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Pulse therapy combined with oral corticosteroids in the management of severe rheumatic carditis and rebound

Published online by Cambridge University Press:  25 October 2017

Renato P. A. Torres
Affiliation:
Department of Pediatric Cardiology, Hospital Pequeno Principe, Curitiba, PR, Brazil
Rômulo F. A. Torres
Affiliation:
Department of Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
Rafael A. Torres
Affiliation:
Department of Cardiology, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, PR, Brazil
Rosângela S. L. A. Torres*
Affiliation:
Universidade Positivo, Curitiba, PR, Brazil
*
Correspondence to: R. S. L. A. Torres, MS, PhD, Universidade Positivo, Rua Professor Pedro Viriato Parigot de Souza, Campina do Siqueira, CEP 80740-050, Curitiba, PR, Brazil. Tel: 55 41 991941237; Fax: 55 41 33101283; E-mail: rslatorres@gmail.com

Abstract

Objective

The aim of the present study was to describe the clinical course, laboratory tests, and the cardiac involvement in rheumatic carditis patients in functional class III and IV, submitted to pulse therapy combined with oral prednisone.

Methods

A total of 120 patients with severe carditis due to acute rheumatic fever were treatment with three cycles of pulse therapy combined with oral corticosteroids. The patients were followed up from the hospital admission until the end of the treatment and returned after 30, 60, and 90 days to control. The patients were evaluated by clinical, laboratory, and transthoracic echocardiogram.

Results

In total, 23 (19.2%) patients at first attack of rheumatic fever and 97 (80.8%) with recurrent carditis were evaluated. Cardiac surgery was performed in 8 (6.6%) patients. The patients showed improved laboratory and radiological parameters (p<0.001) and were discharged, 74 (61.7%) in functional class I and 46 (38.3%) in functional class II. Hospitalisation time ranged from 21 to 176 days, with a mean of 69.1 days. Reduction of left atrium and ventricle diameters was observed, measured by means of transthoracic echocardiography, at hospital admission and discharge (p<0.001). None of the patients experienced rebound.

Conclusions

The pulse therapy was effective in controlling severe rheumatic carditis and the oral corticosteroid prevented rebound episodes. Prolonged hospital stay was required for the clinical stabilisation of patients and to avoid the interruption of medication.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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References

1. WHO. Rheumatic fever and rheumatic heart disease: report of a WHO expert consultation on rheumatic fever and rheumatic heart disease. World Health Organization. Geneva, 2001, Oct 29–Nov 1. Geneva: WHO, 2004.Google Scholar
2. Gewitz, MH, Baltmore, RS, Tani, LY, et al. On behalf of the American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131: 18061818.CrossRefGoogle Scholar
3. Carapetis, JR, Steer, AC, Mulholland, EK, et al. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685694.CrossRefGoogle Scholar
4. Steer, AC, Carapetis, JR, Nolan, TM, et al. Systematic review of rheumatic heart disease prevalence in children in developing countries: the role of environmental factors. J Paediatr Child Health 2002; 38: 229234.CrossRefGoogle ScholarPubMed
5. Czoniczer, G, Amezcua, F, Pellargonio, S, et al. Therapy of severe rheumatic carditis. Comparison of adrenocortical steroids and aspirin. Circulation 1964; 29: 813819.Google Scholar
6. Torres, RSLA, Torres, RPA, Smeesters, PR, et al. Group A Streptococcus antibiotic resistance in southern Brazil: a 17-year surveillance study. Microb Drug Resist 2011; 17: 313319.CrossRefGoogle Scholar
7. Kumar, RK, Tandon, R. Rheumatic fever & rheumatic heart disease: the last 50 years. Indian J Med Res 2013; 137: 643658.Google Scholar
8. Cilliers, A, Adler, AJ, Saloojee, H. Anti-inflammatory treatment for carditis in acute rheumatic fever. Cochrane Database Syst Rev 2015; 5: 156.Google Scholar
9. Couto, AA, Martins, JC, Mansur, EM, et al. High-dose intravenous methylprednisolone (pulsetherapy): possible therapeutic solution for active rheumatic fever with severe carditis. Arq Bras Cardiol 1984; 43: 97101.Google Scholar
10. Markowitz, M, Gordis, L. Rheumatic fever. Major Probl Clin Pediatr 1972; 11: 1309.Google ScholarPubMed
11. Herdy, GV, Couto, AA, Fernandes, JC, et al. Pulse therapy (high venous of venous methylprednisolone) in children with rheumatic carditis. Prospective study of 40 episodes. Arq Bras Cardiol 1993; 60: 377381.Google ScholarPubMed
12. Herdy, GV, Pinto, CA, Olivaes, MC, et al. Rheumatic carditis treated with high doses of pulsetherapy methylprednisolone. Results in 70 children over 12 years. Arq Bras Cardiol 1999; 72: 604606.Google Scholar
13. Akçoral, A, Oran, B, Tavli, V, et al. Effects of high-dose intravenous methylprednisolone in children with acute rheumatic carditis. Acta Paediatr Jpn 1996; 38: 2831.Google Scholar
14. Camara, EJN, Braga, JCV, Alves-silva, LS, et al. Comparison of an intravenous pulse of methylprednisolone versus oral corticosteroid in severe acute rheumatic carditis: a randomized clinical trial. Cardiol Young 2002; 12: 119124.Google Scholar
15. Ilingworth, RS, Burke, J, Doxiadis, SA, et al. Salicylates in rheumatic fever: an attempt to assess their value. Q J Med 1954; 23: 177213.Google Scholar
16. UK and US Joint Report. The natural history of rheumatic fever and rheumatic heart disease: cooperative clinical trial of ACTH, cortisone, and aspirin. Circulation 1965; 32: 457476.Google Scholar
17. Illingworth, RS, Lorber, J, Holt, KS, et al. Acute rheumatic fever in children: a comparison of six forms of treatment in 200 cases. Lancet 1957; 273: 653659.CrossRefGoogle Scholar
18. Bywaters, EG, Thomas, GT. Bed rest, salicylates, and steroid in rheumatic fever. Br Med J 1961; 1: 16281634.Google Scholar
19. Paz, JA, Silva, CA, Marques-Dias, MJ. Randomized double-blind study with prednisone in Sydenham’s chorea. Pediatr Neurol 2006; 34: 264269.Google Scholar
20. Walker, AR, Tani, LY, Thompson, JA, et al. Rheumatic chorea: relationship to systemic manifestations and response to corticosteroids. J Pediatr 2007; 151: 679683.Google Scholar
21. Fusco, C, Ucchino, V, Frattini, D, et al. Acute and chronic corticosteroid treatment of ten patients with paralytic form of Sydenham’s chorea. Eur J Paediatr Neurol 2012; 16: 373378.Google Scholar
22. Bitar, FF, Hayek, P, Obeid, M, et al. Rheumatic fever in children: a 15-year experience in a developing country. Pediatr Cardiol 2000; 21: 119122.Google Scholar
23. Little, SG. The challenges of managing rheumatic disease of the mitral valve in Jamaica. Cardiol Young 2014; 24: 11081110.CrossRefGoogle ScholarPubMed
24. Torres, RPA, Cunha, CLP, Miyague, NI. Estudo de 500 casos de febre reumática na cidade de Curitiba. Divulgação em Saúde para Debate 2000; 19: 7375.Google Scholar