Study population
Twenty-nine patients (mean age 12.3±3.2 years, range 6-18 years; 14 male/15 female) diagnosed with acute rheumatic fever from January 2016 to January 2017 were prospectively enrolled in this study. Two patients who were diagnosed with juvenile idiopathic arthritis and systemic lupus erythematosus upon enrollment in the study were excluded afterward. The study cohort was divided into two subgroups on the basis of valve involvement [9]. The moderate/severe carditis group consisted of 12 patients with moderate/severe valvular involvement. No/mild carditis group consisted of 15 patients with mild valvular involvement or no valvular involvement. All measures were compared with values of 27 healthy children of similar sex and age (mean age 11.7±3.1 years, range 7-17 years; 16 male/11 female, p=0.781 for age, p=0.722 for sex).
The patients were included in the study according to previously defined revised Jones criteria for acute rheumatic fever [10]. Patients with recurrent RHD were not included in the study. Erythrocyte sedimentation rate and C-Reactive protein values were measured in all patients before and after the treatment. After a single dose of benzathine penicillin patients who were diagnosed with moderate/severe carditis were treated with corticosteroids for 4-6 weeks and after steroids, they were administered with non-steroid anti-inflammatory drugs (NSAID) for an additional 2-4 weeks. Patients who were diagnosed as no/mild carditis were treated with NSAID for 2-6 weeks after a single dose of benzathine penicillin. Both the patients and the controls underwent a standard transthoracic echocardiographic examination and STE.
The study complied with the Declaration of Helsinki and the Clinical Research Ethical Committee approved the study (decree no: 2017-027). The families of the patients provided their informed consent.