Recurrence of Sydenham Chorea

Abstract

Background: Sydenham chorea (SC), a major sign of rheumatic fever (RF), is related to systemic streptococcal infection and is treated with antibiotics. Recurrence usually occurs within a short interval following the initial event and is considered part of RF. Objective: To evaluate the rate, nature, and course of recurrent SC during an extended follow-up period. Design: Prospective assessment of a cohort of patients with SC who were admitted between 1985 and 2002. Setting: General community hospital. Methods: Diagnosis of RF was based on the revised Jones criteria. Other causes of chorea were excluded. Recurrence was defined as the development of new signs, lasting more than 24 hours and separated by a minimum of 2 months from the previous episode. Patients were observed from 1 to 14 years following the initial SC episode and for at least 1 year after recurrence. At recurrence, patients were assessed for RF clinical and laboratory activity, including change in cardiac involvement. Results: Twenty-four patients had SC. In 19 patients (79%), the chorea was associated with other RF signs, METHODS All patients diagnosed with RF between 1985 and 2002 at the Bikur Cholim Hospital, Jerusalem, Israel, were screened for SC. Diagnosis of

Treatment of Sydenham’s Chorea: A Review of the Current Evidence

“…In four out of 16 there was no evidence of a recent streptococcal infection or elevated titers. In a similar study performed in Jerusalem, 10 out of 19 SC patients (seven females) developed a total of 11 recurrences of chorea 7. Only six out of 11 recurrences were associated with either poor penicillin adherence or an increase in ASO titers.…”

“…No predictive demographic features for a prolonged course were identified. Additionally, recurrences of chorea are not uncommon, occurring in 15–40% of patients,5,7 Identified triggers for relapses have included poor prophylactic penicillin adherence,5 the use of oral contraceptive agents, and pregnancy 8. Investigative laboratory studies assist in eliminating alternative causes of chorea, but do not confirm the diagnosis.…”

Como a coréia de Sydenham é tratada no Rio de Janeiro?

“…A revisão feita entre os 54 prontuários selecionados ratifica a hipótese de prescrição inadequada da profilaxia secundária entre os médicos, pois que em 8,7% dos prontuários pesquisados não se encontrou qualquer menção ao uso de penicilina benzatina. Uma vez que a indicação da profilaxia secundária com penicilina benzatina é amplamente recomendada na literatura médica 3,8,12,22 e faz parte de virtualmente todos os livros-texto que estudam o assunto 2,7,23 , é com preocupação que notamos um grupo considerável de pediatras que parecem não saber da importância desta prática profilática.…”

“…A incidência de cS em países desenvolvidos é de 0,2 a 0,8 por 100000 por ano, o que representa 10 a 40% dos pacientes com FR 3,[8][9][10][11] . A taxa de recorrência é de 10 a 42% [10][11][12] . cerca de 60 a 71% dos pacientes com cS apresentam lesões cardíacas valvares 3,10,13 .…”

“…Não há consenso sobre a terapia farmacoló-gica para coréia. Entretanto, há unanimidade sobre o uso profilático de penicilina benzatina para evitar novos surtos de coréia ou outras manifestações da FR, principalmente a cardite 3,11,12,22 .…”