In Reply.—Data from our study1 strongly supported the concept2 that if the host escapes carditis in the initial attack, he or she will continue to do so in subsequent recurrences. After reviewing these data1,2 we suggested that "the regimen [for secondary prophylaxis] should be selective... patients who escape carditis in the initial attack should maintain prophylaxis for five years. The duration of five years is admittedly arbitrary but is based on earlier observations that recurrences are most common during the first few years after the index attack."1,3
The statement by Professor Sanyal that "some children with polyarthritis may have subclinical carditis that makes them unduly susceptible to cardiac involvement during subsequent attacks of ARF" lacks evidence; furthermore, we have already highlighted our reservations on the retrospective study of Kuttner and Mayer.4 It is very interesting that the experience of Professor Sanyal with recurrences "... where
MAJEED HA. Acute Rheumatic Fever-Reply. Am J Dis Child. 1985;139(5):441–442. doi:10.1001/archpedi.1985.02140070015010
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