Sixty-two children with acute rheumatic fever were treated with either ACTH, cortisone, salicylates or bed rest alone. Data concerning the effect on acute symptoms and follow-up observations of residual cardiac murmurs are presented. In addition, similar follow-up data on 18 previously-reported patients treated with ACTH are presented.
Joint symptoms responded somewhat more rapidly to ACTH or cortisone than to salicylates, but an impressive response occurred to all of the drugs. Fever subsided within a few hours to 2 days in almost all individuals treated with any of these drugs.
Elevated erythrocyte sedimentation rates returned to normal much more rapidly in the ACTH (mean 16 days) and cortisone (mean, 12 days) groups than in the salicylate (mean, 43 days) or bed-rest (mean, 48 days) groups.
Although laboratory evidence of "rebound" in the form of an elevation of erythrocyte sedimentation rate occurred in 52 per cent of patients in the hormone-treated groups upon reduction or withdrawal of therapy, clinical evidence of "rebound" was rare in these groups but relatively common among the salicylate-treated patients.
After follow-up periods as long as 3 9/12 years, residual cardiac murmurs were rare in the hormone-treated patients as compared to those treated with salicylates or with bed rest alone. Three years after discharge from the hospital, 6 per cent of the hormone-treated patients and 82 per cent of those not treated with hormones had residual cardiac murmurs. Moreover, the appearance of new murmurs following discharge was rare in the hormone groups and the murmurs which appeared were not persistent. New, persistent murmurs were noted relatively commonly following treatment with salicylates or bed rest alone.
The importance of adequate dosage and individualization in therapy of rheumatic fever with ACTH and cortisone is stressed. The conclusions drawn are: the optimal initial doses of ACTH and cortisone are at least 1 I.U. and 3 mg. per pound per day, respectively; the initial daily dose should be continued until all laboratory and clinical evidence of rheumatic activity has disappeared; and then therapy should be decreased gradually but only if the patient shows no evidence of reactivation of rheumatic fever.
- Received December 28, 1954.
- Copyright © 1955 by the American Academy of Pediatrics