, may also be done. Another test is the erythrocyte sedimentation rate (ESR), which measures inflammation in the body.
Doctors also use a standard set of major and minor signs to help diagnose rheumatic fever. Major signs include arthritis in several large joints and heart inflammation. Others are lumps under the skin, quick jerky movements, and a skin rash. The minor signs are fever, a high ESR, joint pain, and an abnormal ECG. You will likely be diagnosed with 2 major signs, or 1 major and 2 minor signs. You also need signs of a past strep infection.
Treatment
Acute rheumatic fever is treated with antibiotics. The goal is to remove all of the strep bacteria from the body. After that, more antibiotics are prescribed to prevent rheumatic fever from coming back.
These antibiotics continue for years: until age 21 for children, and for at least 5 years for teenagers and young adults. If the heart was affected, antibiotics may be needed even longer, perhaps for life. Follow your doctor's instructions about how long to take them.
Medicines such as aspirin or corticosteroids may be needed to help manage swelling of inflamed tissues. Medicines often used to treat seizures may be prescribed for abnormal movements or abnormal behaviors.
When to see a doctor
Contact your provider if you or your child develops symptoms of rheumatic fever. Other conditions have similar symptoms, so careful medical evaluation is needed. If symptoms of strep throat develop, tell your provider. Strep throat needs to be checked and treated, which decreases the risk of rheumatic fever.
Call 911 or go to the emergency room if you or your child has chest pain lasting two minutes or more. Get the same help for severe trouble breathing, fainting, or bluish or grey skin.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can examine you and order first tests if you have symptoms. Quick treatment for strep throat and scarlet fever is the most important way to prevent rheumatic fever.
Common questions
Is rheumatic fever contagious?
No, rheumatic fever is not contagious. The strep throat infection that can come before it is highly contagious.
Can strep throat lead to rheumatic fever?
Yes, rheumatic fever may develop after strep throat or scarlet fever. It mainly affects children ages 5 to 15 and develops about 14 to 28 days after the illness.
Can rheumatic fever be prevented?
Yes, the most important way to prevent rheumatic fever is to get quick treatment for strep throat and scarlet fever.
Can rheumatic fever damage the heart?
Yes, rheumatic fever can cause severe heart problems and heart damage. Long-term problems can include damage to the heart valves, which may leak or become narrow.
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Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
