Management of acute rheumatic fever—a re-appraisal

Rheumatic fever (RF) has fallen off the radar of many physicians, yet remains a daily challenge to many working in less developed areas of India. Rheumatic fever and rheumatic heart disease (RHD) are diseases of poverty. Overcrowding, low socio-economic status, and illiteracy contribute to the high prevalence. Treatment of the disease is mostly supportive as there is no disease-modifying therapy. Nonsteroidal anti-inflammatory drugs should be withheld until the diagnosis is confirmed, and corticosteroids are an option in severe and acute carditis. Most cases of chorea do not require medication, but use of carbamazepine or sodium valproate is recommended in severe cases. New approaches to primary prevention are needed given the limitations of primary prophylaxis as a population based strategy. The most effective approach for control of RF is secondary prophylaxis, which is best delivered as part of a coordinated control program. Group A streptococcal vaccines are still years away from being available.