PEDIATRICS Vol. 16 No. 3 September 1955, pp. 325-334
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THE EFFECT OF INTENSIVE AND PROLONGED THERAPY WITH CORTISONE AND HYDROCORTISONE IN FIRST ATTACKS OF RHEUMATIC CARDITIS

Milton Markowitz M.D.1 and Ann G. Kuttner M.D.1

1 The Harriet Lane Home, Baltimore City Hospitals and the Department of Pediatrics, Johns Hopkins School of Medicine, and from the Department of Pediatrics and the Study Group on Rheumatic Diseases, New York University College of Medicine and the Children's Medical Service, Bellevue Hospital.

Forty patients (39 children and 1 adolescent) with clinical evidence of carditis during first rheumatic attacks were treated with large doses of oral cortisone or oral hydrocortisone for periods varying from 9 weeks to 12 months.

Twenty-nine of these forty patients received treatment within 3 weeks of onset. After follow-up observations ranging from 6 to 22 months, 24 of the 29 patients have no evidence of heart disease. Patients with severe as well as mild carditis responded equally well.

Eleven patients treated later than 3 weeks after onset did less well: only 2 have normal hearts, 8 have rheumatic heart disease and 1 patient died.

The results of this study suggest that cortisone given early in the course of the rheumatic attack in doses sufficiently large to suppress the inflammatory reaction completely and continued until the disease has run its course, may reduce the incidence of residual heart disease. Further studies based on a large series of cases with adequate controls are needed to establish the value of this regimen.

Eleven of the forty patients developed serious side effects. In 4 the symptoms were of sufficient severity to necessitate cessation of therapy. In the remainder the untoward reactions were controlled by reducing the dosage of the steroid.

Submitted on March 11, 1955
Accepted on April 11, 1955




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G. H. STOLLERMAN
RHEUMATIC FEVER
Arch Intern Med, August 1, 1956; 98(2): 211 - 220.
[Abstract] [PDF]