Sodium gentisate in the treatment of acute rheumatic fever.

Five patients with acute rheumatic fever were treated with gentisate, the biologic oxidation product of salicylate. The clinical course of this group was contrasted with that of five patients who received salicylate. It was found that, in the doses employed, gentisate had an effect on the symptoms of acute rheumatic fever equal to that of salicylate, but that it produced none of the toxic reactions which were commonly found after salicylate administration. An oral dose of 2.0 Gm. of gentisate, every three hours, continued for at least ten days after the temperature became normal, was sufficient to control the symptoms of the disease. T HE VALUE of salicylates in the symptomatic management of acute rheumatic fever is well established." 2, 3On the basis of the suggestion that the activity of salicylate depends upon its biologic oxidation product, gentisate, Meyer and Ragan4 5 administered this drug to a series of patients with rheumatic fever. They noted that, despite the absence of toxic manifestations, clinical improvement ensued rapidly. The present report details observations on the effects of sodium gentisate in the treatment of five patients suffering from acute rheumatic fever. In an attempt to evaluate the usefulness of gentisate as an antirheumatic drug, the clinical course of this group of patients has been contrasted with the clinical course of five other patients with rheumatic fever who were treated with salicylates. METHODS AND MATERIAL The patients who were to receive salicylate or gentisate were selected by alternation. The diagnosis of acute rheumatic fever was based upon the presence of fever and polyarthritis, and upon the occurrence of cardiac abnormalities, electrocardiographic abnormalities , and a rapid sedimentation rate. All patients were maintained on absolute bedrest. Other than gentisate or salicylate, treatment was identical for the 10 patients. The course of the disease was determined by the clinical manifestations, serial elec-trocardiograms, white blood counts, and temperature and pulse determinations. Toxic manifestations of salicylate and of gentisate were assayed on the basis of abnormal bleeding tendencies, prolonged pro-thrombin times, neuropsychiatric abnormalities, gas-trointestinal disturbances, and alterations in renal and hepatic function. Following is a brief resume of the ten patients treated. a 13 year old Puerto Rican boy, had been a resident of New York City for one year. He suffered from frequent sore throats, the last occurring four days before admission, when he also developed pain and swelling of the shoulders, knees, and left ankle. On …