Rheumatism: symptoms and first signs in adults

In everyday speech, the word "rheumatism" is used for almost any aching joint pain. In medical literature, it used to refer to acute rheumatic fever — a condition after a streptococcal throat infection that can affect the heart. Below is what it looks like and when it is time to see a doctor.

What rheumatism is

The term "rheumatism" in modern medical literature has been replaced by the term "acute rheumatic fever". In other countries, this term describes lesions of the periarticular soft tissues, and in everyday speech — diseases of the musculoskeletal system.

Acute rheumatic fever is a rare complication of a bacterial throat infection caused by group A streptococcus (tonsillitis, scarlet fever). The immune system, reacting to the infection, attacks healthy tissues, and they become inflamed. The cause of this malfunction is unknown; genes play a role. It mainly affects children aged 5–15 years.

First signs

They appear 14–28 days after tonsillitis or scarlet fever, according to other data — from one to five weeks.

• High temperature, weakness, sweating, decreased appetite, sometimes nosebleeds and abdominal pain.
• Pain and swelling of the joints — more often the ankles, knees, wrists and elbows; the skin may redden, and the pain can move from joint to joint.
• Chest pain, shortness of breath, rapid heartbeat.
• Involuntary jerky movements of the hands, feet and face.
• Small firm nodules under the skin, pale pink ring-shaped rashes on the arms, chest and abdomen.

Age-related features

The main group is children and adolescents. Chorea with involuntary movements and emotional instability is more common in children, including girls. The younger the person, the higher the likelihood of a repeat episode.

Attack and exacerbation

The active phase lasts 3–6 months, sometimes longer. Minimal activity, subacute and maximally active, continuously relapsing are distinguished; latent course and inactive phase are also described separately.

Repeated attacks occur under the influence of infections, exposure to cold, and physical overexertion. The picture resembles the first attack, but the signs of damage to blood vessels and serous membranes are weaker. The likelihood of recurrence is lower if five years have passed.

Cardiac complications

The most vulnerable place is the heart. Inflammation can affect all membranes, but primarily the muscle; weakness, sweating, chest pain, shortness of breath, palpitations, and a temperature above 38 °C appear. Sometimes the heart is affected without noticeable symptoms.

Late consequences are valve damage, damage to the heart muscle, heart failure, inflammation of the inner lining and pericardium, and a rapid irregular rhythm. Rheumatic heart disease can manifest years later, so regular check-ups and treatment may be needed.

Diagnosis and when to see a doctor

The doctor examines the joints and skin and listens to the heart. A blood test for past streptococcal infection (ASO), a complete blood count, ESR, and ECG may be performed.

The diagnosis is made according to major and minor criteria. Major: arthritis of large joints, inflammation of the heart, subcutaneous nodules, chorea, rash. Minor: fever, high ESR, joint pain, ECG changes. Two major criteria or one major and two minor criteria together with evidence of past infection are sufficient.

Rheumatism itself is not a reason to call an ambulance; 103 or 112 — if the condition is life-threatening (for example, sudden deterioration, severe chest pain, difficulty breathing).

See a doctor if there was rheumatic fever before and a sore throat has appeared; if it seems that the episode has returned; if the described symptoms appeared after a bacterial throat infection. There are many similar conditions, so an in-person assessment is needed, and prompt treatment of tonsillitis reduces the risk.

This material is for reference: it does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer