Rheumatic Fever or Rheumatoid Disease: What's the Difference?
Many eons ago, not long after my diagnosis of rheumatoid disease, I went to the library to learn all I could about it. Ever since I’d taken Lamaze training so that I could give birth to my daughter naturally, without any drugs (successfully, and just six years before), I’d been a true believer in education as a weapon against fear and pain.
I lived near and worked on a U.S. Army base in Northern Germany at the time. There were no books about rheumatoid disease (or any other type of arthritis) on the shelves of the base’s small library. I wasn’t terribly surprised, so I pulled a couple of different encyclopedias off the shelves. In them I read the dry, short, and ultimately disappointing entries for rheumatoid arthritis. But I also noticed the entries for “rheumatic fever.”
Might there be some correlation? I didn’t recall having ever had rheumatic fever, but maybe I had when I was a baby, and no one ever mentioned it to me. Certainly, I had no idea how I might have gotten rheumatoid arthritis, a disease I’d always thought only elderly people got. I didn’t have a single relative who also had rheumatoid arthritis, so I was grasping at straws for answers.
I’ll pass along what I learned then, backed up with some better research today. I know I’m not the only one who ever wondered if there was a connection between the two.
They are, but only in that both cause inflammation throughout the body.
Caused by the group A streptococcus bacteria, rheumatic fever is an inflammatory disease that can develop as a complication of an untreated or inadequately treated strep throat infection, usually showing up about four weeks after the strep infection has healed. Strep is usually treated and cured quickly with antibiotics in most developed countries, including the U.S., so today the disease is rare. When it does show up, it’s usually in children between the ages of 5 and 15, though it can affect other ages, including adults.
Rheumatic fever is serious. It causes widespread inflammation and swelling, causing particular trouble in the heart, where it may damage the heart valves and lead over time to congestive heart failure. Rheumatic fever got its name because several of its symptoms mimic rheumatic diseases like rheumatoid and other forms of arthritis. The symptoms include joint swelling and pain, fever, nodules under the skin of the elbows and knees, and weakness, shortness of breath, and fatigue. Other symptoms may include a raised red rash on the stomach and back, uncontrollable body movements (convulsions) or outbursts of unusual behavior, like sudden laughing or crying.
Treatment includes antibiotics to knock out any remaining streptococcus bacteria in the body and prevent re-infection. If the patient is a child, he or she will need to keep taking antibiotics as a preventative measure until the age of 21. Older teens and adults generally take preventive antibiotics for at least five years. If the patient has suffered heart damage from the disease, they’ll probably need to take antibiotics for the rest of their lives.
Rheumatic fever patients also receive anti-inflammatory medications to relieve inflammation, fever, and pain, and some receive corticosteroids. Patients who have convulsions may need anticonvulsant drugs.
Often, damage to the heart done by rheumatic fever doesn’t show up until later in life. People who’ve had the disease as children need to know this so their doctors can monitor them for complications throughout their lives.
Rheumatoid Disease (Arthritis)
No one really knows, yet, what causes RD. Researchers suspect a number of triggers for the disease, including viruses, environmental causes like smoking, and hormones. It may also be genetic. Women get RD two to three times more often than men, and it can affect children as young as infants.
RD is an autoimmune disease. The body’s immune system mistakes its own tissues for foreign invaders, like bacteria or viruses. It sends warrior antibodies to attack and destroy the “invaders.” In RD, the body mainly targets the synovial tissues in the joints, though it may affect other parts of the body, as well. These ongoing attacks cause the joint inflammation, pain, swelling, and damage characteristic of the disease.
The linings of the heart and lungs, the kidneys, the vascular system, and the eyes may also be affected by rheumatoid disease, and often contribute to the fatalities associated with it.
RD is treated with non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs), including the newest group of these, the “biologics.” Treatment with these drugs helps many patients achieve a significant slowing of the disease’s progression, along with relief of many of the symptoms, including joint pain. A few even achieve remission. These drugs can help patients with RD live normal lives with a minimum of joint damage--a much different story than it was even 20 years ago.
There is no cure for rheumatoid disease yet. But research is ongoing.
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?