In the era before antibiotics, rheumatic fever symptoms recurred one or more times in more than half of the affected patients. With each subsequent attack, the possibility of permanent valvular damage is increased. Those who do not have carditis during the initial attack are, however, unlikely to have carditis during recurrent attacks. On rare occasions, however, persons who have repeated attacks of rheumatic fever show a residual nonprogressive arthropathy of the hands and feet known as Jaccoud's arthritis. The typical deformity is marked ulnar deviation and flexion of the metacarpophalangeal joints, with a striking absence of clinical symptoms such as pain.
Erosions are rare.
Tests for rheumatoid factor are negative. Disorders that must be excluded in the differential diagnosis include seronegative rheumatoid disease, osteoarthrosis in a patient with rheumatic heart disease, and ankylosing spondylitis in a patient with aortic regurgitation.