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Everything you need to know about the rheumatic fever of childhood

Growing up, we more or less faced joint pain, especially knee pain. Most of it was due to the growth spurt or excessive playing. But, sometimes things can be severe, and it all starts with a simple joint pain. So, if you want to know if your child’s knee pain is temporary or suggesting something deadly, then scroll through this article.

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What is rheumatic fever?

Rheumatic fever is a bacterial infection. It occurs with a widespread and less harmful organism. Usually, streptococcus is responsible for the common cold, sore throat, and mild infections. The problem starts when a genetic crossover occurs, and our immune system attacks our cells and joints after a streptococcal infection.

How does it occur?

Most patients with rheumatic fever complain of suffering from an episode of a sore throat before the joint pain appears. Once the streptococcus attacks the upper respiratory tract mucosa, our immune system activates several neutrophils and complement systems to produce antibodies against this bacteria.

Molecular crossover

These antibodies against group B, beta-hemolytic streptococcus bacteria, resemble the cellular proteins of our cardiac muscles, joints, and serous membranes. So, instead of attacking the bacterias, these antibodies attack our heart and synovial joint. And, knee joint being the weight bearer of our body, shows the results very early. But, when a patient presents with chest pain and murmur, that’s when things indicate serious complications.

How to diagnose?

We already know that rheumatic fever patients present with joint pain. But, according to the WHO and acclaimed rheumatic societies, there are one major, minor, and adjunctive symptom criteria to diagnose rheumatic fever effectively.

Major criteria

Migratory polyarthritis is the first symptom of the significant criteria. It means the joint pain can start with only one joint, and slowly it will progress and affect other significant joints in the body. Then comes the carditis. It indicates inflammation of different layers of the heart, and usually, in the later stages, the rheumatic fever will present with pancarditis. Here, pancarditis denotes that the inflammation has already spread in all three layers of the heart.

Other features

Chorea or abnormal dancing gait is the most striking feature of rheumatic fever. If a person between five to fifteen presents only chorea without any other history, she probably suffers from rheumatic fever. Also, rheumatic fever can present with subcutaneous nodules and marked red patches all over the body.

Minor criteria

There are some minor criteria to diagnose rheumatic fever clinically. An increase in the current level of acute-phase proteins, ASO titer, associated fever, and such fall in the minor criteria. If two of these minor criteria present with at least one significant criteria, you can clinically confirm your diagnosis.


Physicians have a brilliant clinical eye to diagnose a typical case of rheumatic fever. But, laboratory investigations are an essential part of confirming the diagnosis. Also, it is essential to document everything you suggest to your patient to clarify your legal and ethical background of medical practice.

Specific test

Antirheumatic factor in the serum indicates rheumatic fever almost a hundred percent times. But, these are some conditions where the RA factor can be present in the sample without rheumatic fever. So, you can do a double-stranded DNA analysis to confirm your diagnosis without any fallacy. Complete blood count, ASO titer, CRP, and such are also helpful to establish your case.

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Rheumatic fever tends to destroy the joints and heart irreversibly. But, the treatment protocol is relatively simple and easy to follow. A regular penicillin injection or oral tablet is enough to cure the disease and prevent further progression.

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