The most common rheumatic fever symptoms include joint pain, heart inflammation and skin rash. Pain in the joints can be exhibited alone or might be accompanied by swelling. Heart inflammation can result in chest pain, shortness of breath or heart murmur, or it might exhibit no outward symptoms at all. Skin rash will usually enter when the first symptoms start to subside, and it typically occurs on the torso or arms. Other rheumatic fever symptoms include fever, abdominal pain, nosebleeds, skin nodules and Sydenham's chorea, which is a nervous system disorder occurring very late in the disease.
Joint pain and inflammation are often the first rheumatic fever symptoms to appear. They occur primarily in the knees, ankles, elbows and wrists and sometimes in the shoulders, hips, toes and fingers. This stage is known as migratory polyarthritis; the pain will move from one joint to another, usually migrating upward from the legs. The pain can range from mild to severe and will generally last two to four weeks if untreated. Rheumatic fever does not cause any long-term joint damage.
Heart inflammation can be indicated by rapid heartbeat, chest pain or heart palpitations. It could also lead to heart failure, which would result in tiredness, shortness of breath, vomiting, nausea, stomachache or hacking. In some cases, the heart inflammation might have no outward symptoms at all and will be detected only years later based on damage done to the heart. This stage of the disease will disappear over time, usually in no more than five months, but can cause lasting damage to the heart valves.
After the initial rheumatic fever symptoms have started to subside, a skin rash can affect the torso or arms of the patient. This rash is wavy or snake-like in appearance, going outward to form a ring with clear skin in the middle. It is generally painless and will usually disappear within a day or less. In some cases, small and hard skin nodules will also form under the skin, typically near affected joints.
Syndenham's chorea will usually enter after all other rheumatic fever symptoms have disappeared, and it can last four to eight months. It manifests in sporadic, uncontrollable jerking, generally beginning in the hands and spreading to the face and feet. The condition can affect any muscle in the body other than those of the eyes, although it subsides during sleep. The movements generally start out mild, and it might take as long as a month before they become harmful enough to mandate a doctor's visit. If untreated, the jerking can become so severe that some patients will need to be restricted from injuring themselves or others.