AB0929 ACUTE RHEUMATIC FEVER: IS PROLONGED CORTICOSTEROID TEATMENT ASSOCIATED TO A BETTER CARDIAC OUTCOME?
Authors: Giulia Aiello, Sara Pieropan, Giulia Melotti, Maddalena Maschio, Elisa Tadiotto, Federica Martinis, Gaetano Cantalupo, Mara Pilati, Lucia Rossetti, Camilla Sandrini, Maria Antonia Prioli, Giorgio Piacentini
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Acute rheumatic fever (ARF) is a nonsuppurative sequaela that can occur two to four weeks after group A beta-hemolytic Streptococcus pharyngitis. Despite its decline in incidence in modern countries, ARF still represents worldwide a serious healthcare concern. The most common manifestations are arthritis and carditis, followed by chorea, erythema marginatum, and subcutaneous nodules. The diagnosis of ARF is clinical and requires satisfaction of revised Jones criteria as well as evidence of a recent streptococcal infection. Carditis and chorea both need systemic corticosteroid treatment (prednisone, 1 mg/kg) but with different treatment courses: 2-3 weeks prednisone treatment course in carditis is generally undertaken compared to a longer prednisone treatment period in chorea (at least 2 months). <h3>Objectives</h3> The aim of this study was to investigate if the longer corticosteroid treatment used for patients with chorea and carditis is related to a better regression of cardiac damage compared to the shorter course of corticosteroid treatment in patients with only carditis. <h3>Methods</h3> Data regard 14 patients were retrospectively revised (8 males, 6 females): 7 ARF patients with both cardiac and neurological involvement treated with systemic prednisone for 2 months; 7 ARF patients with only cardiac involvement treated with systemic prednisone for 2 weeks. The regression of cardiac damage in the two different groups was evaluated in relation to the different duration of corticosteroid treatment comparing ultrasound echocardiography (cardiac-US) performed at ARF onset and during a 2-3 year follow-up. The trend of the grade of aortic and mitral valves insufficiencies was chosen as indicator of the ARF cardiac damage evolution. Patients with a similar grade of cardiac damage at disease onset were identified; then pairs were created according to the presence of chorea (so one patient was affected only by carditis and the other one of the same pair, according to the similar cardiac damage, had both carditis and chorea). Cardiac-US damage regression of the 7 pairs was assessed in order to evaluate if the grade of regressione was higher in the patients with only carditis compared with the ones with both carditis and chorea. Results: in 3 pairs a better regression of the cardiac damage was evident in the patients with only carditis; in other 3 a better regression was noticed in the patients with both carditis and chorea; finally no difference was detected in the last pair. No significant cardiac-US difference according to patient pairs appeared in relation to the steroid time treatment course (2-3 weeks vs 2-3 months); however in 85% of the cases (12 patients) steroid therapy did achieve regression on ARF cardiac damage. <h3>Conclusion</h3> This retrospective study does not reveal any significant difference between steroid duration therapies in ARF complicated by carditis; limits of the study are the size sample as well as the intra/inter observer variation during cardiac-US (all exams were achieved in a high level experience paediatric cardiac service); this study underlines the established importance of the use of corticosteroid in ARF carditis. <h3>Disclosure of Interests</h3> None declared