A 10-year-old boy has acute rheumatic fever with prominent migratory polyarthritis of knees and ankles but no clinical carditis. He weighs 30 kg. Which anti-inflammatory regimen is most appropriate for his arthritis?
- A Aspirin 80 to 100 mg/kg/day in divided doses ✓
- B Paracetamol 15 mg/kg four times daily
- C Prednisone 2 mg/kg/day
- D Indomethacin 1 mg/kg/day
Correct answer: A. Aspirin 80 to 100 mg/kg/day in divided doses
Explanation
Salicylates are the drugs of choice for rheumatic fever without carditis, given at anti-inflammatory doses of 80 to 100 mg/kg/day in divided doses, producing dramatic relief of joint symptoms within 24 to 48 hours. Corticosteroids are reserved for moderate to severe carditis because salicylates do not alter cardiac outcomes. Paracetamol lacks adequate anti-inflammatory effect, and indomethacin is not a standard agent for acute rheumatic fever.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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