My sister recently went to the edge of hell and came back. I mean it! At least, that's what it felt like looking at her go through that pain and suffering. It started with swelling in her left knee and slowly went toward fever, body pains, abdominal cramps and delirium and continued for almost ten days. This condition, which actually started 18 years ago, most probably will recur in the future. Now she is 48 and she already suffered this bout of illness three times. Until now her diagnosis was excessive fluid and infection in the synovial joints and penicillin was her mode of treatment for years. But the root cause was not diagnosed up until now. Her physician was following the prevention method after the fact rather than actual cure. I was so glad when one our cousins, who is a physician himself, visited her at home and suggested her to have blood tests done. Sure enough, the report came positive for rheumatic factor. Cortico steroid treatment along with anti-inflammatory drugs took care of her pain and suffering with two days giving her and us immense relief.
By definition, rheumatic fever implies illness related to abnormalities of synovial joints. The illness comes with the infection of synovial fluids leading to several complications in the body. Synovial fluid is secreted by the membranous lining of the joints and tendon sheath. The joints that secret this fluid are called synovial joints. They are all major joints including knees, shoulders, elbows, etc.
Rheumatic fever or acute rheumatic fever is caused by a simple sore throat which, when overlooked, can lead to strep throat and inflammation. Most of the time, the bacteria that causes the strep throat is treated by antibiotics. But some times it could last long and lead to Group A Streptococcal infection. The bacteria known as strep or streptococcus pyogenes becomes active in the throat and nose after being dormant for months causing infection and then swelling in the major joints. This usually happens one to five weeks after the sore throat. Another reason for rheumatic fever is believed to be heredity factor of the recessive genes. Incidence of rheumatic fever is high in families where one or both parents have family history.
Rheumatic fever is associated with heart failure, heart valve disease and affects synovial joints, the skin, and the brain. Signs and symptoms of rheumatic fever include:
1. Pain and redness in the throat.
2. Muscle pain, abdominal pain, chest pain.
3. Vomiting, nose bleed, restlessness, difficulty breathing, pneumonia, tremors, reading and writing difficulty.
4. Fatigue, fever, joint pains and swelling, lumps under skin are among other symptoms.
There is no specific test for this condition except for major symptoms such as arthritis, inflammation of the heart, nodules under skin, rapid and jerky movements, skin rash, and high levels of ESR. Blood tests for recurring strep throat and infection including swab and culture; chest x-rays, joint x-rays are among others.
Treatments for strep throat and rheumatic fever are usually done for Penicillin lasting for two to three weeks and after that every four weeks. Penicillin, sulfadiazine, and erythromycin are the usual antibiotics. Anti-inflammatory medicines include aspirin and cortico steroids. Diuretics are sometimes recommended for reducing the swelling. Surgery for the damaged heart valves is sometimes necessary. The major impact of the rheumatic fever is on the heart valves. Whenever the attack occurs the valves are scarred causing the heart work harder to close the valves which eventually leads to congestive heart failure and rheumatic heart failure. Untreated strep throat infection leads to the production of the antibodies which in turn attack the tissues of the joints as well as the heart valves. In case of heart valves damage surgery is done to repair or replace the valves.
Patients who suffer from rheumatic fever have to be extremely careful in taking precautions when they first start noticing the signs of sore throat or having common colds. Common colds in early monsoon or rainy seasons are mostly the cause for starting the sore throats and infections. Some times these colds seem to be gone, but the bacteria stays on for weeks as inactive. Penicillin is given to prevent the infection in the synovial joints. but will not be effective if it is given after the fact. While there is no permanent cure for rheumatic fever, cortico steroids seem to bring relief to the joint pains, fever, and body pains faster. Patients with history of this recurring condition should take steps to get their heart checked on yearly basis and tests for osteoporosis as precautionary measures as it increases the chances of heart valve failure with more number of episodes. As for my sister she is recovered more than half way with the last episode and hopefully she will remain that way for a long time. If the patients take good care of themselves with the initial signs of common cold this hell raising condition would be avoided in the first place for many patients because, OUR LIFE MATTERS.