Rheumatic Fever

Question 1

Should I treat for GAS pharyngitis in Acute rheumatic fever even when there is no pharyngitis

Answer 1

YES

UpToDate 2018.

Even if Throat culture is negative, GAS treatment should be given

Question 2

Dose of Naproxen in Acute rheumatic fever

Answer 2

10-20 mg /kg/day
Children - Max- 1 gram in a day
Adults- Max- 1250 mg in a day

Question 3

How long arthritis treatment should be given in ARF

Answer 3

Till all joint symptoms resolve

Normally 1-2 weeks

Sometimes upto 8 weeks

Recurrence of arthritis with reducing dose of anti- inflammatory is REBOUND phenomena of ARF and not recurrence

Question 4

Which is better to monitor inflammatory status in acute rheumatic fever- CRP or ESR

Answer 4

CRP

CRP normalize over a matter of days once inflammation is settled

ESR takes up to 2 months to settle

Uptodate 2018

But CRP is susceptible to artefacts and other causes of inflammation may limit its use

Question 5

How frequently to measure CRP in Acute rheumatic fever

Answer 5

Twice a week initially,

Then ever 1-2 weeks

Question 6

Duration of GAS treatment

Answer 6

Usually 10days with penicillins and cephalosporins

Uptodate 2018

Cefpodoxime and Cefdinir- 5 days is enough

Question 7

ACC/AHA guideline on rh fever prophylaxis 2009

Answer 7

Persistent valvular diseases- Till 40 yrs or for 10yrs- whichever is longer

Carditis but no residual disease- Till 21 yrs or 10yrs whichever is longer

No carditis- Till 21 yrs or 5 yrs whichever is longer

Question 8

Azithromycin in rheumatic fever prophylaxis

Answer 8

250 mg once daily

Question 9

Symptoms of ARF develop …….days after pharyngitis

Answer 9

2-3 weeks

Question 10

What is the relationship between anti inflammatory therapy and cardiac outcomes in Acute rheumatic fever

Answer 10

No evidence that it improves cardiac outcomes

Uptodate 2018

These are basically for joint symptoms . Not routinely recommended for carditis

May be a role for steroids in severe carditis