The Pattern of Symptoms, Pre-Treatment Interval, and Prognosis of Acute Rheumatic Fever

Abstract

The types of complaint that had brought 264 children and adolescents with first attacks of acute rheumatic fever to medical attention were correlated with the time interval between first symptom and beginning of treatment and with the incidence of cardiac involvement, rigorously and objectively appraised, before and after treatment. Residual heart damage occurred in 25% (53 of 209) of patients who began treatment within 2 weeks after onset of symptoms and in 69% (38 of 55) of those whose treatment began after 2 weeks. However, further examination of these data showed the following pertinent features. (1) Residual heart disease, which was unrelated to time or type of treatment, was present in 30 patients admitted with severe carditis and was absent in 151 patients who had no carditis on admission. In the 83 patients with mild carditis, residual heart disease occurred somewhat less frequently in those treated early than in those treated late, but the difference was not statistically significant. (2) Of 202 patients who presented with overt arthritis, only 3% had severe carditis, while 61% had no carditis; of 62 patients without arthritis, 39% had severe carditis and only 13% had no carditis. (3) Arthritis occurred as a presenting complaint in 89% of patients treated within 2 weeks but only in 42% of those treated after 2 weeks. These data fail to confirm the traditional belief that early treatment of acute rheumatic fever reduces the incidence of residual heart disease. Because arthritis usually brought about quick medical attention the "early treatment" group contained large numbers of patients without carditis in whom the absence of residual heart disease was caused by the behavior of the disease rather than by therapy or rapidity of starting treatment.