The symptoms of rheumatic fever depend on whether the heart, joints, or nervous system are affected. Most people with rheumatic fever have fever and joint pain. The joint pain (arthritis) usually affects large joints such as the knees, elbows, ankles, or wrists. The joint pain characteristically migrates from one joint to another, so that one or more joints may be swollen, red, and extremely tender. The joint pain is usually reversible.
Many people who develop rheumatic fever suffer damage to the tissues of the heart, which may include their heart valves (endocarditis), heart muscle (myocarditis), sac covering the heart (pericarditis), or all three. This may cause no symptoms, but some people feel heart palpitations or chest pain. Occasionally, there is heart failure, though few people in North America die during a rheumatic fever episode.
In severe cases, the valves ultimately have to be replaced with artificial ones. People with damaged valves and those with an artificial heart valve are at increased risk of a heart infection later in life (infectious endocarditis).
The central nervous system may also be affected to produce a symptom known as chorea. Chorea affects females more frequently and almost never occurs after puberty. The onset of chorea is usually gradual, and it often first appears several months after the rheumatic fever has passed. Occasionally, chorea is the only visible symptom of rheumatic fever. Teachers may be the first to notice it and mistake it for clumsiness or restlessness. Symptoms of chorea may include:
- muscular weakness
- involuntary, purposeless movements of the arms and legs
- emotional disturbances (crying and restlessness)
Rheumatic fever can also cause skin lesions to develop. These can be firm and painless nodules under the skin that can be present for one or more weeks, or non-itching rashes (called erythema marginatum) that usually affect the trunk of the body and appear and disappear within hours.