Treatment of acute rheumatic fever

Written by Yang Ya Meng
Rheumatology
Updated on September 29, 2024
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The treatment of rheumatic fever includes general treatment, where patients are advised to rest in bed. The second is the use of antibiotics, aimed at eliminating streptococcal infections to prevent recurrent attacks of rheumatic fever. The third is anti-rheumatic treatment, with the preferred choice being non-steroidal anti-inflammatory drugs, such as sustained-release diclofenac sodium tablets. If the patient's rheumatic fever affects the heart, corticosteroid treatment is also required. In addition, to assist in the reduction of corticosteroids, some immunosuppressants need to be added, such as methotrexate and leflunomide, which help control the condition. For the treatment of complications of rheumatic disease, such as concurrent lung infection, antibiotic treatment should also be considered. (The use of medication should be under the guidance of a professional doctor.)

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Written by Liu Li Ning
Rheumatology
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How to quickly relieve rheumatic fever pain?

Rheumatic fever pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs) for rapid pain relief. NSAIDs are the first-line medications for treating rheumatic fever pain. Commonly used ones include diclofenac sodium sustained-release capsules, etoricoxib, meloxicam, or etodolac. These medications may cause gastrointestinal discomfort, so they cannot be used by patients with active peptic ulcers. If there are contraindications to using NSAIDs, pain relief can be achieved with medications such as tramadol or Aconitum alkaloid tablets. If rheumatic fever is accompanied by carditis, treatment with corticosteroids is also necessary. Since the onset of rheumatic fever is related to streptococcal infections, the use of penicillin antibiotics for anti-infection treatment is also recommended.

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Written by Li Jing
Rheumatology
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What are the symptoms of rheumatic fever?

Rheumatic fever is a delayed, non-suppurative sequelae caused by a streptococcus infection. It primarily presents as arthritis, heart valve disease, chorea, subcutaneous nodules, and erythema, and some cases also exhibit fever. It mainly occurs in adolescents and children aged 5 to 14. It is primarily related to symptoms that appear after an upper respiratory tract streptococcus infection. If the individual has good resistance, symptoms may only resemble those of a cold, such as sore throat, runny nose, and fever, and these symptoms can be relieved after anti-infection treatment without any residual sequelae. However, people with weaker resistance may develop these sequelae after an upper respiratory tract infection, including joint pain and heart valve disease. Therefore, it is crucial to receive proper treatment during the acute phase to prevent any lasting sequelae.

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Written by Yang Ya Meng
Rheumatology
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What tests are needed for rheumatic fever?

The examinations for rheumatic fever include laboratory tests and electrocardiograms, as well as imaging studies. Laboratory tests include indicators of streptococcal infection, commonly using throat swab bacterial cultures, which have a positivity rate of about 20% to 25%. They also include anti-streptolysin O tests, generally considered positive if the titer is above 1:400. Secondly, the tests include those for acute inflammatory response, common markers of which are elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Electrocardiograms help in detecting various arrhythmias, such as sinus tachycardia and prolonged PR interval. Echocardiography can be used to detect any abnormalities in the mitral valve of the heart.

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Written by Yang Ya Meng
Rheumatology
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What are the symptoms of rheumatic fever?

In the early stage of rheumatic fever, most patients show signs of infection, such as pharyngitis or tonsillitis. Patients with rheumatic fever often also experience fever, with body temperatures generally ranging from 38 to 40°C. Additionally, there may be migrating arthritis characterized by redness, swelling, warmth, pain, and limited mobility in the joints. Rheumatic fever patients may also suffer from cardiac valve lesions, primarily manifesting as valvulitis, myocarditis, or pericarditis, with damage to the valves being most common. Skin rashes, mainly presenting as ring-shaped erythema or subcutaneous nodules, can also occur. Some patients with rheumatic fever may experience chorea, which are among the primary symptoms of the condition.

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Written by Yang Ya Meng
Rheumatology
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Rheumatic fever clinical symptoms

The clinical manifestations of rheumatic fever primarily include: Some patients may experience low fever and rashes, and about half of the patients may exhibit symptoms such as morning stiffness. The joint pain associated with rheumatic fever often occurs more frequently in the large joints of the lower limbs and is asymmetrical, but it can also affect small joints and central axis joints. It commonly presents as non-migratory arthritis. Secondly, patients with rheumatic fever may experience cardiac involvement, with the most common being heart valve disease, particularly mitral valve stenosis. Additionally, patients with rheumatic fever may also suffer from kidney involvement, often presenting with symptoms such as hematuria and proteinuria, which are typical clinical symptoms of rheumatism.