Rheumatic chorea: relationship to systemic manifestations and response to corticosteroids.
OBJECTIVE
To describe Sydenham chorea among children in a cohort of patients with rheumatic fever (RF).


METHODS
An existing database was used to identify demographic characteristics, clinical manifestations, and therapy in persons with RF identified in Salt Lake City, Utah, from 1985 through January 2002.


RESULTS
Of 584 cases in the database, 537 (91%) were new-onset RF (median age of 10 years) and 177 (33%) had chorea. Patients with chorea were more often female (OR = 0.37, 95% CI = 0.25-0.55, P < .0001) and were less likely to have carditis or arthritis. Prednisone treatment may lead to a shortened course of chorea (4.0 weeks in prednisone-treated [n = 32] vs 9.0 weeks in untreated [n = 14]; P < .0001). Among 33 patients seen at a median of 10.3 years (range 6.3-14.9 years) after their initial bout of chorea, 20% reported residual tremor or mood swings. Ten of the 33 (30%) had one or more recurrences of chorea.


CONCLUSIONS
Chorea affected one-third of the children with RF. Patients with chorea were less likely to have severe cardiac or rheumatologic complications of RF. Therapy with prednisone shortened the duration of rheumatic chorea; some reported recurrences of chorea and had minor neurologic sequelae.
Walker
Adrianne R
AR
Department of Pediatrics, the University of Utah School of Medicine, Salt Lake City, Utah, USA.
Tani
Lloyd Y
LY
Thompson
Joel A
JA
Firth
Sean D
SD
Veasy
L George
LG
Bale
James F
JF
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002819:Chorea / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D012213:Rheumatic Fever / Q000150:complications*; D012307:Risk Factors
D005938:Glucocorticoids; D011241:Prednisone