Comparative effects of aspirin, ACTH and cortisone on the acute course of rheumatic fever in young adult males

Abstract

A comparison was made of the effects of treatment with aspirin, cortisone and ACTH in 148 young adult males with acute rheumatic fever. Sixty-one of the patients received aspirin; forty-five received cortisone and forty-two received ACTH. Fever, joint pain and objective evidences of joint involvement were relieved most promptly with aspirin; ACTH was more effective in this respect than cortisone. Apart from the promptness of relief, there was little difference in the three drugs in their effects on the symptoms of acute rheumatic fever. The pattern of response of the erythrocyte sedimentation rate was different in each of the three therapy groups. Cortisone and ACTH treatment resulted in shortening the duration of abnormal auriculoventricular conduction; however, this might be a result of a specific action on conduction. Other indices of the effects of the drugs on carditis are presented but their final interpretation must await the results of a longterm follow-up. In each group, however, new murmurs appeared and persisted while the patients were receiving ostensibly full therapeutic dosages of the drugs. A clinical and/or laboratory relapse or “rebound” occurred in almost all of the patients in each group after cessation of therapy. This relapse subsided spontaneously in all except six aspirin-treated patients, one cortisone-treated patient and one ACTH-treated patient. A second course of therapy was administered to these patients. Toxicity and/or side-effects associated with use of the three drugs occurred in all the aspirin and ACTH-treated patients and in 75 per cent of the cortisone-treated patients. In only four patients, two each in the aspirin and ACTH-treated groups, were these severe enough to necessitate discontinuance of therapy. Acute psychoses developed in two ACTH-treated patients. Since an untreated control group of patients was not included in this study, it is not possible to determine what effect, if any, these three drugs had on the duration or residuals of acute rheumatic fever. It is clear, however, that the over-all effect of each of the drugs leaves much to be desired in the treatment of acute rheumatic fever and that adequate therapy for this disease is not presently available