What are the treatments for rheumatic fever?
The treatment depends on which part of the body is affected.
- For the joint pains, usually aspirin or ibuprofen is sufficient. They settle in a few weeks.
- For heart problems, a specialist doctor may need to prescribe medicines that relieve the strain on the heart. These are medicines like 'water' tablets (diuretics), angiotensin-converting enzyme (ACE) inhibitors and digoxin. Sometimes the damage to the heart valves is so bad that urgent heart surgery is needed.
- The jerky movements (chorea) are sometimes difficult to treat. Generally sedatives are used like diazepam. If the chorea is very severe and lasts several weeks then specialist procedures like plasmapheresis are used: this is a way of 'cleaning' your blood by pumping it through a special machine and back into your body.
- Usually the antibiotic penicillin is given for ten days to make sure that none of the original bacterium, the streptococcus, is still in the body.
- If the heart problems are particularly bad, some people recommend penicillin until the age of 21 years at least.
- Rheumatic fever is one of the few conditions where bed rest is recommended, even if the person feels well enough to be up and about. They should rest until the blood tests for inflammation return to normal.
What is the outlook for someone who has had rheumatic fever?
- Generally the symptoms of the fever, joint pains, heart problems and chorea fade away by about three months in most people.
- Very occasionally the chorea goes on for years but this is very rare.
- The main long-term problem is with the heart. About a third of people who have had rheumatic fever will get long-term problems with their heart. This is then called rheumatic heart disease. It can damage the heart permanently and require lifelong medication or even surgery to the heart valves many years later.
Further reading and references
Patient-friendly guide to rheumatic fever; Mayo Clinic
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