Rheumatic Fever

*dose should be reduced if tinnitus or other toxic symptoms develop.

Aspirin should be continued until fever, all signs of joint inflammation and the ESR have returned to normal, and then tapered gradually over 2 weeks. If symptoms recur, full doses should be restarted.

In severe carditis with development of increasing heart failure or failure of response to aspirin, add:

Gradual reduction and discontinuation of prednisolone may be started after 3-4 weeks when there has been a substantial reduction in clinical disease.

Heart failure should be managed in the usual way.

All patients with carditis should be kept on strict bed rest until all evidence of active carditis has resolved and the ESR has returned to normal. Activity can then be gradually increased.

• Prophylaxis should be given to all patients with a history of rheumatic fever and to those with heart valve lesions thought to be of rheumatic origin. The optimum duration of prophylaxis is controversial but should be continued up to at least 21 years of age. If at that age there are any significant heart murmurs, prophylaxis should be life-long.
• Specific situations requiring prophylaxis for longer periods (can be lifelong):
  • definite carditis in previous attacks
  • high risk of exposure to streptococcal infection at home or work (crowded conditions, high exposure to children)

Note: The need for continuing prophylaxis should be reviewed at 21-30 years and patients with rheumatic heart disease must take prophylaxis life long.