Rheumatic fever

风湿热

Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026

Rheumatic fever is an inflammatory condition that follows Group A Streptococcal infection and remains a major global health burden through its cardiac sequelae. Approximately 33 million people live with rheumatic heart disease and an additional 47 million have asymptomatic valve damage, with global deaths from the disease estimated at 345,000 in 2010. The illness predominantly affects socioeconomically disadvantaged populations and has become uncommon in Western countries since the 1960s owing to antibiotic use, though outbreaks have recurred in some settings since the 1980s. ^[1]^[2]^[3]^[4]

Read the full clinical and epidemiological profile 6

Definition

Rheumatic fever is an inflammatory disease that develops as an autoimmune response to pharyngitis caused by Group A Streptococcus, typically appearing two to four weeks after the initial throat infection. It can involve the heart, joints, skin, and brain, and repeated or severe episodes may lead to rheumatic heart disease with persistent valve damage. ^[1]^[3]^[4]^[5]

Clinical features

The disorder presents with fever, multiple painful joints, involuntary muscle movements, and occasionally a non-itchy rash termed erythema marginatum. Cardiac involvement occurs in about half of cases, and valve damage may follow single or repeated attacks. The condition is recognized as a systemic inflammatory disorder driven by autoimmune mechanisms after streptococcal exposure. ^[1]^[4]^[5]

Epidemiology

Globally, about 33 million individuals are affected by rheumatic heart disease and 47 million more have asymptomatic valve injury, with 345,000 deaths attributed to the disease in 2010, a decline from 463,000 in 1990. Western nations have seen rare occurrence since the 1960s, yet limited outbreaks have appeared since the 1980s. The disease is most common among Indigenous Australians, Māori, and Pacific Islanders, and is concentrated in socioeconomically disadvantaged populations with restricted health-care access. ^[1]^[2]^[4]

Transmission

Rheumatic fever itself is not directly transmitted between persons; it arises following infection of the throat by Streptococcus pyogenes, with untreated streptococcal pharyngitis leading to rheumatic fever in up to three percent of cases. The preceding group A streptococcal infection is the necessary exposure, and the disease typically emerges two to four weeks afterward. ^[1]

Prevention

Prompt and effective antibiotic treatment of streptococcal sore throat substantially lowers the risk of rheumatic fever, representing primary prevention. Among those with a prior episode, sustained antibiotic use as secondary prophylaxis is advised because recurrence is highly likely. Broader measures include improved sanitation and addressing overcrowding and domestic air pollution, while socioeconomic disadvantage and limited health-care access are key contextual factors to be addressed. ^[1]^[4]^[5]

References

1 Wikipedia contributors. Rheumatic fever - Wikipedia [Internet]. Wikipedia. cited 4 Sept 2026. Available from: https://en.wikipedia.org/wiki/Rheumatic_fever
2 Rwebembera J et al. Acute rheumatic fever and rheumatic heart disease: updates in diagnosis and treatment. Curr Opin Pediatr. 2024 Oct 1. PMID: 39254753. doi: 10.1097/MOP.0000000000001384. PubMed: https://pubmed.ncbi.nlm.nih.gov/39254753/
3 Carapetis JR et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers. 2016 Jan 14. PMID: 27188830. doi: 10.1038/nrdp.2015.84. PubMed: https://pubmed.ncbi.nlm.nih.gov/27188830/
4 Hirani K et al. Acute rheumatic fever. Lancet. 2025 Jun 14. PMID: 40484016. doi: 10.1016/S0140-6736(25)00185-0. PubMed: https://pubmed.ncbi.nlm.nih.gov/40484016/
5 Balan S et al. Acute rheumatic fever and Post-streptococcal reactive arthritis. Best Pract Res Clin Rheumatol. 2025 May. PMID: 40345912. doi: 10.1016/j.berh.2025.102067. PubMed: https://pubmed.ncbi.nlm.nih.gov/40345912/