Rheumatic Fever

Area of Science:

• Rheumatology
• Cardiology
• Infectious Diseases

Background:

• Acute rheumatic fever (ARF) can lead to rheumatic heart disease (RHD).
• Previous studies on ARF treatment outcomes used older corticosteroids.
• Current treatment guidelines for ARF and RHD vary regarding corticosteroid use and secondary prophylaxis.

Purpose of the Study:

• To evaluate the efficacy of corticosteroids versus aspirin in managing ARF with carditis.
• To assess the long-term impact of steroid therapy on valvular disease in RHD.
• To compare the effectiveness of different secondary prophylaxis regimens for ARF.

Main Methods:

• Review of existing literature on ARF and RHD treatment.
• Comparison of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) between aspirin and corticosteroid treatment groups.
• Analysis of valve replacement rates in centers with differing steroid usage policies.
• Long-term follow-up data analysis of patients receiving oral penicillin versus benzathine penicillin for secondary prophylaxis.

Main Results:

• Corticosteroids led to faster normalization of inflammatory markers compared to aspirin.
• Centers routinely using steroids for carditis reported lower rates of valve replacement.
• Oral penicillin prophylaxis demonstrated comparable recurrence rates to benzathine penicillin in experienced follow-up.
• Benzathine penicillin injections every 3 weeks showed poor compliance due to pain.

Conclusions:

• Corticosteroids are recommended for ARF with carditis to reduce inflammation and potentially prevent long-term valvular damage.
• Aspirin is suitable for ARF arthritis without carditis.
• Oral penicillin may be a viable alternative for secondary prophylaxis, provided compliance is ensured.