Treatment Guideline Chart
Acute rheumatic fever is an autoimmune response to a previous group A beta-hemolytic streptococcal (GAS) infection causing acute generalized anti-inflammatory response primarily affecting the heart.
It often presents in patients 5-14 years of age and uncommon before 3 years and after 21 years of age.
Patients presenting with acute rheumatic fever are severely unwell, in extreme pain and requires hospitalization.

Rheumatic%20fever%20-%20acute Management

Follow Up


  • 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
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