Management of suspected acute rheumatic fever

Patients with suspected acute rheumatic fever should be hospitalised as soon as possible for investigation, treatment and education. Admission to a hospital with echocardiography services is strongly recommended to facilitate correct diagnosis and classification, to guide long-term management and follow-up.

Heart failure complicating rheumatic carditis requires urgent management. See The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease for recommendations.

Arthritis due to acute rheumatic fever can present with severe pain. Arthritis, arthralgia and fever due to acute rheumatic fever are very responsive to nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin. However, it can be useful to avoid NSAIDs initially in patients with monoarthritis or monoarthralgia while monitoring for development of polyarthritis or polyarthralgia to ensure these important diagnostic features are not masked. For alternatives to NSAIDs to manage acute pain, see Using analgesics to manage acute pain.