When acute rheumatic fever presents with arthritis, severe arthralgia, or fever, the clinical scenario calls for a structured, evidence-based approach. Prompt recognition of the specific presentation determines which interventions are appropriate and how quickly they should be initiated.
Anti-inflammatory therapy should be commenced in patients with arthritis or severe arthralgia once the diagnosis of ARF has been made. Fever alone — or fever accompanied by mild arthralgia only — may not follow the same treatment pathway, and the clinical presentation drives the management decision.
Once ARF is confirmed and arthritis or severe arthralgia is present, oral anti-inflammatory therapy is the cornerstone of management. Multiple agents are available, with the choice guided by the patient's age, weight, and clinical profile. The complete selection criteria, sequencing, and dosing algorithm are detailed in the full protocol.
The target is substantial remission of arthritis — often within hours and almost always within three days. The duration of treatment is dictated by the clinical response and improvement in inflammatory markers (ESR, CRP).