Rheumatic fever is usually undistinguished and can present mainly with irregular fever patterns, but flaccid fever is most common. Most children present with prolonged low-grade fever, with symptoms lasting 3-4 weeks or even longer. Also, about 1-3 weeks before the overall onset, there may be a history of short-term fever such as pharyngitis, tonsillitis, or the flu, with varying degrees of mildness. Arthritis often has an acute onset, while cardiac inflammation has an insidious course. Symptoms may also include mental fatigue, fatigue, poor appetite, pallor, excessive sweating, rhinorrhea, and malaise, as well as gradual onset of skin and central nervous system damage, such as chorea.