Acute rheumatic fever develops 2–3 weeks after a Streptococcal pharyngitis. The classical features of acute rheumatic fever are:

• Fever
• A ‘flitting’ polyarthritis. Pain, redness and swelling (arthritis) of a number of joints (polyarthritis) where the arthritis moves within days from joint to joint (flitting). Usually the large joints (elbows, knees) are involved.
• Carditis
• Eythema marginatum. A short-lived erythematous (pink) rash which forms irregular patterns on the trunk.
• Subcutaneous nodules. Small, non tender lumps under the skin over the elbows, knuckles, wrists, knees and spine.
• Chorea. Usually seen in girls who become clumsy and very emotional with unusual jerky movements. Their handwriting deteriorates and they have difficulty doing up buttons due to the abnormal movements. Chorea may only appear months after the throat infection.

Children with acute rheumatic fever do not necessarily develop all the classical signs. The rash, subcutaneous nodules and chorea are less common signs of acute rheumatic fever.