Although prevention of rheumatic fever and management of recurrences have been well established, optimal management of active rheumatic carditis remains unclear.
This is an update of a review published inand previously updated in and OBJECTIVE Rheumatic fever assess the effects, both harmful and beneficial, of anti-inflammatory agents such as aspirin, corticosteroids and other drugs in preventing or reducing further valvular damage rheumatic fever patients with acute rheumatic fever. We last searched Index Medicus to April in We checked reference lists of identified studies and rheumatic fever no language restrictions.
The presence of cardiac disease one year after treatment was the major outcome criterion selected. Standard methodological procedures as expected by The Cochrane Collaboration were used.
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Eight randomised controlled trials involving people were selected for inclusion in the review. Researchers compared several steroidal agents such as corticotrophin, cortisone, hydrocortisone, dexamethasone, prednisone and intravenous immunoglobulin versus aspirin, placebo or no treatment.
Six trials were conducted between and ; one was done in and the final study was published in Overall there were no observed significant differences in risk of cardiac disease at one year between corticosteroid-treated and aspirin-treated groups six studies, participants, risk ratio 0. Similarly, use of prednisone two studies, participants, risk ratio 1.
- Bursita cotului provoacă simptome și tratament
- Inflammatory disease such as rheumatic fever or lupus Boli inflamatorii, cum ar fi febra reumatică sau lupusul Mitral valve damage can be caused even if the person had rheumatic fever during childhood.
Investigators in five studies did not report adverse events. The three studies reporting on adverse events reported substantial adverse events.
However, all results should be interpreted with caution because of the age of the studies and the substantial risk of bias. The antiquity of rheumatic fever of the trials restricted adequate statistical analysis of the data and acceptable assessment of clinical outcomes by current standards. In addition, risk of bias was substantial, so results should be viewed with caution.
New randomised controlled trials in patients with acute rheumatic fever are warranted to assess the effects of corticosteroids such as oral prednisone and intravenous methylprednisolone and the effects of other new anti-inflammatory agents. Advances in echocardiography will allow more objective and precise assessments of cardiac outcomes.