What is acute rheumatic fever (ARF) and rheumatic heart disease (RHD)?
Key takeaways
- Acute rheumatic fever is an illness that happens in some people after a germ called Strep A infects the throat or skin (sores).
- Sore throats and skin sores need to be checked by a doctor or health professional and treated early to stop rheumatic fever developing.
- If the heart is affected during rheumatic fever, this can lead to rheumatic heart disease.
- Rheumatic heart disease is permanent damage to one or more valves after having ARF. Treatment for RHD includes regular health check-ups and medicine to keep the heart strong.
- In Australia, acute rheumatic fever and rheumatic heart disease are mostly seen in First Nations peoples, who have some of the highest rates in the world. Some Māori and Pacific Islander communities are also at higher risk.
- Young people between 5–15 years old are often most affected by acute rheumatic fever, but adults can get it too.
What is acute rheumatic fever?
Germs called group A Streptococcus (also known as Strep A) can cause infections in the throat and in skin sores. The body’s immune system fights the Strep A germs, but for some people, the body’s immune system gets confused. It fights the Strep A germ and also attacks healthy parts of the body including the joints, heart, brain and skin. This immune reaction to the Strep A germ causes an illness called acute rheumatic fever (also known as ARF).
What are the signs and symptoms of acute rheumatic fever?
Joints (arthritis/arthralgia): pain and swelling, commonly in the knees, hips, ankles, wrists and elbows. Some people are in so much pain they can’t walk.
Heart (carditis): swelling of the heart, which may cause chest pain and a heart murmur.
Brain (chorea): jerky movements that can’t be controlled. These movements can last for many months but stop during sleep.
Skin: small lumps under the skin around the joints (subcutaneous nodules) or a painless rash (erythema marginatum). Skin symptoms are rare.
Fever: hot and cold chills.
People who have ARF may experience one or more of these symptoms, but not usually all of them. The ARF sickness usually last a few weeks, although the jerky movements may last for longer.
See your doctor or healthcare professional if you experience any of these symptoms or signs and are concerned about ARF.
What is rheumatic heart disease?
Rheumatic heart disease (RHD) is damage to one or more of the heart’s valves after having acute rheumatic fever (ARF).
There are four valves in the heart which open and close with each heartbeat to keep the blood flowing in one direction. If the valves are damaged, the blood does not flow through the heart properly.
When someone gets ARF again and again, it can cause more damage to the heart over time. Signs of RHD may not be noticed for many years.
If RHD is left untreated, the heart works harder to control blood flow, and this can lead to heart failure and life-threatening conditions like stroke and abnormal heart rhythms.
How are acute rheumatic fever and rheumatic heart disease diagnosed?
- ARF is diagnosed by looking at signs and symptoms and doing tests like heart scans (electrocardiogram and echocardiogram) and blood tests.
- RHD is diagnosed by echocardiogram (ultrasound of the heart).
- International guidelines are used in Australia to help determine the diagnosis and the severity of RHD. Learn more at For professionals: Guidelines for acute rheumatic fever and rheumatic heart disease
How to prevent acute rheumatic fever (ARF)
Cover skin sores to stop the spread of germs
Go to the clinic if you have a sore throat or skin sores
Wash hands
Shower daily to keep skin clean
Wash clothes, bedding and towels often to keep the germs away
Hang washing in the sun and air out mattress
How is ARF treated?
- People who have had ARF can stay strong and healthy by keeping up with regular medical care from a health professional.
- ARF requires long-term antibiotics to help stop further Strep A infections and ARF from coming back.
- Penicillin needles are given every 21-28 days to help protect your heart from Strep A. The penicillin needles work well and are needed for many years.
- Tablet options are available for people who cannot have needles or who are allergic to penicillin.
How is rheumatic heart disease treated?
People who have RHD need to be under the care of a medical professional health professional. With regular care, people with RHD can live strong, healthy lives.
Treatment for everyone:
Penicillin needles on time every 21-28 days to stop ARF from coming back.
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Regular tests, including echocardiograms (ultrasound on the heart)
Check-ups with the doctor and dentist.
Additional treatment if required:
Specialist care for pregnant women.
Surgery to fix the heart valves.
Understanding acute rheumatic fever and rheumatic heart disease
ARF and RHD explained
Acute rheumatic fever and rheumatic heart disease are preventable heart conditions. Experts and communities discuss how to end RHD in Australia.
Champions4Change
A First Nations-led program for people living with acute rheumatic fever and rheumatic heart disease
Michael’s Story
Learn what to do if your child or family member has an episode of acute rheumatic fever.
Red Dust RHD Program - Minjilang
Young people in Minjilang, a small community on Croker island 250km northeast of Darwin, on what acute rheumatic fever and rheumatic heart disease is.
Take Heart: Deadly Heart
Powerful content that shines a light on the impact of acute rheumatic fever and rheumatic heart disease in Australia.
Ending Rheumatic Heart Disease: Tenaya’s Story
Aged just seven, Tenaya underwent emergency life-saving surgery to repair her heart valve as a result of developing RHD.
Champions4Change (C4C)
Australia signed the World Health Assembly pledge in 2018 to eliminate RHD by 2031. The Heart Foundation actively collaborates with First Nations communities, stakeholders, and health services to achieve this goal. One approach is through our Champions4Change program.
The Champions4Change program is a national program led by First Nations people with lived experience of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).
Aiming to bring Champions together to use their cultural knowledge and voices to help others understand what it means to live with these conditions.
Guidelines for acute rheumatic fever and rheumatic heart disease
Australian guidelines for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease
Key takeaways
- The Guidelines include standards, recommendations, and guidance for best practice clinical care.
- A cultural safety framework that places people living with acute rheumatic fever and rheumatic heart disease and their families at the centre of care.
A free ARF & RHD Guideline App is available for iPhone, iPad, and Android devices. It includes key information from the Guidelines and an acute rheumatic fever diagnosis calculator.
Last updated17 March 2026
Last reviewed12 February 2026