Elsevier

The Journal of Pediatrics

Volume 143, Issue 3, September 2003, Pages 399-401
The Journal of Pediatrics

Clinical and laboratory observations
Naproxen as an alternative to aspirin for the treatment of arthritis of rheumatic fever: a randomized trial

https://doi.org/10.1067/S0022-3476(03)00388-3Get rights and content

Abstract

We performed a prospective, randomized, open-label equivalence study comparing the use of naproxen to aspirin in 33 patients with rheumatic fever. The mean time until resolution of arthritis was 2.9±2.9 days in both groups. Liver enzyme elevations were more frequent in the aspirin group (P = .002). We conclude that naproxen is as effective, is easier to use, and is safer than aspirin in the treatment of the arthritis of rheumatic fever.

Section snippets

Study design

We enrolled consecutive patients age 4 to 18 years diagnosed with RF according to the revised Jones criteria.7 Patients with arthritis with or without carditis were included. Exclusion criteria included (1) isolated carditis or chorea, without arthritis; (2) use of ASA or other NSAIDs 24 hours before study enrollment; (3) initial use of corticosteroids for treatment of carditis; (4) and a history of adverse reactions to NSAIDs.

Patients with suspected RF admitted to the emergency ward of seven

Results

From 1999 to 2001, we evaluated 51 patients with RF. Eight were excluded because of previous use of ASA or NSAIDs, seven because of carditis treated initially with corticosteroids, two because of patient refusal, and one because of compliance concerns. Thirty-three patients were randomized; 16 received ASA and 17 NXN. Baseline characteristics were similar (Table I). None of the patients with recurrent RF had severe valvular lesions.

There were no significant differences between the groups in the

Discussion

In this randomized, open-label equivalency study, we did not find significant differences between NXN and ASA therapy in the resolution of RF-related arthritis, fever, and laboratory evidence of inflammation. There were more adverse reactions associated with ASA therapy, especially elevations of serum hepatic enzymes. The price for both drugs in Israel is similar, about $10 for a 25-kg child for 1 month's treatment.

The power of this study to detect a 2-day difference in the primary outcome of

Acknowledgements

We thank Dr Michael Lauer of the Cleveland Clinic Foundation for his critical review of the manuscript.

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Supported in part by grant no. S/4507 from the Chief Scientist's Office of the Ministry of Health, Israel.

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