Rheumatic Fever

What is Rheumatic Fever?

Rheumatic fever is an autoimmune disorder that follows a group A streptococcus infection, usually strep throat, in children and adolescents. It can lead to rheumatic heart disease, a lasting valve injury.^[1] The immune response to the bacteria cross-reacts with the body's own tissues, which is why the heart, joints, skin and brain can be inflamed.^[2]

Rheumatic fever is a medical problem that needs a physician. This page covers only the supportive role that complementary care can play afterward.

Common symptoms

Symptoms usually start 2 to 4 weeks after the infection.^[3] Doctors group the main features as major signs: heart inflammation (carditis), arthritis, jerky involuntary movements (Sydenham chorea), a characteristic rash, and lumps under the skin. Fever, joint pain and raised blood markers of inflammation count as minor signs.^[4]

The joint pain typically affects large joints and moves from one to another. Chorea occurs in up to 40% of people with rheumatic fever, and it can come with emotional symptoms.^[5]

Causes and risk factors

The cause is an immune reaction to group A streptococcus, most often after throat infection, and in some settings after skin infection.^[1] Genetic factors and social conditions, such as poverty and crowded housing, shape the risk.^{[1, 6]} A single severe episode or repeated episodes can cause rheumatic heart disease.^[2]

How it is diagnosed and treated conventionally

Diagnosis uses the Jones criteria, which combine the signs above with evidence of a recent strep infection, and heart ultrasound (echocardiography) is now used to detect heart involvement.^[4]

Penicillin has been the mainstay of treatment for decades, and no other treatment has been proven to change the likelihood or severity of rheumatic heart disease after an episode.^[2] Long-term antibiotic prevention is the key step afterward. A Cochrane review of 11 older trials found that antibiotics probably reduce recurrence of rheumatic fever, and that injected penicillin was probably more effective than oral antibiotics.^[3] Anti-inflammatory medicines and heart treatment are directed by physicians.^[6]

Why Rheumatic Fever calls for a whole-person approach

Rheumatic fever begins with an infection but is driven by the body's own immune response. Over time it can leave behind damage to the heart valves that needs ongoing care, along with pain, fatigue and the stress of living with a long-term condition.^[2]

Quality of life is now getting more attention in this disease.^[2] That is the area where supportive care can reasonably play a part.

Immune response after infection

Rheumatic fever develops because antibodies and immune cells that respond to streptococcal antigens also react with human tissues, a process called molecular mimicry.^{[2, 5]} This is the reason treatment centers on clearing the infection and preventing new ones.

Heart valve damage and its effects

Rheumatic heart disease can cause breathlessness, fatigue and, in advanced cases, heart failure.^[2] Heart conditions need specialist monitoring, and some people take anticoagulants such as warfarin, which matters for needle therapy and herbs.^[7]

Joint pain and inflammation

The arthritis of rheumatic fever is painful but usually temporary. Pain management is part of the treatment, and chronic pain is one of the areas where acupuncture has been studied.^[8]

Stress, mood and sleep

Chorea can bring emotional symptoms.^[5] Long-term illness and repeated injections for prevention can also be a burden for people living with the condition. Mind-body practices have been studied in related heart conditions.^[9]

Acupuncture as supportive care in Rheumatic Fever

What the research shows

No clinical trials of acupuncture for rheumatic fever were found. Evidence from related areas is limited.

A systematic review of acupuncture for heart failure found seven trials, most with considerable methodological flaws. Some reported better exercise capacity and quality of life, but the authors judged the evidence inconclusive.^[10] An umbrella review of integrative medicine for chronic heart failure found that acupuncture may improve a blood marker of heart strain, with low to very low certainty, and that evidence for most integrative approaches is limited.^[11]

For pain more broadly, a pooled analysis of 39 trials with 20,827 patients found acupuncture beat sham and no acupuncture for chronic musculoskeletal pain, osteoarthritis and headache.^[8] Those conditions are not rheumatic fever, so the findings are only an indirect guide.

How acupuncture may work

How acupuncture might act in rheumatic fever has not been studied. Nothing in the research suggests that it affects the immune reaction behind the disease or the heart valves.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at selected points, usually left in for about 20 to 40 minutes. A course is typically several visits, with reassessment to see whether pain, sleep or fatigue is changing.

In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you take warfarin or other blood thinners, have a heart valve problem, a pacemaker or an artificial valve, or are pregnant. Because rheumatic heart disease can make infection of the heart valves more dangerous, your cardiologist should know about any needle treatment. Electroacupuncture is not suitable with a pacemaker.

Ayurvedic medicine as supportive care in Rheumatic Fever

The Ayurvedic view

Ayurveda has no exact counterpart for rheumatic fever. Practitioners may relate its joint symptoms to Amavata, a condition described as ama (poorly processed material) combined with aggravated Vata that settles in the joints, and its heart effects to Hridroga, the traditional term for heart disorders. These are traditional frameworks, not biomedical diagnoses.

Therapies that may be used

For supportive care, a practitioner may suggest:

• Regular meals and a steady daily routine to support sleep and energy
• Gentle movement and breathing practices, adapted to heart function and approved by your cardiologist
• Warm oil massage for muscle and joint stiffness
• Individually chosen herbs, only after review of your medicines

Panchakarma is not appropriate during pregnancy, acute illness or frailty. It is not suitable during active rheumatic fever or when there is significant heart disease.

What the research shows

There are no clinical trials of Ayurveda for rheumatic fever. The evidence is very limited. One case report described a patient with mitral stenosis attributed to rheumatic fever who was treated with Ayurvedic management and was reported to have a larger valve area after 11 months. A single case with no comparison cannot show that the treatment caused the change.^[13]

For yoga, a systematic review of seven trials in heart disease found only weak, low or very low certainty evidence, with no adverse events reported in the three trials that reported safety.^[14] A review of mind-body interventions in heart failure found small to moderate improvements in quality of life, exercise capacity, mood and fatigue in most of 24 small trials.^[9] These studies were not of rheumatic heart disease.

Herbal medicine as supportive care in Rheumatic Fever

Herbs and formulas that have been studied

No herbal formula has been tested in a clinical trial for rheumatic fever or rheumatic heart disease. Traditional Chinese medicine groups joint pain under patterns of wind, cold and damp obstruction. Herbs may be chosen for these patterns, and a practitioner selects them individually.

What the research shows

There is no clinical evidence for the disease itself. In chronic heart failure, an umbrella review found that intravenous Chinese herbal medicines may improve a blood marker of heart strain, with low to very low certainty, which is not relevant to oral herbs or to rheumatic fever.^[11] Herbs are not a substitute for antibiotic prevention or any other medicine.

Safety and herb-drug interactions

Safety matters especially in heart disease. Case reports link combining warfarin with herbs, including ginseng, danshen, ginkgo, dang gui, ginger and Boswellia, to bleeding and other serious effects.^{[7, 15]} Another review links herbs such as danshen and ginkgo to bleeding when combined with warfarin or aspirin, which some people with heart disease take.^[16]

Aconite roots, used in some traditional formulas for cold and joint pain after processing, contain alkaloids that are toxic to the heart and nerves, and poisoning can cause dangerous heart rhythm problems.^[17] Herbs can also be contaminated with aconite.^[18] Aconite is best avoided by people with heart disease.

About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[19] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine's wind-damp obstruction pattern describes migrating joint pain, and Ayurveda's Amavata also describes painful joints with inflammation. Researchers study related ideas such as inflammatory signaling and immune cross-reactivity in rheumatic fever, but nothing shows that these traditional patterns correspond to that biology.^[2]

The realistic overlap is at the symptom level, such as pain, stress, sleep and fatigue, which are measured with questionnaires in the studies above.

How this care fits with your medical care

Complementary care for rheumatic fever is supportive only and begins after the condition is under medical management. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Do not stop or change prescribed medicines. This includes long-term preventive penicillin, which lowers the risk of recurrence.^[3] We do not diagnose or manage rheumatic fever. Please bring your diagnosis, recent echocardiogram and test results, a full list of medicines and supplements, and the names of your cardiologist and other physicians.

When to seek urgent medical care

Suspected rheumatic fever and rheumatic heart disease need prompt medical assessment.^{[1, 6]}

• Fever and joint pain, rash or new jerky movements after a sore throat or strep infection
• A sore throat that has not been evaluated or treated, especially with a past history of rheumatic fever
• Shortness of breath, chest pain, palpitations, fainting or new leg or ankle swelling
• Fever with a heart valve problem or artificial valve, which can signal a heart infection
• Bleeding that does not stop, black stools or a severe headache while taking blood thinners

If any of these occur, call 911 or go to the nearest emergency department.