# Acute rheumatic fever without carditis - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 (ibuprofen oral monograph) · 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) · DailyMed Ibuprofen Tablet Package Insert (DailyMed, NLM) · Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever-without-carditis-full.txt) · Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 (ibuprofen oral monograph) - DailyMed Ibuprofen Tablet Package Insert (DailyMed, NLM) - Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without-carditis-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 - Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever-without-carditis-full.txt) - Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Penicillin G benzathine — injection - Acetylsalicylic acid — oral.solid - Prednisolone — 5 mg — oral.solid ## Complete treatment card ```text ACUTE RHEUMATIC FEVER WITHOUT CARDITIS Sources: MSF Essential Drugs 2024 (ibuprofen oral monograph) · 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) · DailyMed Ibuprofen Tablet Package Insert (DailyMed, NLM) · Acute rheumatic fever without carditis - disease-level clinical article (acute-rheumatic-fever- without-carditis-full.txt) · Acute Rheumatic Fever - disease-level clinical article (acute- rheumatic-fever-without-carditis-clinical.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 · Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) Review status: REVIEWED against 6 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Sore throat two to four weeks before joint symptoms begin, from untreated strep infection [sore throat] - Roughly a third of patients cannot recall having had a preceding throat infection - General fever, chills, and tiredness affect most patients with the illness [chills · fatigue · fever] - Migratory joint aches, usually the earliest complaint, in 60 to 80 percent of cases [joint pain] - Sudden irregular jerking movements involving the face, hands, and feet, worse on one side - Chorea can bring agitation, anxiety, or bouts of inappropriate laughing or crying [anxiety · chorea · irritability] SIGNS - what you find (6) - Affected joints look red, swollen, and are markedly tender to touch - Firm, painless lumps over joints, mainly on the extensor surfaces - A pink ring-shaped rash with raised edges and a clear center on the trunk and limbs, sparing the face [rash] - The rash fades from one spot and reappears elsewhere, described as a snake-like, fleeting pattern [rash] - Grip strength intermittently gives way when the patient squeezes the examiner's hand, the classic milkmaid finding - Facial grimacing, tics, and slurred or poorly formed speech and handwriting can accompany chorea [chorea · tics] TESTS (7) - Throat culture is the reference standard for confirming strep, though results take time - Rapid strep antigen tests run under 90 percent sensitive, so a negative needs backup culture - Antistreptolysin O or anti-DNase B antibody levels climb two to three weeks after the strep infection - A doubling of the antibody titer on repeat testing counts as a positive result - Every patient needs a cardiac work-up including chest x-ray, ECG, and echocardiogram - The ECG most often shows a prolonged PR interval, adjusted for the patient's age - Echocardiography can pick up heart involvement that the physical exam misses entirely IF NOT THIS - what else fits (8) - Lyme disease can mimic the migratory joint pain of ARF - Reactive arthritis following a strep infection is a joint-pain mimic - Septic arthritis is a joint-involvement mimic to rule out - A drug reaction or serum sickness can also cause migratory joint pain - PANDAS, a post-strep autoimmune neuropsychiatric syndrome, mimics the chorea of ARF - Tourette syndrome is on the differential for the abnormal movements seen in chorea - Kawasaki disease overlaps with ARF's rash and systemic features - Juvenile idiopathic arthritis and lupus belong on the differential for the systemic picture Source StatPearls "Acute Rheumatic Fever" - disease-level clinical article Status traced to the source above Rx: Main treatment | Secondary prophylaxis | If aspirin or an NSAID cannot be used MAIN TREATMENT - choose one 1. IBUPROFEN [1st line] Adult 200 to 400 mg three to four times daily, with or after food. Never more than 1200 mg in a day. Peds 5-10 mg/kg/dose [child max 400 mg] (Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily).) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source MSF Essential Drugs 2024 (ibuprofen oral monograph) Why Rheumatic fever polyarthritis needs sustained anti-inflammatory dosing to control joint inflammation, the same scale used for pericarditis, rather than a low symptomatic-relief dose. Caution Any new murmur, chest pain, or breathlessness during the illness means carditis may be developing and referral is needed. This is genuine anti-inflammatory dosing for migratory polyarthritis, not a symptomatic pain-relief dose - do not substitute a low PRN dose. Gastroprotection (e.g. a PPI) should be given alongside this dose. Any new murmur, chest pain, or breathlessness during treatment suggests carditis is developing - refer immediately; this course does not replace the secondary antibiotic prophylaxis, which must be arranged separately. Taper rather than stop abruptly as symptoms and inflammatory markers settle. Do not use in children under 12 years of age. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute Rheumatic Fever - disease-level clinical article (acute-rheumatic-fever-without- carditis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Initial management of acute rheumatic fever should be as an inpatient, including cases without carditis at diagnosis, since carditis can be subclinical and detected only by echocardiography - an outpatient ibuprofen course alone is not enough. 3. ACETYLSALICYLIC ACID [2nd line] Adult 60 to 100 mg/kg/day in divided doses until symptom resolution Peds 60-100 mg/kg/day (60 to 100 mg/kg/day in divided doses until symptom resolution) 3kg -> 180-300 mg/day 4kg -> 240-400 mg/day 5kg -> 300-500 mg/day 6kg -> 360-600 mg/day 7kg -> 420-700 mg/day 8kg -> 480-800 mg/day 9kg -> 540-900 mg/day 10kg -> 600-1000 mg/day 11kg -> 660-1100 mg/day 12kg -> 720-1200 mg/day 13kg -> 780-1300 mg/day 14kg -> 840-1400 mg/day 15kg -> 900-1500 mg/day 16kg -> 960-1600 mg/day 17kg -> 1020-1700 mg/day 18kg -> 1080-1800 mg/day 19kg -> 1140-1900 mg/day 20kg -> 1200-2000 mg/day 21kg -> 1260-2100 mg/day 22kg -> 1320-2200 mg/day 23kg -> 1380-2300 mg/day 24kg -> 1440-2400 mg/day 25kg -> 1500-2500 mg/day 26kg -> 1560-2600 mg/day 27kg -> 1620-2700 mg/day 28kg -> 1680-2800 mg/day 29kg -> 1740-2900 mg/day 30kg -> 1800-3000 mg/day 31kg -> 1860-3100 mg/day 32kg -> 1920-3200 mg/day 33kg -> 1980-3300 mg/day 34kg -> 2040-3400 mg/day 35kg -> 2100-3500 mg/day 36kg -> 2160-3600 mg/day 37kg -> 2220-3700 mg/day 38kg -> 2280-3800 mg/day 39kg -> 2340-3900 mg/day 40kg -> 2400-4000 mg/day 41kg -> 2460-4100 mg/day 42kg -> 2520-4200 mg/day 43kg -> 2580-4300 mg/day 44kg -> 2640-4400 mg/day 45kg -> 2700-4500 mg/day 46kg -> 2760-4600 mg/day 47kg -> 2820-4700 mg/day 48kg -> 2880-4800 mg/day 49kg -> 2940-4900 mg/day 50kg -> 3000-5000 mg/day Source Acute rheumatic fever without carditis - disease-level clinical article (acute- rheumatic-fever-without-carditis-clinical.txt) Why Traditional anti-inflammatory therapy for arthritis in acute rheumatic fever. Caution Risk of Reye syndrome in children and adolescents; requires monitoring of salicylate levels and GI tolerance. Gastroprotection recommended during high-dose therapy. Egypt ASPOCID 300 MG 200 TABS. CID 80.00 EGP (0.40/unit) AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ECOPRIN 325MG 10 ENTERIC COATED TAB. SIGMA 5.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPRICARLO 81MG 30 CHEWABLE TABS. EUROPEAN EGYPTIAN PHARM. IND. 45.00 EGP ASPIRIN PROTECT 100 MG 30 GASTRO-RESISTANT TABS. MEMPHIS > BAYER BITTERF... 78.00 EGP JUSPRIN 81 MG 60 E.C.TABS. FUTURE PHARMA... 81.00 EGP SECONDARY PROPHYLAXIS 4. PENICILLIN G BENZATHINE [1st line] Adult IM: 1.2 million units once every 21 to 28 days x 5 years or until age 21 Peds ≤27 kg: 600,000 units every 3 to 4 weeks. >27 kg: 1.2 million units every 3 to 4 weeks. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Intramuscular penicillin G benzathine secondary prophylaxis prevents recurrent Group A streptococcal infection and recurrent attacks of rheumatic fever. Caution Hypersensitivity to penicillin(s) or any component of the formulation Do not administer IV, intra-arterially, or SubQ. inadvertent IV administration has resulted in thrombosis, severe neurovascular damage, cardiac arrest, and death. Egypt HAYA BENZ-R 1.2 M.I.U. VIAL FOR I.M INJ. SEDICO > HAYA PHARM-EGYPT 5.06 EGP PENICID LA 1 200 000 UNITS VIAL CID 6.50 EGP BENZACILLIN 1.2 M.I.U.FOR I.M.INJ VIAL. EL NASR 7.00 EGP RETARPEN 1.2 M.I.U. VIAL SANDOZ > OCTO... 10.50 EGP LASTIPEN 1 200 000 IU VIAL MISR 12.00 EGP BENZABIOTIC 1.2 M.I.U. I.M. VIAL. SEDICO 16.00 EGP DEPO-PEN 1.2 MIU VIAL. MUP 25.00 EGP PENCILONG (PENCITARD) 1200000 I.U./VIAL NCPC NORTH BEST CO > ACDIMA INTE... 25.00 EGP IF ASPIRIN OR AN NSAID CANNOT BE USED 5. PREDNISOLONE [2nd line] Adult 5 to 60 mg/day as a single daily dose or in 2 to 4 divided doses, tapered Peds The ENDF prednisolone monograph gives no paediatric figure for this indication, so none is stated here. Acute rheumatic fever is largely a childhood disease - refer. Source Egyptian National Drug Formulary - Endocrine System 2024 (prednisolone monograph) Why The disease article gives a glucocorticoid as the option when the patient cannot take aspirin or an NSAID; the card previously offered only those two. Caution Abrupt withdrawal is not recommended, particularly with doses of 40 mg or more or 3 weeks of treatment or more. The dose should be gradually decreased to the lowest dose that maintains an adequate clinical response. No paediatric dose is stated in the ENDF for this use, and this is a predominantly paediatric condition - refer rather than extrapolate. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)