A prospective study was done to determine the clinical profile of acute rheumatic fever in the first attacks and in recurrences separately. The data were compared with those from other countries. Eighty children were in their first attack while 46 had recurrences. Arthritis, the most common manifestations, was seen in 61 per cent of patients with first attack followed by carditis in 41 per cent, chorea in 28 per cent and subcutaneous nodules in 3 per cent. However, in the recurrences, arthritis was present in 52 per cent, carditis in 81 per cent, chorea in 11 per cent, and nodules in 4 per cent of cases. In both the groups, no case with erythema marginatum was seen. The results show that in the first attack the clinical picture broadly resembles that in European and North American countries. The presenting symptoms and signs are different during recurrence.