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Factsheet: Rheumatic Fever

New Zealand has one of the highest rates of rheumatic fever in the developed world, with 168 cases reported in 2010. It can result in significant long-term health problems. It is largely preventable and research shows that the underlying causes are poor social circumstances and inadequate living conditions.

What is rheumatic fever?

Rheumatic fever (RF) is an inflammatory condition affecting many parts of the body - the joints, heart, skin and brain. It arises from an autoimmune response to a streptococcal throat infection. Symptoms of RF typically come on 3 weeks after a throat infection. 80% of cases are in young people, with the average age 5-14 years old. Symptoms include:

- Sore swollen joints
- Rash
- Fever
- Tummy pain
- Jerky movements
- A history of a throat infection or tonsillitis in the previous few weeks.

Most people with acute RF will be very unwell, with considerable pain, and will require admission to hospital.

If RF is treated effectively, most people will make a full recovery. However, untreated RF can cause long-term damage to the heart valves, often necessitating life-long treatment and heart surgery in later life. This heart damage is known as Rheumatic Heart Disease, and is responsible for around 200 premature deaths in NZ each year.

Who is most at risk?

Maori and Pacific Island populations living in NZ - respectively 20 and 37 times more likely than anyone else to be admitted to hospital with rheumatic fever. This is largely due to socioeconomic factors:

- over-crowding,
- poor nutrition,
- inadequate access to health care,
- lack of heating,
- poorly insulated homes.

Most cases in NZ are found in the North Island, with especially high rates in certain communities, eg Hawkes Bay, Porirua, Northland, Tairawhiti.

How is it treated?

RF is diagnosed clinically (i.e. by a combination of tests, symptoms and findings on examination). Once a diagnosis has been made, the following treatment will be commenced:

- Antibiotics - the streptococcal bug responsible for the infection can be eradicated with prolonged courses of penicillin; children will need ongoing injections every month for 10 years or more to prevent recurrence;
- Anti-inflammatory drugs - these can help reduce pain and swelling in affected joints and in the heart muscle;
- Bed rest - sometimes for up to 3 months.

Long-term follow-up of anyone with RF is very important. Regular antibiotic injections prevent recurrences and reduce the risk of further damage to the heart valves. Anyone who has rheumatic heart disease, or damage to their heart valves, needs life-long extra antibiotic protection for any dental or medical procedures and during pregnancy.

Can it be prevented?

Yes - in most cases treatment of the initial throat infection would avoid RF ever developing. Any child with a sore throat, especially if they are in the high risk groups discussed above, should see a doctor to exclude streptococcal infection. If there is a suspicion of streptococcal throat infection, a 10 day course of penicillin should be prescribed. A throat swab can be taken to confirm the diagnosis. If the anitbiotics are stopped early, there is a risk of the infection recurring. The following symptoms are suggestive of streptococcal throat infection:

- Swelling of the tonsils, with pus visible at the back of the throat;
- Tender lymph nodes in the neck;
- Temperatures over 38 degrees;
- No cough or runny nose (which suggests a viral cause rather than the streptococcal bacteria).

If in doubt, and your child has a fever, sore throat or sore joint - seek medical advice.

For further information (keyword rheumatic fever) or
Talk to Healthline, your practice nurse, doctor or pharmacist.

(TX:  21June 2011)