Clinical and laboratory observationsNaproxen as an alternative to aspirin for the treatment of arthritis of rheumatic fever: a randomized trial☆
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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2018, The LancetCitation Excerpt :Data on the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) other than aspirin in the treatment of acute rheumatic fever are scarce. In a small, open-label, randomised controlled trial (RCT), naproxen (15–20 mg/kg/day in two divided doses) showed comparable symptom relief to aspirin.85 Other NSAIDs such as ibuprofen could plausibly also be effective, but this assumption is based on anecdotal data.
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Supported in part by grant no. S/4507 from the Chief Scientist's Office of the Ministry of Health, Israel.