The symptoms of rheumatic fever usually develop one to five weeks after a streptococcal throat infection.

In a majority of cases the disease will begin following a case of acute angina or pharyngitis. In other cases, patients will suffer from other focal infections such as dental granulomas or abscesses, otitis, paradontosis, sinusitis, or other diseases where Streptococcus is involved such as scarlet fever, etc.

Upon the streptococcal infection until the emergence of symptoms of rheumatic polyarthritis, a long latent period must pass, which usually lasts from one up until 4 weeks.

During this asymptomatic period, the patient will feel physically well, but there may be prodromal (warning) symptoms, such as general fatigue, pallor, sub-febrile (low-grade) fever, arthralgia or myalgia (pain in the joints or muscles), digestive problems (nausea, vomiting, diarrhea, etc).

When the disease begins, the symptoms include:

  1. High fever: 38-39 degrees

  1. A burning feeling in the throat

  1. Difficulty swallowing

  1. Redness of the pharynges and the tonsils, they may even contain purulent exudate

  1. Skin rash

  1. Enlargement of the submandibular lymph nodes

  1. Red splotches in the mouth cavity

  1. Headaches

  1. Nausea

  1. Vomiting

  1. Articular pain, which involves the pain jumping from joint to joint in quick succession

Articular rheumatism will not cause deformations, ankylosis, or infection of the articulation, but it will affect the heart, and cause myocarditis, endocarditis, and more rarely, pericarditis.
Heart damage constitutes the major risk, whereas articular changes will usually subside without medication.

When the heart is affected, the condition of the patient becomes worse, and the symptoms include:

  1. respiratory insufficiency (difficulties breathing) especially in children, especially at night

  1. chest pain

  1. tachycardia

  1. persistent coughing

  1. extreme fatigue

  1. stomach ache

  1. a state of general lethargy

  1. chorea minor which is mostly observed in young girls. These are small convulsive attacks, which appear epileptic and require specific medication.

The most common forms of rheumatic polyarthritis are not the severe cases which involve a high fever and especially pronounced articular symptoms. More often the disease presents in the form of febrile polyarthralgia.

The inaccurate assessment of these conditions, especially in children for whom the disease is most common, leads to a slower determination of diagnosis. This may be a mistake which can keep from preventing heart damage.

Common symptoms*

Common symptoms of rheumatic fever are described below.


Pain and swelling of the joints ( Arthritis ) is the most common symptom of rheumatic fever, affecting three out offour people.

The larger joints, such as the knees, ankles, elbows and wrists are usually affected, typically on both sides of the body. Several joints are usually affected at the same time.

The symptoms of arthritis should pass within four to six weeks as the inflammation settles, without causing any permanent damage.

Heart inflammation (carditis)

Inflammation of the heart (carditis) is another common and potentially serious symptom of rheumatic fever.

Carditis occurs in an estimated 30-60% of people with rheumatic fever and is more common in younger children.

As a result of the inflammation, the heart has difficulty pumping blood around the body, which can cause the following symptoms:

  • shortness of breath , particularly when you're physically active or when sleeping (it can often wake you up, gasping for breath)
  • persistent cough
  • rapid heartbeat (tachycardia)
  • feeling tired all the time
  • chest pain

Carditis can persist for several months, but it should improve over time.

Sydenham's chorea

Sydenham's chorea is a term that describes a collection of symptoms related to inflammation of the nerves. These symptoms are:

  • involuntary and uncontrollable jerking and twitching of the body most often, the hands and feet
  • difficulty with tasks requiring fine hand movements, such as writing
  • problems with balance
  • unusual emotional outbursts, such as crying or laughing for no apparent reason

Around in one in four children with rheumatic fever will develop Sydenham's chorea, but it is rare in adults.

Sydenham's chorea usually passes within a few months, although in some cases it can persist for up totwo years. It shouldn't cause any permanent damage to the nervous system.

Skin rash

Around 1 in 10 children with rheumatic fever will develop a skin rash, known as erythema marginatum. The rash is usually painless, non-itchy and spreads slowly over the child's body. It may only be noticeable in children with fair skin.

The rash usually comes and goes over the course of a few weeks or months, beforedisappearingaltogether.

It's rare for adults with rheumatic fever to develop a skin rash.

Less common symptoms*

Less common symptoms of rheumatic fever include:

  • subcutaneous skin nodulessmall painless bumps or lumps under the skin, usually found on the wrists, elbows and knees
  • a high temperature (fever) of39C (102F) or above
  • abdominal pain
  • nosebleeds
Medical Review: Diana Hysi, MD.
*Sections supplied by NHS Choices
Content supplied by the NHS Website

Medically Reviewed by a doctor on 28 Nov 2016