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Therapgents Agents in Rheumatic Carditis: Comparative Effects of Acetylsalicylic Acid, Corticotropin, and Cortisone

Therapgents Agents in Rheumatic Carditis: Comparative Effects of Acetylsalicylic Acid,... Abstract Although the symptoms of acute rheumatic fever appear to be favorably altered by a number of drugs,* the essential problems of therapy are to prevent death from acute carditis and to decrease the incidence of subsequent valvular heart disease.4 The present report compares the effect of acetylsalicylic acid (Aspirin), cortisone, and corticotropin (ACTH) on valvular heart disease as evidenced by the presence of murmurs 14 months after the onset of therapy.† A previous paper 5 concerning the same group of patients dealt with a comparison of the effects of these drugs on the acute course of rheumatic fever. METHODS Details of the methods employed and the population involved have been described elsewhere.5 All male airmen admitted to Warren Air Force Base Hospital who met the standard diagnostic criteria and who exhibited signs of rheumatic activity on the day treatment began were accepted for study. Each patient was assigned References 1. References 1-3. 2. Dr. David Rutstein, Chairman, Miss Marjorie Bellows, Statistician, and the principal investigators of the Cooperative Rheumatic Fever Study gave advice and the protocol used in this study. 3. Corticotropin (ACTHAR) was furnished by The Armour Laboratories, Chicago. 4. During the follow-up period two patients developed a dermatitis attributed to sulfadiazine, and in one patient massive hematuria, which subsequently disappeared, was noted. All three patients then received penicillin for prophylaxis. 5. Dr. Walter Pritchard, Associate Professor of Medicine, Western Reserve University School of Medicine, was the independent observer for this study. 6. All the patients excluded from the study were followed for at least eight months. Of the eight patients treated with acetylsalicylic acid no murmur was heard in four at the time of discharge. In two patients the murmur indicative of mitral valvular disease was present; in one patient the murmur of probable mitral valvular disease was heard, and in one patient a nonsignificant murmur was heard. Of the four patients treated with cortisone no murmur was heard in three at the time of discharge and in one patient a nonsignificant murmur was present. In the one corticotropin-treated patient who did not complete the follow-up period no murmur was heard at the time of discharge. 7. Development of or change in murmur, change in heart size, pericarditis, or congestive heart failure; not including patients with abnormal atrioventricular conduction as the sole manifestation of carditis. 8. Catanzaro, F., and Stolzer, B. L.: To be published. 9. References 3 and 6-8. 10. References 9-13. 11. Catanzaro, F., and Stolzer, B. L.: To be published. 12. Clark, E. J., and Houser, H. B.: Comparative Effects of 3-Hydroxy-2-Phenylcinchoninic Acid (HPC) and Aspirin on the Acute Course of Rheumatic Fever and the Occurrence of Rheumatic Valvular Disease , Am. Heart J. 45:576, 1953.Crossref 13. Hench, P. S.; Kendall, E. C.; Slocumb, C. H., and Polley, H. F.: Effects of Cortisone Acetate and Pituitary ACTH on Rheumatoid Arthritis, Rheumatic Fever and Certain Other Conditions , Ann. Int. Med. 85:545, 1950.Crossref 14. Manchester, R. C.: Rheumatic Fever in Naval Enlisted Personnel: II. Effectiveness of Intensive Salicylate Therapy in Cases of Acute Infection , Arch. Int. Med. 78:170, 1946.Crossref 15. Bland, E. F., and Jones, T. D.: Rheumatic Fever and Rheumatic Heart Disease: A 20 Year Report on 1000 Patients Followed Since Childhood , Circulation 4:836, 1951.Crossref 16. Houser, H. B.; Clark, E. J., and Stolzer, B. L.: Comparative Effects of Aspirin, ACTH and Cortisone on the Acute Course of Rheumatic Fever in Young Adult Males , Am. J. Med. 16:168, 1954.Crossref 17. Wyckoff, J.; DeGraff, A. C., and Parent, S.: The Relationship of Auriculoventricular Conduction Time in Rheumatic Fever to Salicylate Therapy , Am. Heart J. 5:568, 1930.Crossref 18. Master, A. M., and Romanoff, A.: Treatment of Rheumatic Fever Patients With and Without Salicylates: A Clinical and Electrocardiographic Study , J. A. M. A. 98:1978, 1932.Crossref 19. Coburn, A. F.: Salicylate Therapy in Rheumatic Fever: A Rational Technique , Bull. Johns Hopkins Hosp. 73:435, 1943. 20. Wilson, M. G., and Helper, H. N.: Effect of Pituitary Adrenocorticotrophic Hormone (ACTH) in Acute Rheumatic Carditis , J. A. M. A. 145:133, 1951.Crossref 21. Kuttner, A. G.; Baldwin, J. S.; McEwen, C.; Bunim, J. J.; Ziff, M., and Ford, D. K.: Effect of ACTH and Cortisone on Rheumatic Carditis , J. A. M. A. 148:628, 1952.Crossref 22. Barnes, A. R.; Smith, H. L.; Slocumb, C. H.; Polley, H. F., and Hench, P. S.: Effect of Cortisone and Corticotropin (ACTH) on the Acute Phase of Rheumatic Fever , A. M. A. Am. J. Dis. Child. 82:397, 1951. 23. Massell, B. F.; Warren, J. E.; Sturgis, G. P.; Hall, B., and Craige, E.: The Clinical Response of Rheumatic Fever and Acute Carditis to ACTH , New England J. Med. 242:641, 1950.Crossref 24. Dorfman, A.; Smull, K.; Bergenstal, D. M.; Howard, R.; Muller, R.; Oleson, D., and Saenz, E.: Effect of Adrenocorticotrophic Hormone on Rheumatic Fever , Pediatrics 8:603, 1951. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Therapgents Agents in Rheumatic Carditis: Comparative Effects of Acetylsalicylic Acid, Corticotropin, and Cortisone

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Publisher
American Medical Association
Copyright
Copyright © 1955 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1955.00250110047006
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Abstract

Abstract Although the symptoms of acute rheumatic fever appear to be favorably altered by a number of drugs,* the essential problems of therapy are to prevent death from acute carditis and to decrease the incidence of subsequent valvular heart disease.4 The present report compares the effect of acetylsalicylic acid (Aspirin), cortisone, and corticotropin (ACTH) on valvular heart disease as evidenced by the presence of murmurs 14 months after the onset of therapy.† A previous paper 5 concerning the same group of patients dealt with a comparison of the effects of these drugs on the acute course of rheumatic fever. METHODS Details of the methods employed and the population involved have been described elsewhere.5 All male airmen admitted to Warren Air Force Base Hospital who met the standard diagnostic criteria and who exhibited signs of rheumatic activity on the day treatment began were accepted for study. Each patient was assigned References 1. References 1-3. 2. Dr. David Rutstein, Chairman, Miss Marjorie Bellows, Statistician, and the principal investigators of the Cooperative Rheumatic Fever Study gave advice and the protocol used in this study. 3. Corticotropin (ACTHAR) was furnished by The Armour Laboratories, Chicago. 4. During the follow-up period two patients developed a dermatitis attributed to sulfadiazine, and in one patient massive hematuria, which subsequently disappeared, was noted. All three patients then received penicillin for prophylaxis. 5. Dr. Walter Pritchard, Associate Professor of Medicine, Western Reserve University School of Medicine, was the independent observer for this study. 6. All the patients excluded from the study were followed for at least eight months. Of the eight patients treated with acetylsalicylic acid no murmur was heard in four at the time of discharge. In two patients the murmur indicative of mitral valvular disease was present; in one patient the murmur of probable mitral valvular disease was heard, and in one patient a nonsignificant murmur was heard. Of the four patients treated with cortisone no murmur was heard in three at the time of discharge and in one patient a nonsignificant murmur was present. In the one corticotropin-treated patient who did not complete the follow-up period no murmur was heard at the time of discharge. 7. Development of or change in murmur, change in heart size, pericarditis, or congestive heart failure; not including patients with abnormal atrioventricular conduction as the sole manifestation of carditis. 8. Catanzaro, F., and Stolzer, B. L.: To be published. 9. References 3 and 6-8. 10. References 9-13. 11. Catanzaro, F., and Stolzer, B. L.: To be published. 12. Clark, E. J., and Houser, H. B.: Comparative Effects of 3-Hydroxy-2-Phenylcinchoninic Acid (HPC) and Aspirin on the Acute Course of Rheumatic Fever and the Occurrence of Rheumatic Valvular Disease , Am. Heart J. 45:576, 1953.Crossref 13. Hench, P. S.; Kendall, E. C.; Slocumb, C. H., and Polley, H. F.: Effects of Cortisone Acetate and Pituitary ACTH on Rheumatoid Arthritis, Rheumatic Fever and Certain Other Conditions , Ann. Int. Med. 85:545, 1950.Crossref 14. Manchester, R. C.: Rheumatic Fever in Naval Enlisted Personnel: II. Effectiveness of Intensive Salicylate Therapy in Cases of Acute Infection , Arch. Int. Med. 78:170, 1946.Crossref 15. Bland, E. F., and Jones, T. D.: Rheumatic Fever and Rheumatic Heart Disease: A 20 Year Report on 1000 Patients Followed Since Childhood , Circulation 4:836, 1951.Crossref 16. Houser, H. B.; Clark, E. J., and Stolzer, B. L.: Comparative Effects of Aspirin, ACTH and Cortisone on the Acute Course of Rheumatic Fever in Young Adult Males , Am. J. Med. 16:168, 1954.Crossref 17. Wyckoff, J.; DeGraff, A. C., and Parent, S.: The Relationship of Auriculoventricular Conduction Time in Rheumatic Fever to Salicylate Therapy , Am. Heart J. 5:568, 1930.Crossref 18. Master, A. M., and Romanoff, A.: Treatment of Rheumatic Fever Patients With and Without Salicylates: A Clinical and Electrocardiographic Study , J. A. M. A. 98:1978, 1932.Crossref 19. Coburn, A. F.: Salicylate Therapy in Rheumatic Fever: A Rational Technique , Bull. Johns Hopkins Hosp. 73:435, 1943. 20. Wilson, M. G., and Helper, H. N.: Effect of Pituitary Adrenocorticotrophic Hormone (ACTH) in Acute Rheumatic Carditis , J. A. M. A. 145:133, 1951.Crossref 21. Kuttner, A. G.; Baldwin, J. S.; McEwen, C.; Bunim, J. J.; Ziff, M., and Ford, D. K.: Effect of ACTH and Cortisone on Rheumatic Carditis , J. A. M. A. 148:628, 1952.Crossref 22. Barnes, A. R.; Smith, H. L.; Slocumb, C. H.; Polley, H. F., and Hench, P. S.: Effect of Cortisone and Corticotropin (ACTH) on the Acute Phase of Rheumatic Fever , A. M. A. Am. J. Dis. Child. 82:397, 1951. 23. Massell, B. F.; Warren, J. E.; Sturgis, G. P.; Hall, B., and Craige, E.: The Clinical Response of Rheumatic Fever and Acute Carditis to ACTH , New England J. Med. 242:641, 1950.Crossref 24. Dorfman, A.; Smull, K.; Bergenstal, D. M.; Howard, R.; Muller, R.; Oleson, D., and Saenz, E.: Effect of Adrenocorticotrophic Hormone on Rheumatic Fever , Pediatrics 8:603, 1951.

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1955

References