Therapeutics for rheumatic fever and rheumatic heart disease

Ralph, Anna P.; Currie, Bart J.

doi:10.18773/austprescr.2022.034

Cited by 15 publications

(22 citation statements)

References 24 publications

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“…Model residuals were checked for lack of patterns across fitted values and predictors (DHARMa package) and no temporal autocorrelation. Data were analysed using STATA version 15…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…When total ARF diagnoses are captured, our data show that the increases over time chiefly represent improving detection of uncertain cases from 22/78 (28%) in 2013 to 98/193 (51%) in 2018, with a smaller proportional increase in numbers of definite ARF (Fig 1). Efforts to improve detection have included promotion of accessible clinical practice guidelines (2,3,15) and a diagnosis calculator available for smartphone use. (16) The clinical manifestations of ARF we report are supported by previous NT data, (17) showing arthritis to be most common major criterion followed by carditis then chorea, with almost all additionally having fever.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of possible and probable rheumatic fever: a cohort study using northern Australian register data, 2013-2019

Goddard

Kaestli

Makalic

et al. 2023

Preprint

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Background: Outcomes after acute rheumatic fever (ARF) diagnosis are variable, ranging from recovery to development of severe rheumatic heart disease (RHD). There is no diagnostic test. Evaluation using the Australian clinical diagnostic criteria can result in a diagnosis of ‘definite’, ‘probable’ or ‘possible’ ARF. The ‘possible’ category was introduced in 2013 in Australia’s Northern Territory (NT). Our aim was to compare longitudinal outcomes after a diagnosis of definite, probable or possible ARF. Methods: We extracted data from the NT RHD register for Indigenous Australians with an initial diagnosis of ARF during the 5.5-year study period (01/01/2013 – 30/06/2019). Descriptive statistics were used to describe the demographic and clinical characteristics at initial ARF diagnosis. Kaplan-Meier curves were used to assess the probability of survival free of disease progression and the cumulative incidence risk at each year since initial diagnosis was calculated. Cox proportional hazards regression was used to determine whether time to disease progression differed according to ARF diagnosis and whether progression was associated with specific predictors at diagnosis. A multinomial logistic regression model was performed to assess whether ARF diagnosis was associated with RHD outcome and to assess associations between ARF diagnosis and clinical manifestations. A generalised linear mixed model (GLMM) was developed to assess any differences in the long-term antibiotic adherence between ARF diagnosis categories and to examine longitudinal trends in adherence. Results: There were 913 initial ARF cases, 732 with normal baseline echocardiography. Of these, 92 (13%) experienced disease progression: definite ARF 61/348 (18%); probable ARF 20/181 (11%); possible ARF 11/203 (5%). The proportion of ARF diagnoses that were uncertain (i.e. possible or probable) increased over time, from 22/78 (28%) in 2013 to 98/193 (51%) in 2018. Cumulative incidence risk of any disease progression at 5.5 years was 33.6 (23.6–46.2) for definite ARF, 13.5 (8.8–20.6) for probable and 11.4% (95% CI 6.0–21.3) for possible ARF. The probability of disease-free survival was lowest for definite ARF and highest for possible ARF (p=0.004). Cox proportional hazards regression indicated that disease progression was 2.19 times more likely in those with definite ARF than those with possible ARF (p=0.026). Progression to RHD was reported in 37/348 (11%) definite ARF, 10/181 (6%) probable ARF, and 5/203 (2%) possible ARF. The multinomial logistic regression model demonstrated a significantly higher risk of progression from no RHD to RHD if the initial diagnosis was definite compared to possible ARF (p<0.001 for both mild and moderate-severe RHD outcomes). The GLMM estimated that patients with definite ARF had a significantly higher adherence to antibiotic prophylaxis compared with probable ARF (p=0.024). Conclusion: These data indicate that the ARF diagnostic categories are being applied appropriately, are capturing more uncertain cases over time, provide a useful way to stratify risk and guide prognosis, and can help inform practice. Possible ARF is not entirely benign; some cases progress to RHD.

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“…Model residuals were checked for lack of patterns across fitted values and predictors (DHARMa package) and no temporal autocorrelation. Data were analysed using STATA version 15…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of possible and probable rheumatic fever: a cohort study using northern Australian register data, 2013-2019

Goddard

Kaestli

Makalic

et al. 2023

Preprint

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“…There is limited evidence for using corticosteroids to reduce likelihood of developing RHD. Those with severe carditis may benefit from corticosteroids 21…”

Section: Case: Partmentioning

confidence: 99%

Sore knee – why and when to call a cardiologist

Kendall

McGinn

Sands

2023

Arch Dis Child Educ Pract Ed

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A young girl received a diagnosis of septic arthritis of the knee unresponsive to standard medical and surgical treatment. We report the patient’s clinical journey with clinical commentary throughout, underlying the importance of differential diagnosis that may open several scenarios and a different final diagnosis accordingly. Finally, we will discuss the treatment and management of the patient’s final diagnosis.

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“…Recent recommendations in the 2020 Australian Guidelines for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease suggest that secondary prophylaxis in patients diagnosed with acute rheumatic fever or rheumatic heart disease can be shortened in some individuals without cardiac involvement [135,136]. Non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen or naproxen are considered first-line drugs.…”

Section: Treatmentmentioning

confidence: 99%

The Role of Inflammation and Oxidative Stress in Rheumatic Heart Disease

Franczyk

Gluba-Brzózka

Rysz-Górzyńska

et al. 2022

IJMS

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Rheumatic heart disease (RHD), an acquired valvular disease, remains an important cause of morbidity and mortality in developing countries. This chronic illness starts from untreated streptococcal throat infection, resulting in acute rheumatic fever (ARF) in susceptible individuals. Repeated infections lead to a chronic phase characterized by the damage of heart valves. Inflammation has been found to play important role in the development of this disease. All the studies presented in this review clearly show the involvement of the inflammatory state in the progression of this disease. However, the exact role of cytokines in inflammation sites remains to be examined, since most studies have so far focused on peripheral blood. Such analysis would provide information on inflammatory mechanisms in situ.

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Therapeutics for rheumatic fever and rheumatic heart disease

Cited by 15 publications

References 24 publications

Outcomes of possible and probable rheumatic fever: a cohort study using northern Australian register data, 2013-2019

Outcomes of possible and probable rheumatic fever: a cohort study using northern Australian register data, 2013-2019

Sore knee – why and when to call a cardiologist

The Role of Inflammation and Oxidative Stress in Rheumatic Heart Disease

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