Evidence supporting the use of: Acetylsalicylic acid
For the health condition: Rheumatic Fever

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Acetylsalicylic acid (aspirin) is scientifically validated as a treatment for rheumatic fever, particularly for its anti-inflammatory properties in managing the arthritis associated with the disease. Rheumatic fever is an autoimmune response to group A streptococcal infection, and it often presents with migratory polyarthritis. Clinical guidelines, including those from the World Health Organization (WHO) and the American Heart Association (AHA), recommend high-dose aspirin as first-line therapy for the symptomatic relief of joint pain and inflammation in rheumatic fever, except in cases where arthritis is mild or where other contraindications exist.

The evidence supporting the use of acetylsalicylic acid is based on decades of clinical experience and observational studies, which have shown that it provides rapid and significant relief of arthritis symptoms. However, aspirin does not alter the course of carditis or prevent long-term complications of rheumatic fever (such as rheumatic heart disease), and its use is mainly palliative for joint manifestations. The anti-inflammatory effect is attributed to aspirin’s inhibition of cyclooxygenase enzymes, leading to reduced prostaglandin synthesis and thus decreased inflammation.

While randomized controlled trials are limited due to the rarity and ethical considerations of withholding treatment, the consistency of beneficial clinical outcomes in observational studies and expert consensus support its continued use. Aspirin remains a mainstay in the symptomatic management of rheumatic fever–related arthritis, though corticosteroids are preferred for severe carditis.

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