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Acute Rheumatic Fever Follow-up

  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
Updated: Jul 19, 2016

Further Outpatient Care

See the list below:

  • Periodic monitoring at 3- to 4-month intervals is critical to evaluate for progress with the resumption of physical activity, resolution of the constitutional symptoms, and freedom from adverse effects from medications.
  • Less frequent visits, perhaps once a year, are appropriate while following a prophylaxis regimen.


Transfer to a short-term–care facility should be arranged when patients have active life-threatening sequelae, notably carditis.



Patients should be educated to seek medical attention upon the first signs of pharyngitis. Once the disease is established, patients should be educated regarding benefits and risks of compliance with their medical regimen, which may be protracted.



See the list below:

  • Acute episodes are self-limited, with an average duration of 3 months for untreated attacks. Recurrence tends to occur within the first few years of the attack.
  • The outcome of carditis is likely to be more severe if patients have pre-existing heart disease. Carditis resolves without sequelae in 65-75% of patients.
  • Severe cardiac failure, total disability, and death may occur years after the acute attack.
  • The risk of developing a new episode is highest during the 5 years following an acute attack. This justifies prophylaxis for all patients for at least 5 years or until the patient reaches age 18 years.


The course followed by a patient after a first attack is highly variable and unpredictable. Approximately 90% of episodes last less than 3 months. Only a minority persist longer, in the form of unremitting rheumatic carditis or prolonged chorea.

In an Australian study, recurrence of ARF occurred most often in the first year after initial ARF episode (incidence 3.7 per 100 person-years), but low-level risk persisted for more than 10 years. Risk of progression to rheumatic heart disease was also highest in the first year (incidence 35.9), almost 10 times higher than that of ARF recurrence.[16]

Contributor Information and Disclosures

Robert J Meador, Jr, MD Rheumatologist, Dallas Diagnostic Association

Robert J Meador, Jr, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, Texas Medical Association, Dallas County Medical Society, Lupus Foundation of America, Lone Star Chapter, Sjögren’s Syndrome Foundation

Disclosure: Nothing to disclose.


Irwin Jon Russell, MD, PhD, MS, FACR, ACR-Master Medical Director for Fibromyalgia Research and Consulting, (Retired) Faculty, Division of Clinical Immunology and Rheumatology, University of Texas Health Science Center at San Antonio

Irwin Jon Russell, MD, PhD, MS, FACR, ACR-Master is a member of the following medical societies: Alpha Omega Alpha, International Myopain Society, American College of Physicians, American College of Rheumatology, International Association for the Study of Pain

Disclosure: Received consulting fee from Daiichii Sankyo for review panel membership; Received grant/research funds from Pfizer Pharma for independent contractor; Received grant/research funds from Lilly Pharma for independent contractor.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Janssen<br/>Serve(d) as a speaker or a member of a speakers bureau for: Abbvie; Genentech; Pfizer; Questcor.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

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Clinical manifestations and time course of acute rheumatic fever.
Chest radiograph showing cardiomegaly due to carditis of acute rheumatic fever.
Erythema marginatum, the characteristic rash of acute rheumatic fever.
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