Rheumatic Fever

In the acute stage, joint pains and fever should be controlled by aspirin or possibly a corticosteroid, tailored according to need (but see Reye's syndrome, p. 289).

When there is evidence of carditis (cardiac enlargement or pericarditis), complete bed rest is advised and a corticosteroid should be used instead of aspirin since the latter may precipitate cardiac failure. Prednisolone should be given in a dose sufficient to suppress clinical and laboratory (ESR, plasma viscosity, C-reactive protein) signs of inflammation; 10-15 mg/d is usually adequate in adults, and specific therapy for cardiac failure may also be necessary.

Neither aspirin nor adrenal steroid prevents the development of late cardiac complications.

A 10-day course of benzylpenicillin should be given to kill any streptococci (for prophylaxis see p. 239).

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