The Collaborative Clinical Study on Acute Rheumatic Fever in Adults from 27 Referral Hospitals in Korea

Yu, J M; Park, J E; Kim, I O; Oh, D J; Roh, Y M; Suh, S K; Bae, J H; Song, J S; Kim, K S; Kim, K B; Kim, Y N; Kim, K S; Suh, C S; Lee, H C; Lee, H S; Joo, I J; Shin, Y K; Shin, Y W; Sohn, G I; Kim, Y H; Seo, J D; Lee, Y W; Kwon, Y J; Kim, S G; Seo, S W; Lee, W K; Cho, S Y; Shim, W H; Choe, K H; Park, K S; Kim, J S; Lee, W H; Shin, G J; Yoo, W S; Choi, S K; Kim, J S; Song, C S; Rhee, Y W; Kim, S W; Han, G H; Kim, K H; Lee, S W; Park, S C; Lee, C J; Pang, M K; Park, O K; Kang, J C; Park, J C; Kang, S K; Ko, J K; Park, S K; Kim, J J; Kim, K W; Lee, S G; Ryoo, U H; Kang, C S; Ryu, W S; Kim, J H; Kim, C S; Chae, J S; Park, C H; Lee, Y; Kim, S G; Kwak, S T; Koh, Y B; Shin, D Y; Park, M S; Lee, C K; Lee, B H; Lim, H K

Abstract

With the big economic growth and the environmental improvement over the past decades the prevalence and the characteristics of acute rheumatic fever is considered to have much changed in Korea. To understand the present status of acute rheumatic fever in adult populations in Korea, we conducted the nationwide collaborative study. A total of 241 patients (age> or =14 years) were observed at the 27 referral hospitals in Korea from Jan. 1983 to Sept. 1986. The following results were obtained : 1) The male to female ratio was 1: 1.2 in whole patients but in patients above age 20, female patients were more prevalent (M:F = 1:2.7). The majority of the patients were seen between the age of 14 and 19 and the number of patients got decreased with the increase of age. 2) The patients were observed throughout the seasons but more patients were seen in Febrary and July. 3) The major manifestations were polyarthritis (57%), carditis (38%), erythema marginatum (28%), subcutaneous nodule (6%), and chorea(3%). 4) Anemia Hb< or =12gm/dl) was present in 60%, leukocytosis in 53.5%, increased ESR in 94.2%, and increased ASO in 90.9%. The P-R interval was prolonged on EKG in 41.4% of the patients. 5) Carditis was suspicious in 95 patients. It was much more prevalent below the age of 20. Significant heart murmur was present in 68% of the patients. No significant heart murmur could be heard in 45 patients (32%). 6) The two dimensional echocardiography revealed mitral valve incolvement in 79 patients (56%) among 140 patients observed. Mitral regurgitation was the most prevalent lesion. Aortic valve regurgitation was observed in 18 patients (13%). The pericardial effusion was seen in 38 patients(27%). In 40 patients (29%), the echocardiography revealed normal. 7) The recurrence of rheumatic fever was seen in 40 patients (16.6%). The recurrence was much more frequent below the age of 20. Most of the recurrences were developed within 3 years following the first attack;54% within one year and 67% within 3 years. 8) Most of the patients were treated with salicylate and the short term prognosis was very good; 93% of the patients were improved during the hospitalization, but 7 patients died, mostly due to heart failure. 9) There is a strong impression that if diagnosed early and the proper treatment is introduced early, little sequelas (valvular damage) are remained (32% of patients didn't have significant heart murmur and 29% of patients didn't have significant abnormal findings on echocardiography). The present report certainly underestimates the real prevalence of acute rheumatic fever in korea. rheumatic fever is still the quite significant health problem in Korea. Better detection and treatment program such as registry and the public education is required. Also further prospective nationwide epidemiologic study is required.

The Collaborative Clinical Study on Acute Rheumatic Fever in Adults from 27 Referral Hospitals in Korea

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