Last reviewed 06/2022

There are two theories concerning the pathogenesis of rheumatic fever (RF):

Cross-reactive antibodies:

  • clear association with previous streptococcal infection
  • anti-viral titres are often elevated - antistreptolysin O antibodies
  • streptococci are not directly involved as lesions are sterile
  • the more serious the streptococcal infection, the more likely is the development of RF, on average 3% of all streptococcal pharyngitides will cause RF
  • all recurrences of RF are preceded by strep infection
  • recurrence rate range from 5-50%
  • the development of RF depends on the virulence of the organism and also on the immune response genes of the host
  • putative cross-reactive bacterial antigens include hyaluronic acid and M proteins


  • streptococcal infection stimulates the production of antibodies which react with the heart but not with the streptococci
  • autoantibodies are present in Aschoff bodies