Treatment of rheumatism (rheumatic fever)

A streptococcal throat infection can sometimes cause complications that do not appear immediately. A few weeks after the illness, joint pain, elevated temperature, weakness, rapid heartbeat, or shortness of breath may appear. This is how rheumatism may manifest itself — a disease in which, after a previous infection, the immune system mistakenly attacks its own tissues, due to which the inflammatory process can spread to the joints, heart, skin, or nervous system.

At the Oxford Medical medical center, the doctor will help determine the cause of the symptoms and select appropriate treatment. If necessary, you can take tests, undergo an ECG, heart ultrasound, and other necessary examinations. Make an appointment at a time convenient for you by phone or through the online appointment form on the website.

Rheumatic fever — is an immune-inflammatory disease that can occur after an infection caused by group A streptococcus. Most often, this refers to a throat infection if it was not diagnosed and treated in a timely manner.

In medical practice, the term «rheumatism» is often used as an everyday name for acute rheumatic fever. However, it is important to understand: this is not simply «joint pain», but a systemic disease that requires careful diagnostics and properly selected treatment.

The main cause of rheumatism — a previous streptococcal infection, most often pharyngitis or tonsillitis, caused by group A β-hemolytic streptococcus. According to Centers for Disease Control and Prevention, acute rheumatic fever can develop as a delayed complication after an infection caused by Streptococcus pyogenes, and symptoms usually appear 1–5 weeks after a streptococcal infection.

Doctors of «Oxford Medical» note: the risk of developing the disease increases if the streptococcal infection was not treated, was treated untimely, or the patient independently stopped antibacterial therapy earlier than the doctor recommended. That is why, with a sore throat, high temperature, plaque on the tonsils, and enlarged lymph nodes, it is important to consult a doctor, and not to select medicines independently.

Factors that can increase the risk of developing rheumatism include:

• a previous streptococcal throat infection;

• absence of timely treatment of a bacterial infection;

• recurrent streptococcal infections;

• childhood and adolescence;

• hereditary predisposition to autoimmune disorders.

According to Centers for Disease Control and Prevention, acute rheumatic fever most often occurs in children aged 5–15 years, and the first episode of the disease rarely occurs in adults older than 35 years.

Rheumatic fever is characterized by damage to large joints: knee, ankle, elbow, wrist joints. The pain may «move» from one joint to another: for example, first the knee hurts, then the pain decreases and appears in another area.

Heart involvement is also possible. In this case, heart murmurs, rapid heartbeat, shortness of breath during exertion, pain or discomfort in the chest may appear. Skin manifestations of rheumatism occur less often. These include ring-shaped pink rashes on the torso or limbs, as well as small subcutaneous nodules near the joints.

Forms of rheumatism are determined by which organs or systems are most involved in the inflammatory process.

In addition to forms, stages of rheumatism are also distinguished:

• Acute rheumatic fever. During this period, there are active manifestations of the disease: temperature, joint pain, signs of damage to the heart, skin, or nervous system. In tests, elevated inflammatory markers are usually determined.

• Subsiding stage. Symptoms gradually weaken, well-being improves, and laboratory signs of inflammation decrease. At this stage, it is important not to stop monitoring and treatment without a doctor's recommendation.

• Inactive stage. There are no signs of active inflammation, but the patient may need further monitoring, especially if there were previously changes on the part of the heart or there is a risk of recurrent episodes.

After determining the form and stage, the doctor can more accurately assess the risks for the patient. This helps not only to reduce current symptoms, but also to prevent long-term consequences of rheumatism.

Diagnosis of rheumatism begins with an examination and detailed collection of anamnesis. To clarify the diagnosis, the following may be prescribed:

• general blood test and inflammatory markers;

• tests to confirm a previous streptococcal infection;

• ECG to assess the rhythm and conduction of the heart;

• heart ultrasound to assess the valves, myocardial contractility, and signs of carditis.

The diagnosis is established on the basis of the combination of clinical signs, laboratory indicators, and results of instrumental examinations.

Treatment of rheumatic fever is aimed at eliminating the streptococcal infection, reducing inflammation, controlling symptoms, and preventing recurrent attacks. The tactics depend on the patient’s age and the stage of the disease.

Treatment may include:

• antibacterial therapy to eliminate the streptococcal infection;

• anti-inflammatory medications to reduce pain, temperature, and inflammation;

• medications to support heart function in signs of carditis;

• secondary prevention with antibiotics to reduce the risk of recurrent episodes;

• restriction of physical activity during the period of active inflammation;

• rehabilitation measures after stabilization of the condition.

After active inflammation decreases, physiotherapeutic procedures may be prescribed. They can contribute to the restoration of mobility, reduction of stiffness, and gradual return to the usual level of physical activity. The doctor may also provide dietary recommendations: the diet for rheumatism should include lean meat, fish, eggs, fermented dairy products, vegetables, fruits, cereals, and vegetable oils. It is worth limiting excess salt, smoked foods, fast food, sweet drinks, and fatty fried dishes, especially with swelling or signs of heart damage.

Doctors of «Oxford Medical» recommend not stopping treatment independently after pain or temperature decreases. In rheumatic fever, it is important not only to improve well-being, but also to reduce the risk of a recurrent streptococcal infection, which can provoke a new episode of the disease.

Complications of rheumatism are most often associated with heart damage. According to MSD Manual, during the first episode of acute rheumatic fever, carditis occurs in approximately 50–70% of patients, and persistent damage to the heart valves may manifest much later. Recurrent episodes of rheumatic fever can gradually damage the valves, which increases the risk of rheumatic heart disease, circulatory disorders, and the need for long-term cardiological monitoring.

Possible consequences of rheumatism:

• rheumatic damage to the heart valves;

• heart failure with significant valve damage;

• heart rhythm disorder;

• recurrent episodes of rheumatic fever;

• long-term restriction of physical activity;

• chronic worsening of well-being due to heart damage.

Joint manifestations usually do not lead to persistent joint deformity, but they can be painful and significantly limit mobility during the period of active inflammation. Instead, cardiac complications have the greatest clinical significance, therefore monitoring the condition of the heart is an mandatory part of observation.

Doctors of «Oxford Medical» note: primary prevention of rheumatism begins with the correct actions for a sore throat. If there is a high temperature, plaque on the tonsils, pain in the lymph nodes, and sharp pain during swallowing, it is worth consulting a doctor and checking whether the cause is a streptococcal infection. It is precisely this that can trigger rheumatic fever.

After a previous rheumatic fever, prevention becomes long-term. The doctor may prescribe regular antibacterial prevention, ECG monitoring, and heart ultrasound. Such measures are needed to protect the heart valves, because recurrent episodes of rheumatism increase the risk of their damage.

The total price of treatment depends on the form of the disease, the severity of symptoms, the condition of the heart and joints, as well as the necessary scope of diagnostic and treatment procedures. You can preliminarily familiarize yourself with the prices for medical services here.

Treatment of rheumatism in Kyiv at the «Oxford Medical» clinic is carried out according to modern clinical protocols. The doctor determines the tactics after diagnosis and assessment of the patient’s condition. To receive individual recommendations, it is worth making an appointment with a rheumatologist. During the consultation, the doctor will explain which tests and examinations are needed specifically in your case, orient you regarding the treatment tactics and its cost.

The information is for informational purposes and does not replace a doctor’s consultation.

Sources:

• Centers for Disease Control and Prevention

• US National Library of Medicine

• MSD Manual Professional Edition