Acute rheumatic fever: Treatment and prevention
- Andrew Steer, MBBS, PhD, FRACP
Andrew Steer, MBBS, PhD, FRACP
- Associate Professor
- Pediatric Infectious Diseases Physician
- Royal Children's Hospital Melbourne
- Allan Gibofsky, MD, JD, FACP, FCLM
Allan Gibofsky, MD, JD, FACP, FCLM
- Professor of Medicine and Public Health
- Weill Medical College of Cornell University
- Section Editors
- Robert Sundel, MD
Robert Sundel, MD
- Section Editor — Pediatric Rheumatology
- Associate Professor of Pediatrics
- Harvard Medical School
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Acute rheumatic fever (ARF) is a nonsuppurative complication of pharyngeal infection with group A Streptococcus (GAS). Signs and symptoms of ARF develop two to three weeks following pharyngitis and include arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum .
Treatment and secondary prevention of rheumatic fever are reviewed here. Primary prevention (eg, treatment of streptococcal tonsillopharyngitis) and the epidemiology, pathogenesis, clinical manifestations, and diagnosis of ARF are discussed in detail separately. (See "Treatment and prevention of streptococcal tonsillopharyngitis" and "Acute rheumatic fever: Epidemiology and pathogenesis" and "Acute rheumatic fever: Clinical manifestations and diagnosis".)
Treatment of ARF consists of anti-inflammatory therapy, antibiotic therapy, and heart failure management [2,3].
Goals of treatment — The four major goals of treatment are:
●Symptomatic relief of acute disease manifestations (eg, arthritis)
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- Goals of treatment
- Eradication of GAS carriage
- - GAS pharyngitis
- - GAS pyoderma
- - Household contacts
- Arthritis management
- Carditis management
- - Severe carditis
- - Indications for valve surgery
- Sydenham chorea management
- RISK FACTORS FOR RECURRENT DISEASE
- Primary prevention
- Secondary prevention (antibiotic prophylaxis)
- - Duration
- - Antibiotic selection
- - Administration of parenteral prophylaxis
- - Case reporting and prevention programs
- - Education
- POSTSTREPTOCOCCAL REACTIVE ARTHRITIS
- SUMMARY AND RECOMMENDATIONS