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Related Concept Videos

Rheumatic Heart Disease I: Introduction01:23

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Related Experiment Video

Updated: Mar 9, 2026

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[Rheumatoid arthritis].

D Aletaha1, A Kerschbaumer2

  • 1Klinische Abteilung für Rheumatologie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich. daniel.aletaha@meduniwien.ac.at.

Zeitschrift Fur Rheumatologie
|January 7, 2017
PubMed
Summary
This summary is machine-generated.

Reducing rheumatoid arthritis (RA) therapy is challenging. Successful RA treatment tapering depends on disease activity, duration, and gradual dose reduction, balancing benefits against relapse risks.

Keywords:
DiscontinuationDosageNocebo effectReductionTherapy

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Area of Science:

  • Rheumatology
  • Clinical Pharmacology

Background:

  • Effective rheumatoid arthritis (RA) therapies can achieve low disease activity or remission.
  • Therapy reduction and discontinuation are increasingly discussed due to medical and economic benefits.
  • Balancing benefits against the risk of RA exacerbation is crucial.

Purpose of the Study:

  • To review current data on tapering disease-modifying antirheumatic drugs (DMARDs) in RA.
  • To analyze factors influencing safe and successful RA therapy reduction.
  • To discuss tapering strategies for conventional DMARD monotherapy, combination therapy with biologics, and biologic monotherapy.

Main Methods:

  • Literature review of studies on RA therapy tapering.
  • Analysis of influencing factors such as disease activity, duration, and tapering method.
  • Consideration of the nocebo effect in interpreting study results.

Main Results:

  • Disease activity, duration, and the tapering process (gradual vs. abrupt) are key factors for successful RA therapy reduction.
  • Tapering strategies vary for conventional DMARDs, biologics, and combination therapies.
  • The nocebo effect can impact patient-reported outcomes in drug tapering studies.

Conclusions:

  • Careful consideration of disease-specific factors and patient status is essential for safe RA therapy tapering.
  • Gradual dose reduction is generally preferred over abrupt discontinuation.
  • Further research is needed to optimize tapering protocols and manage potential exacerbations.