Role of bed rest in treatment of rheumatic fever; review of literature and survey of current opinions.

Abstract

• Sixteen specialists in rheumatic fever independently contributed opinions as to the role of bed rest in the treatment of this disease. None were able to cite adequate, long-term, well-controlled studies comparing the course of patients whose treatment had included a rigid regimen of bed rest with the course of patients who had been given more liberty. None had made such a controlled study themselves, and three indicated that they had no experience with treatment other than strict bed rest. None felt that they had seen evidence that the known ill-effects of absolute bed rest on other types of subjects tended to delay recovery in patients with rheumatic fever, but several mentioned the emotional effects of strict bed rest. The most decisive criterion for allowing increased activity was stated as (1) subsidence of the acute debilitating symptoms, by five physicians; (2) downward trend of laboratory signs, by five other physicians; and (3) disappearance of all signs of inflammatory activity and freedom from recurrence of symptoms after cessation of steroid and aspirin therapy, by six physicians. All agreed that they would prescribe absolute bed rest in acute rheumatic fever with manifestations of arthritis and carditis with heart failure, but differed as to the strictness and duration of the bed rest in the absence of heart failure or signs of carditis. There was a diversity of opinions as to the hypothetical case of a patient with inactive rheumatic fever, an organic apical systolic murmur, and no cardiac enlargement, but eight physicians stated that they would allow all normal activity except for competitive sports.