Rheumatic%20fever%20-%20acute Management

Monitoring

• Inflammatory markers (eg CRP, ESR) may be used to monitor acute disease process and response to therapy
• Initial measurement is done twice a week then every 1-2 weeks until levels return to normal off therapy
• ESR may stay elevated for up to 2 months while CRP usually goes back to normal level after a few days once acute inflammation has resolved
• Increase in inflammatory marker level while treatment is being tapered suggests rebound of inflammation

Risk Factors for Recurrence

• Lack of compliance to secondary prophylaxis
• Multiple previous attacks
• Shorter time interval since previous attack
• Ongoing/increased exposure to streptococcal infections
• Younger age
• Presence of cardiac involvement