Rheumatic fever (RF) is an inflammatory disease that can involve the heart, joints, skin, and

brain.[1] The disease typically develops two to four weeks after a streptococcal throat infection.[2]
Signs and symptoms include fever, multiple painful joints, involuntary muscle movements, and
occasionally a characteristic non-itchy rash known as erythema marginatum. The heart is
involved in about half of cases. Damage to the heart valves, known as rheumatic heart disease
(RHD), usually occurs after repeated attacks but can sometimes occur after one. The damaged
valves may result in heart failure, atrial fibrillation and infection of the valves.[1]

Rheumatic fever may occur following an infection of the throat by the bacterium Streptococcus
pyogenes.[1] If the infection is untreated rheumatic fever can occur in up to three percent of
people.[6] The underlying mechanism is believed to involve the production of antibodies against a
person's own tissues. Due to their genetics, some people are more likely to get the disease when
exposed to the bacteria than others. Other risk factors include malnutrition and poverty.[1]
Diagnosis of RF is often based on the presence of signs and symptoms in combination with
evidence of a recent streptococcal infection.[3]

Treating people who have strep throat with antibiotics, such as penicillin, decreases the risk of
developing rheumatic fever.[4] In order to avoid antibiotic misuse this often involves testing
people with sore throats for the infection, which may not be available in the developing world.
Other preventive measures include improved sanitation. In those with rheumatic fever and
rheumatic heart disease, prolonged periods of antibiotics are sometimes recommended. Gradual
return to normal activities may occur following an attack. Once RHD develops, treatment is
more difficult. Occasionally valve replacement surgery or valve repair is required. Otherwise
complications are treated as per normal.[1]

Rheumatic fever occurs in about 325,000 children each year and about 33.4 million people
currently have rheumatic heart disease.[1][7] Those who develop RF are most often between the
ages of 5 and 14,[1] with 20% of first-time attacks occurring in adults.[8] The disease is most
common in the developing world and among indigenous peoples in the developed world.[1] In
2015 it resulted in 319,400 deaths down from 374,000 deaths in 1990.[5][9] Most deaths occur in
the developing world where as many as 12.5% of people affected may die each year.[1]
Descriptions of the condition are believed to date back to at least the 5th century BCE in the
writings of Hippocrates.[10] The disease is so named because its symptoms are similar to those of
some rheumatic disorders.[11]