Противовоспалительное лечение кардита при острой ревматической лихорадке
Appendices
Appendix 1. Glossary
Acetylsalicylic acid (ASA)
Type of anti‐inflammatory analgesic; also called aspirin.
ACTH
Corticotrophin.
Anticoagulant therapy
Use of anticoagulant drugs to reduce or prevent intravascular or intracardiac clotting.
Aspirin
Type of anti‐inflammatory analgesic; also called acetylsalicylic acid (ASA).
Auscultation
Act of listening for sounds within the body.
Carditis
Inflammation of the heart, including pericarditis, myocarditis and endocarditis, according to whether the enveloping outer membrane, the muscle or the inner lining is affected.
C‐reactive protein (CRP)
Blood test used as an indicator of acute inflammation. C‐reactive protein is a protein of the pentraxin family, produced by the liver during periods of inflammation and detectable in serum in various disease conditions, particularly during acute phases of immune response. Normally C‐reactive protein should be negative in the bloodstream.
Endocardium
Innermost lining of the heart cavities.
Erythrocyte sedimentation rate (ESR)
Test that measures the rate at which red blood cells settle through a column of liquid. Non‐specific index of inflammation.
Heart valves
One‐way inlets or outlets between heart chambers that allow blood to be pumped in the appropriate direction. The heart has four main valves: tricuspid, mitral, aortic and pulmonic valves.
Intravenous immunoglobulin (IVIG)
Sterile solution of concentrated antibodies extracted from healthy people. IVIG is used to prevent bacterial infection in people with low or inappropriate antibody production. Injected into a vein or muscle.
Lesion
Any pathological or traumatic discontinuity of tissue or loss of function of a part.
Mitral valve
Heart valve that divides the left atrium and the left ventricle. During left atrial contraction, the mitral valve opens to allow blood to flow into the left ventricle. Upon closure, the mitral valve prohibits regurgitation of blood back into the left atrium. The mitral valve is the only heart valve that has only two valve cusps (all others have three).
Murmur
Noise found on physical examination of the heart that can, in some cases, indicate the presence of cardiac disease. Murmurs result from vibrations set up in the bloodstream and surrounding heart and great vessels as the result of turbulent flow.
Myocardial (Myocardium)
Term used to describe the middle layer of the heart wall (heart muscle).
Pentoxifylline
Drug that is a methylxanthine derivative with diverse pharmacological properties that cause inhibition of inflammation.
P‐R interval (also called PQ interval)
In the electrocardiogram, time elapsing between beginning of the P wave and beginning of the next QRS complex; corresponds to the a‐c interval of the venous pulse and is normally 0.12 to 0.20 seconds.
Pericardium
Double membranous sac that envelopes and protects the heart. Layer in contact with the heart is referred to as the visceral layer; the outer layer in contact with surrounding organs is the parietal pericardium. Between the two layers is the pericardial space.
Regurgitant heart valve
Valve fails to close properly and causes regurgitation of blood flow (flowing backward).
Salicylates
Type of anti‐inflammatory analgesic; includes aspirin (acetylsalicylic acid).
Sequelae
Condition following as a consequence of a disease.
Stenotic heart valve
Heart valve fails to open properly.
Warfarin (warfarin sodium).
Oral anticoagulant used for prophylaxis of embolisation in rheumatic heart disease.
Acetylsalicylic Acid (ASA)
Type of anti‐inflammatory analgesic; also called aspirin.
ACTH
Corticotrophin.
Anticoagulant therapy
Use of anticoagulant drugs to reduce or prevent intravascular or intracardiac clotting.
Aspirin
Type of anti‐inflammatory analgesic; also called acetylsalicylic acid (ASA).
Auscultation
Act of listening for sounds within the body.
Carditis
Inflammation of the heart, including pericarditis, myocarditis and endocarditis, according to whether the enveloping outer membrane, the muscle or the inner lining is affected.
C‐reactive protein (CRP)
Blood test used as an indicator of acute inflammation. C‐reactive protein is a protein of the pentraxin family, produced by the liver during periods of inflammation and detectable in serum in various disease conditions, particularly during acute phases of immune response. Normally C‐reactive protein should be negative in the bloodstream.
Endocardium
Innermost lining of the heart cavities.
Erythrocyte sedimentation rate (ESR)
Test that measures the rate at which red blood cells settle through a column of liquid. Non‐specific index of inflammation.
Heart valves
One‐way inlets or outlets between heart chambers that allow blood to be pumped in the appropriate direction. The heart has four main valves: tricuspid, mitral, aortic and pulmonic valves.
Intravenous immunoglobulin (IVIG)
Sterile solution of concentrated antibodies extracted from healthy people. IVIG is used to prevent bacterial infection in people with low or inappropriate antibody production. Injected into a vein or muscle.
Lesion
Any pathological or traumatic discontinuity of tissue or loss of function of a part.
Mitral valve
Heart valve that divides the left atrium and the left ventricle. During left atrial contraction, the mitral valve opens to allow blood to flow into the left ventricle. Upon closure, the mitral valve prohibits regurgitation of blood back into the left atrium. The mitral valve is the only heart valve that has only two valve cusps (all others have three).
Murmur
Noise found on physical examination of the heart that can, in some cases, indicate the presence of cardiac disease. Murmurs result from vibrations set up in the bloodstream and surrounding heart and great vessels as the result of turbulent flow.
Myocardial (Myocardium)
Term used to describe the middle layer of the heart wall (heart muscle).
Pentoxifylline
Drug that is a methylxanthine derivative with diverse pharmacological properties that causes inhibition of inflammation.
P‐R interval (also called PQ interval)
In the electrocardiogram, time elapsing between beginning of the P wave and beginning of the next QRS complex; corresponds to the a‐c interval of the venous pulse and is normally 0.12 to 0.20 seconds.
Pericardium
Double membranous sac that envelopes and protects the heart. Layer in contact with the heart is referred to as the visceral layer; the outer layer in contact with surrounding organs is the parietal pericardium. Between the two layers is the pericardial space.
Regurgitant heart valve
Valve fails to close properly and causes regurgitation of blood flow (flowing backward).
Salicylates
Type of anti‐inflammatory analgesic; includes aspirin (acetylsalicylic acid).
Sequelae
Conditions following as a consequence of a disease.
Stenotic heart valve
Heart valve fails to open properly.
Warfarin (warfarin sodium).
Oral anticoagulant used for prophylaxis of embolisation in rheumatic heart disease.
Appendix 2. 2013 search strategies
CENTRAL
#1MeSH descriptor: [Rheumatic Fever] explode all trees
#2(rheumat* near/6 fever*)
#3(rheumat* near/6 acute)
#4rhd
#5(rheumat* and streptococc*)
#6(rheumat* near/6 polyarthrit*)
#7(arthrit* and streptococc*)
#8MeSH descriptor: [Chorea] this term only
#9chorea
#10carditis
#11(streptococc* and heart)
#12(streptococc* and card*)
#13(rheumat* and fever)
#14#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13
#15MeSH descriptor: [Anti‐Inflammatory Agents] explode all trees
#16MeSH descriptor: [Antirheumatic Agents] explode all trees
#17antiinflam*
#18anti‐inflam*
#19(inflammation near/6 mediator*)
#20(antirheumatic* near/6 agent*)
#21corticosteroid*
#22steroid*
#23nsaid*
#24salicylat*
#25aspirin*
#26prednisone*
#27cortisone
#28hydrocortisone
#29dexamethasone
#30intravenous next immunoglobulin*
#31ivig
#32acetylsalicylic*
#33corticotropin*
#34acth
#35corticotrophin
#36pentoxifylline
#37#15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26
#38#27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36
#39#37 or #38
#40#14 and #39
MEDLINE
1. exp Rheumatic Fever/
2. Rheumatic Heart Disease/
3. (rheumat$ adj3 fever$).tw.
4. (rheumat$ adj3 card$).tw.
5. (rheumat$ adj3 heart$).tw.
6. (rheumat$ adj3 valv$).tw.
7. or/1‐6
8. exp Anti‐Inflammatory Agents/
9. exp Antirheumatic Agents/
10. Aspirin/
11. corticosteroid$.tw.
12. prednisone.tw.
13. aspirin.tw.
14. acetylsalicyl$.tw.
15. (antiinflam$ or anti‐inflam$).tw.
16. Adrenocorticotropic Hormone/
17. acetylsalicylic.tw.
18. hydrocortisone.tw.
19. corticotrophin.tw.
20. corticotropin.tw.
21. acth.tw.
22. dexamethasone.tw.
23. Immunoglobulins, Intravenous/
24. ivig.tw.
25. immunoglobulin$.tw.
26. Pentoxifylline/
27. pentoxifylline.tw.
28. or/8‐27
29. 7 and 28
30. randomized controlled trial.pt.
31. controlled clinical trial.pt.
32. randomized.ab.
33. placebo.ab.
34. drug therapy.fs.
35. randomly.ab.
36. trial.ab.
37. groups.ab.
38. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37
39. exp animals/ not humans.sh.
40. 38 not 39
41. 29 and 40
42. (2011* or 2012* or 2013*).ed.
43. 41 and 42
EMBASE
1. rheumatic fever/
2. rheumatic heart disease/
3. (rheumat$ adj3 fever$).tw.
4. (rheumat$ adj3 card$).tw.
5. (rheumat$ adj3 heart$).tw.
6. (rheumat$ adj3 valv$).tw.
7. or/1‐6
8. exp antiinflammatory agent/
9. corticosteroid therapy/
10. exp corticosteroid/
11. acetylsalicylic acid/
12. corticosteroid$.tw.
13. prednisone.tw.
14. aspirin.tw.
15. acetylsalicyl$.tw.
16. (antiinflam$ or anti‐inflam$).tw.
17. corticotropin/
18. acetylsalicylic.tw.
19. hydrocortisone.tw.
20. corticotrophin.tw.
21. corticotropin.tw.
22. acth.tw.
23. dexamethasone.tw.
24. exp immunoglobulin/
25. immunoglobulin$.tw.
26. pentoxifylline/
27. Pentoxifylline.tw.
28. or/8‐27
29. 28 and 7
30. random$.tw.
31. factorial$.tw.
32. crossover$.tw.
33. cross over$.tw.
34. cross‐over$.tw.
35. placebo$.tw.
36. (doubl$ adj blind$).tw.
37. (singl$ adj blind$).tw.
38. assign$.tw.
39. allocat$.tw.
40. volunteer$.tw.
41. crossover procedure/
42. double blind procedure/
43. randomized controlled trial/
44. single blind procedure/
45. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44
46. (animal/ or nonhuman/) not human/
47. 45 not 46
48. 29 and 47
49. limit 48 to embase
50. (2011* or 2012* or 2013*).dd.
51. (2011* or 2012* or 2013*).em.
52. 50 or 51
53. 49 and 52
LILACS
(carditis or rheumat$) [Words] and (anti‐inflam$ or antiinflam$ or antirheum$) [Words] and random$ [Words]
Appendix 3. 2011 search strategies
CENTRAL (2011)
#1 MeSH descriptor RHEUMATIC FEVER explode all trees
#2 (rheumat* near/6 fever*)
#3 (rheumat* near/6 acute)
#4 rhd
#5 (rheumat* and streptococc*)
#6 (rheumat* near/6 polyarthrit*)
#7 (arthrit* and streptococc*)
#8 MeSH descriptor CHOREA this term only
#9 chorea
#10 carditis
#11 (streptococc* and heart)
#12 (streptococc* and card*)
#13 ( (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12)
#14 MeSH descriptor ANTI‐INFLAMMATORY AGENTS explode all trees
#15 MeSH descriptor ANTIRHEUMATIC AGENTS explode all trees
#16 antiinflam*
#17 anti‐inflam*
#18 (inflammation near/6 mediator*)
#19 (antirheumatic* near/6 agent*)
#20 corticosteroid*
#21 steroid*
#22 nsaid*
#23 salicylat*
#24 aspirin*
#25 prednisone*
#26 (#14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25)
#27 (#13 and #26)
#28 cortisone
#29 hydrocortisone
#30 dexamethasone
#31 intravenous next immunoglobulin*
#32 ivig
#33 acetylsalicylic*
#34 corticotropin*
#35 acth
#36 corticotrophin
#37 (rheumat* and fever)
#38 pentoxifylline
#39 (#28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38)
#40 (#39 and #13)
#41 (#27 or #40)
MEDLINE (Ovid) 2011
1. exp Rheumatic Fever/
2. Rheumatic Heart Disease/
3. (rheumat$ adj3 fever$).tw.
4. (rheumat$ adj3 card$).tw.
5. (rheumat$ adj3 heart$).tw.
6. (rheumat$ adj3 valv$).tw.
7. or/1‐6
8. exp Anti‐Inflammatory Agents/
9. exp Antirheumatic Agents/
10. Aspirin/
11. corticosteroid$.tw.
12. prednisone.tw.
13. aspirin.tw.
14. acetylsalicyl$.tw.
15. (antiinflam$ or anti‐inflam$).tw.
16. Adrenocorticotropic Hormone/
17. acetylsalicylic.tw.
18. hydrocortisone.tw.
19. corticotrophin.tw.
20. corticotropin.tw.
21. acth.tw.
22. dexamethasone.tw.
23. Immunoglobulins, Intravenous/
24. ivig.tw.
25. immunoglobulin$.tw.
26. Pentoxifylline/
27. pentoxifylline.tw.
28. or/8‐27
29. 7 and 28
30. randomized controlled trial.pt.
31. controlled clinical trial.pt.
32. randomized.ab.
33. placebo.ab.
34. drug therapy.fs.
35. randomly.ab.
36. trial.ab.
37. groups.ab.
38. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37
39. exp animals/ not humans.sh.
40. 38 not 39
41. 29 and 40
EMBASE (Ovid) 2011
1. rheumatic fever/
2. rheumatic heart disease/
3. (rheumat$ adj3 fever$).tw.
4. (rheumat$ adj3 card$).tw.
5. (rheumat$ adj3 heart$).tw.
6. (rheumat$ adj3 valv$).tw.
7. or/1‐6
8. exp antiinflammatory agent/
9. corticosteroid therapy/
10. exp corticosteroid/
11. acetylsalicylic acid/
12. corticosteroid$.tw.
13. prednisone.tw.
14. aspirin.tw.
15. acetylsalicyl$.tw.
16. (antiinflam$ or anti‐inflam$).tw.
17. corticotropin/
18. acetylsalicylic.tw.
19. hydrocortisone.tw.
20. corticotrophin.tw.
21. corticotropin.tw.
22. acth.tw.
23. dexamethasone.tw.
24. exp immunoglobulin/
25. immunoglobulin$.tw.
26. pentoxifylline/
27. Pentoxifylline.tw.
28. or/8‐27
29. 28 and 7
30. random$.tw.
31. factorial$.tw.
32. crossover$.tw.
33. cross over$.tw.
34. cross‐over$.tw.
35. placebo$.tw.
36. (doubl$ adj blind$).tw.
37. (singl$ adj blind$).tw.
38. assign$.tw.
39. allocat$.tw.
40. volunteer$.tw.
41. crossover procedure/
42. double blind procedure/
43. randomized controlled trial/
44. single blind procedure/
45. 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44
46. (animal/ or nonhuman/) not human/
47. 45 not 46
48. 29 and 47
LILACS
(carditis or rheumat$) [Words] and (anti‐inflam* or antiinflam$ or antirheum$)
Appendix 4. 2002 search strategies
CENTRAL search strategy ‐ 2002 version
#1 RHEUMATIC‐FEVER*:ME
#2 (RHEUMAT* and FEVER*)
#3 (RHEUMAT* near ACUTE)
#5 RHD
#6 (RHEUMAT* and STREPTOCOCC*)
#7 (RHEUMAT* near POLYARTHRIT*)
#8 (ARTHRIT* and STREPTOCOCC*)
#9 CHOREA:ME
#10 CHOREA
#11 CARDITIS
#12 (STREPTOCOCC* and HEART)
#13 (STREPTOCOCC* and CARD*)
#14 (((((((((((#1 or #2) or #3) or #4) or #5) or #6) or #7) or #8) or #9) or #10) or #11) or #12)
#15 ANTI‐INFLAMMATORY‐AGENTS*:ME
#16 ANTIRHEUMATIC‐AGENTS*:ME
#17 ANTIINFLAM*
#18 ANTI‐INFLAM*
#19 (INFLAMMATION near MEDIATOR*)
#20 (ANTIRHEUMATIC* near AGENT*)
#21 CORTICOSTEROID*
#22 STEROID*
#23 NSAID*
#24 SALICYLAT*
#25 ASPIRIN*
#26 PREDNISONE*
#27 (((((((((((#14 or #15) or #16) or #17) or #18) or #19) or #20) or #21) or #22) or #23) or #24) or #25)
#28 (#14 and #27)
MEDLINE (Ovid) 2002
1 exp Rheumatic Fever/
2 Rheumatic Heart Disease/
3 (rheumat$ adj3 fever$).tw.
4 (rheumat$ adj3 card$).tw.
5 (rheumat$ adj3 heart$).tw.
6 (rheumat$ adj3 valv$).tw.
7 or/1‐6
8 exp Anti‐Inflammatory Agents/
9 exp Antirheumatic Agents/
10 Acetylsalicylic Acid/
11 corticosteroid$.tw.
12 prednisone.tw.
13 aspirin.tw.
14 acetylsalicyl$.tw.
15 (antiinflam$ or anti‐inflam$).tw.
16 Corticotropin/
17 acetylsalicylic.tw.
18 hydrocortisone.tw.
19 corticotrophin.tw.
20 corticotropin.tw.
21 acth.tw.
22 dexamethasone.tw.
23 Immunoglobulins, Intravenous/
24 ivig.tw.
25 immunoglobulin$.tw.
26 Pentoxifylline/
27 pentoxifylline.tw.
28 or/8‐27
29 7 and 28
EMBASE (Ovid) 2002
1 Rheumatic Fever/
2 Rheumatic Heart Disease/
3 (rheumat$ adj3 fever$).tw.
4 (rheumat$ adj3 card$).tw.
5 (rheumat$ adj3 heart$).tw.
6 (rheumat$ adj3 valv$).tw.
7 or/1‐6
8 exp Antiinflammatory Agent/
9 corticosteroid therapy/
10 exp corticosteroid/
11 Acetylsalicylic Acid/
12 corticosteroid$.tw.
13 prednisone.tw.
14 aspirin.tw.
15 acetylsalicyl$.tw.
16 (antiinflam$ or anti‐inflam$).tw.
17 Corticotropin/
18 acetylsalicylic.tw.
19 hydrocortisone.tw.
20 corticotrophin.tw.
21 corticotropin.tw.
22 acth.tw.
23 dexamethasone.tw.
24 exp Immunoglobulin/
25 immunoglobulin$.tw.
26 Pentoxifylline/
27 Pentoxifylline.tw.
28 or/8‐27
29 28 and 7
30 controlled study/
31 clinical trial/
32 major clinical study/
33 random$.tw.
34 randomized controlled trial/
35 trial$.tw.
36 compar$.tw.
37 control$.tw.
38 follow‐up.tw.
39 blind$.tw.
40 double blind procedure/
41 placebo$.tw.
42 clinical article/
43 placebo/
44 doubl$.tw.
45 or/30‐44
46 45 and 29
LILACS
(carditis or rheumat$) [Words] and (anti‐inflam* or antiinflam$ or antirheum$)
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Corticosteroids versus aspirin, Outcome 1 Cardiac disease after 1 year.
Comparison 1 Corticosteroids versus aspirin, Outcome 2 Outcome of severe cardiac disease after 1 year.
Comparison 2 Individual corticosteroids versus aspirin, Outcome 1 Cardiac disease after 1 year.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Cardiac disease after 1 year Show forest plot | 6 | 907 | Risk Ratio (M‐H, Random, 95% CI) | 0.87 [0.66, 1.15] |
| 2 Outcome of severe cardiac disease after 1 year Show forest plot | 3 | 119 | Risk Ratio (M‐H, Random, 95% CI) | 0.94 [0.32, 2.70] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Cardiac disease after 1 year Show forest plot | 3 | 276 | Risk Ratio (M‐H, Random, 95% CI) | 0.86 [0.42, 1.76] |
| 1.1 Hydrocortisone versus aspirin | 1 | 64 | Risk Ratio (M‐H, Random, 95% CI) | 0.43 [0.19, 0.97] |
| 1.2 Prednisone versus aspirin | 2 | 212 | Risk Ratio (M‐H, Random, 95% CI) | 1.13 [0.52, 2.45] |
