A 28-year-old woman from rural India presents with acute rheumatic fever (ARF) manifesting with polyarthritis, carditis, and erythema marginatum. She has no history of penicillin allergy. What is the drug of choice for initial anti-inflammatory management of her acute carditis?
A. Indomethacin
B. Aspirin
C. Ibuprofen
D. Naproxen
Explanation
Anti-inflammatory Management in Acute Rheumatic Fever
Key Point
Aspirin is the first-line anti-inflammatory agent for acute rheumatic fever (ARF), particularly when carditis is present. It provides both analgesic and anti-inflammatory benefits at high doses (80–100 mg/kg/day in divided doses).
Mechanism of Action
Aspirin irreversibly inhibits cyclooxygenase (COX-1 and COX-2), suppressing prostaglandin synthesis and reducing inflammation. At high doses, it achieves salicylate levels of 20–30 mg/dL, which is the therapeutic target for ARF.
Dosing in ARF with Carditis
Initial phase: 80–100 mg/kg/day in 4–6 divided doses for 2–3 weeks
Maintenance phase: 70–80 mg/kg/day until clinical and laboratory signs of inflammation resolve
Total duration: 6–12 weeks depending on severity
High-YieldNEET PG
Aspirin is superior to other NSAIDs in ARF because:
1.
It has the longest half-life among NSAIDs, allowing less frequent dosing
Large body of evidence supports its efficacy in reducing carditis progression and preventing permanent valve damage
4.
Serum salicylate levels can be monitored to ensure therapeutic range
Why Not Other NSAIDs?
Table
Feature
Aspirin
Indomethacin
Ibuprofen
Naproxen
Reversibility
Irreversible COX inhibition
Reversible
Reversible
Reversible
Evidence in ARF
Gold standard
Limited
Limited
Limited
Monitoring
Serum salicylate levels
None available
None available
None available
Carditis efficacy
Superior
Inferior
Inferior
Inferior
GI side effects
Common at high doses
Significant
Significant
Significant
Clinical Pearl
When carditis is severe or there is evidence of heart failure, corticosteroids (prednisolone 0.5–1 mg/kg/day) are added to aspirin rather than replacing it. Aspirin is never discontinued; steroids are used as adjunctive therapy.
Warning
Do not confuse aspirin dosing in ARF (high-dose, 80–100 mg/kg/day) with its use in other conditions. Therapeutic salicylate levels (20–30 mg/dL) must be achieved for anti-inflammatory effect; analgesic doses (10–15 mg/kg/day) are insufficient.
Harrison 21e Ch 297
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
