The Treatment of Acute Rheumatic Fever.

A controlled study of therapy on 131 patients with first attacks of acute rheumatic fever of 18 days or less duration was conducted. All patients were given a basic regimen of bed rest and initial penicillin therapy followed by sulfadiazine prophylaxis. The effect of the basic regimen was compared with hydrocortisone, salicylates, and a combination of these two agents. Both aspirin and hydrocortisone favorably affected certain acute manifestations; the effect of the latter was more striking. Treatment with hydrocortisone appeared to result in a decrease in apical systolic murmurs at the end of 1 year, as compared with treatment with aspirin or no specific anti-rheumatic therapy. No advantage of combined therapy was found. It is recommended that acute rheumatic fever with carditis be treated with hormones; but in the absence of carditis, salicylates should be employed.