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Is pentoxifylline therapy effective for the treatment of acute rheumatic carditis? A pilot study
N Narin1, M Karakukcu, F Narin
1Department of Pediatrics, School of Medicine, Erciyes University, Kayseri, Turkey. nnarin@erciyes.edu.tr
Insights
Pentoxifylline combined with steroid treatment did not show additional benefits for acute rheumatic carditis compared to steroid therapy alone. This study found no significant differences in key inflammatory markers or cardiac indices between the two treatment groups.
Area of Science:
- Pediatrics
- Rheumatology
- Pharmacology
Background:
- Acute rheumatic carditis is a significant complication of rheumatic fever.
- Steroid therapy is a cornerstone in managing acute rheumatic carditis.
- The potential adjunctive role of pentoxifylline in this condition requires investigation.
Purpose of the Study:
- To evaluate the efficacy of pentoxifylline as an add-on therapy to steroids in treating acute rheumatic carditis in children.
- To compare treatment outcomes between children receiving steroid plus pentoxifylline versus steroid alone.
Main Methods:
- A randomized controlled trial involving 33 children (ages 6-16) with acute rheumatic carditis.
- Group 1 received steroid plus pentoxifylline; Group 2 received steroid alone for 3-6 weeks.
- Laboratory markers (WBC, ESR, CRP, cytokines) and cardiac evaluations (CXR, ECG, Echo) were assessed at baseline and follow-up points (7th, 30th, 90th days).
Main Results:
- Both groups showed significant reductions in white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and interleukin-1alpha by day 90.
- Tumor necrosis factor-alpha normalized by day 30 in the pentoxifylline group and by day 7 in the steroid-only group.
- No significant differences were observed between the two groups in the improvement of inflammatory markers or cardiac parameters.
Conclusions:
- Pentoxifylline does not provide additional benefits when used as an adjunct to steroid therapy for acute rheumatic carditis.
- Steroid monotherapy appears to be as effective as combination therapy with pentoxifylline for this condition.
Objective:
The aim of the present study was to determine whether pentoxifylline has a beneficial effect on the treatment of rheumatic carditis.
Methods:
A total of 33 children between the ages 6 and 16 were studied in two groups. The first group (5 boys, 10 girls, mean age: 12.2 +/- 2.9 years) was treated with steroid plus pentoxifylline and the second group (6 boys, 12 girls, mean age; 11.6 +/- 2.8 years) was treated with steroid only for 3-6 weeks until the acute-phase reactants became normal. At admission and on the 7th, 30th, and 90th days of the treatment, laboratory studies including white blood cell count, erythrocyte sedimentation rate, C-reactive protein, throat culture and cytokines (interleukin-1alpha, tumour necrosis factor-alpha) were performed. Cardiac evaluation with chest X-ray, electrocardiography and echocardiography was performed in all patients. In the control group (12 boys, 3 girls, mean age; 10.7 +/- 3.2 years) all parameters were evaluated once only.
Results:
In both groups, the similar white blood cell count was significantly decreased on the 90th day, and there was no significant difference between the two groups. C-reactive protein, erythrocyte sedimentation rate and interleukin-1alpha were significantly decreased on the 30th and 90th days. In the first group (treated with steroid plus pentoxifylline), the cardiothoracic index was significantly greater at the beginning of the therapy. In the first group, tumour necrosis factor-alpha became normal on the 30th day and in the second group, tumour necrosis factor-alpha became normal on the 7th day of therapy. For all parameters, there was no significant difference between the two groups with respect to the type of therapy used.
Conclusion:
The present study showed that pentoxifylline plus steroid treatment has no beneficial effects on the treatment of acute rheumatic carditis when compared with steroid alone.