Rheumatic Fever

Rheumatic Fever

The term ‘rheumatic’ refers to any aches/ pain in muscles, bones or joints. Rheumatic fever is named after the complaints it causes, i.e. fever accompanied with rheumatism. Many a time, cramps or growing pains in children is often misinterpreted with rheumatic fever and feared due to the death and disability it causes. Even though there is a fall in the incidences due to the availability of advanced medical care, its diagnosis still gives terror to everyone, since it is the commonest cause of heart diseases, under the age of 18.

Fever is always considered friend since it is body’s reaction to fight against any disease. Rheumatic fever is also considered as a delayed auto immune response that usually follows a mal-treated or untreated streptococcal infection in the throat. It creates alarm for the spreading of the disease to the heart, joints, nervous system, brain and skin. In case of rheumatic fever, infective driving force attacks the human connective tissues (in heart valves, ligaments, blood vessels, subcutaneous tissues, nerves, etc.) with inflammatory exudation and proliferation. Delay in treatment of sore throat, joint pains, etc., (symptoms of rheumatic fever) may burden your heart. Unless cared for in the initial days, it will reward with disability.

“Never underestimate anyone” comes true with rheumatic fever. Likewise, there is a saying – “The heart of fool is in his mouth”. If everything is controlled in the mouth (throat) itself, nothing can go deep to attack the heart. So, if a sore throat is ignored, heart damage will be rewarded for our foolishness. Throat care in rheumatic fever should be equivalent to heart care.

Incidences – Rheumatic fever can occur in any age group of 4 – 40, but the incidences are higher in the age group of 5 – 15. It is the commonest sequence of untreated or mal-treated throat pain (pharyngitis) caused by Streptococcus. Females are most commonly affected than males. Also, females suffer more commonly from heart complaints, whereas males suffer more from joint disorders. Likewise, children suffer more commonly from heart problem and adults more commonly from joint trouble. The reason behind all this is still obscure. The incidence of rheumatic fever is often triggered by the start of winter, where it is more contagious.

Causes – Rheumatic fever is considered an auto immune response to bacterial invasion of the body. Bacteria worthily blamed for the occurrence is Group A – Beta Haemolytic Streptococcus. Even though it is clearly stated that this bacteria leads to rheumatic fever disease, it does not cause the disease in all infective cases. So, we are still in the dark about susceptibility or the exact cause of the disease.

Symptoms – Rheumatic fever symptoms start with redness and pain in the throat. The Beta haemolytic streptococcus infection harbouring in the throat, in due course (3-4 weeks) starts its cyclone with joint pains and fever, ending in damaging the joints and heart valves. Rarely, it also attacks the brain and skin. Manifestation of the complaints varies from patient to patient. Usually, acute symptoms go off within 4-6 weeks. Regarding joint pain, mostly larger joints, especially the knee, is most commonly involved. Later, the pain flits from one joint to another (knee, elbow, shoulder and ankle) with redness, swelling, heat and occasional skin eruptions (erythema) over the joints.

Regarding heart involvement, the mitral valve is most commonly affected to become fibrosed, stenosed and prolapsed. The other common accompanying complaints are muscle pain, malaise, abdomen pain, vomiting, chest pain, nose bleed, restlessness, difficulty in breathing, pneumonia, difficulty in speaking or writing, tremors, etc. In skin, non-tender subcutaneous nodules or erythema marginatum may occur giving more value to diagnose rheumatic fever easily.

Diagnosis and investigations – Nowadays, the severity or presence of rheumatic fever is scaled with antistreptolysin O (ASO titre) in the blood. The raised value, i.e. exceeding normal (200 units) is considered to be positive for rheumatic fever. The recent infection also has high ESR (erythrocyte sedimentation rate) level and leucocytosis. Other than these, other common tests usually followed are:

Throat swab & culture – to rule out the type of bacteria in the initial days of throat pain
ECG & Echo cardiogram – to rule out cardiac involvement later X-ray of chest and joints – to rule out development of complications With maltreated or uncontrolled cases, even with auscultation, rigid valve opening clicks followed by late systolic murmurs can be heard as additional sounds in heart sounds.

Complications – In case of rheumatic fever, complication often arises from two sources, i.e. one from the disease as such, and another from treatment. Complications of disease are mainly heart-related (Carditis) and joints-related (Poly arthritis). In the case of the heart, the thin delicate heart valves get infected and become thick and fibrosed. These processes cause stenosis and turbulence in the blood flow followed with prolapsed valve (leakage valve). Also rarely, neurological complications like involuntary movements, difficulty in writing and speaking can arise.

The complications of treatment are mainly that of steroids used nowadays to control infection. It weakens the immune mechanism and attracts many infection/complications later on. Also continuous use of antibiotics and pain-killers lead to further complications, especially related with the stomach and skin. Most people take care of the end result of the disease i.e., by replacing the valve and treating the arthritis. Treating the end result without controlling/treating disease will often lead to recurrence. For example – even after valvular transplantation, complications can arise again in the heart, if disease is not properly cared thereof or failed to prevent infection thereafter.

Prevention – Prevention is better than cure. Usually, rheumatic fever gets activated or reactivated with streptococcal throat infection. So, taking prevention for throat infection/cold (with medicines and preventive measures) will be the most valuable measure. The other possible way to prevent it is by raising immunity level with nutritious diet, exercise, rest and Homeopathic medicines. Since exact pathogenesis is not clearly understood, we should take care in the initial days of the disease itself, or serious complications may follow. To say in a simple manner, take care while you have throat pain or fever or you may need extra care with heart and joints.

General treatment – The advanced medical era attests no clear-cut treatment for rheumatic fever. Since no one claims complete cure, treatment aims only in eradicating streptococcal infection in the throat with antibiotics and prevent further recurrence with prolonged use of penicillin every 3 weeks (21 days). This mode of treatment often controls the infection and tapers it early. Sometimes, throat pain gets prescribed with Erythromycin, joint pain gets prescribed with pain-killers and fever, with anti-pyretic drugs.

Reactivation of the disease usually ends in carditis and disabled life. So, to avoid risk, some doctors insist on continuing penicillin therapy throughout life and some others would recommend it till the age of 30 and some others, recommend it till the age of 21 and many doctors advice to continue treatment till the age of 18. To avoid tension and outweigh the risks, it is better to continue medication till the age of 18.

Sometimes, even with penicillin treatment, some will not get normal level of ASO titre and they have throat pain and leg pain recurrently/continuously. These patients are made to take steroids to control the acute phase temporarily. But most of the times, they cannot taper them off or stop them. In advanced conditions, with valvular damage, surgery helps with replacement of damaged valves. Sometimes, mild stenosis is temporarily managed with balloonoplasty.

Homeopathic approach: Taking penicillin therapy usually suppresses the trigger for the time being only. It never raises our resistance. So, it is advised for every 21 days in Allopathy. Homeopathy treats patients (symptoms of the patients) by raising immunity. In the light of concept “similars” Homeopathic remedies expel the disease force/bacteria and make the patient more comfortable with treatment by supporting the healing process with the stimulation of the immune mechanism.

It will make our resistance go up, giving no chance for recurrence of the disease with re-infection of the same bacteria/virus. So, patients being diagnosed with rheumatic fever can be treated well with Homoeopathy to avoid any recurrence or complication.

Children often suffer from throat pain, tonsillitis, leg pain/joint pains. These complaints should be cared for properly. Parents should not ignore sore throats with salt water gargling and leg pain with simple massaging and application of pain balms, as symptoms tends to wax and wane for months/years. They should be seriously investigated in all aspects to prevent serious illnesses. Caution has to be taken when there is fever with rash/joint pains. Homeopathy can bring back ASO titre value within normal limits and make one maintain it normal without any fluctuations. In advanced cases, Homeopathy can pacify other distressing symptoms of the disease.

In the treatment of rheumatic fever, Homeopathy often proves its efficacy by controlling, preventing and curing the disease. Homeopathic treatment will provide dramatic relief and prevention in cases of rheumatic fever with sore throat and joint pains. One thing everyone should have in mind is that no medicine can revert back the structural damage, where pacifying the symptoms is the only way other than surgery.

Homeopathic medicines commonly used in cases of Rheumatic fever are Aconite, Apis, Ars alb, Baptisia, Belladonna, Bryonia, Cactus, Calc Carb, Chamomilla, Chinchona, Cimicifuga, Gelsemium, Ferrrum Phos, Kali mur, Lachesis, Merc sol, Pulsatilla, Pyrogen, Rhus tox, etc. These Medicines should be taken under the advice and diagnosis of a qualified Homeopath.

for new hope

Dr. S. Chidambaranathan, BHMS, MD (Homeo)

Laxmi Homeo Clinic

24 E. New Mahalipatti Road

Madurai, TN 625 001

India

Tel:  +91-452-233-8833 | +91-984-319-1011 (Mob)

Fax: +91-452-233-0196

E-mail:  drcheena@yahoo.com

www.drcheena.com / www.drcheena.in

(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)