Rheumatism is an inflammation of connective tissue with predominant localization process in the cardiovascular system.
The development of rheumatic fever is closely related to prior acute or chronic nasopharyngeal infection caused by Streptococcus, direct or indirect damaging effects of its components and toxins in the body with the development of immune inflammation.
The electoral defeat of the heart valves and myocardium with the development of aseptic inflammation immune responsible protivostreptokokkovyh antibodies that cross-react with heart tissues (molecular masking).
An important role of genetic FAC tors, which is confirmed by the more frequent incidence of children from families in which one of the parents suffers from rheumatism.
Symptoms of rheumatism
Rheumatism characterized by variety of manifestations and variable course. It generally occurs at school age, less often in preschool children and almost never occurs in children under 3 years.
- In typical cases, the first signs of rheumatism in the form of fever, signs of intoxication (fatigue, weakness, headache), joint pain, and other manifestations of the disease are detected 2-3 weeks after sore throat or pharyngitis.
- one of the earliest signs of rheumatism are pain in joints, found in 60-100% of cases (rheumatoid arthritis).
- Rheumatoid arthritis is characterized by acute onset, involvement of the large or medium joints (usually the knee, ankle, elbow), fast reverse the development process.
- Signs of heart disease are identified in 70-85% of cases. Complaints of a cardiac nature (pain in the heart region, palpitation, dyspnea) were observed in severe heart disturbances.
- Frequently, especially early in the disease, there are a variety of asthenic manifestations (lethargy, malaise, fatigue).
The symptoms of rheumatism refers Annularly rash and rheumatic nodules.
Annularly rash (erythema annulare) is a pale pale pink rash in the form of a thin annular rim, not towering over the surface of the skin, and disappearing on pressure. The rash is found in 7-10% of patients with predominantly rheumatic fever at the peak of the disease and is usually unstable in nature.
Subcutaneous rheumatoid nodules are rounded, dense, sedentary, painless, single or multiple education with localization in the large and medium-sized joints, the spinous processes of the vertebrae, the tendons. Currently are rare, especially in severe form of rheumatism, persisting from several days to 1-2 months.
Pain in the abdomen, lungs, kidneys, liver and other organs rheumatism is currently very rare, mostly with his heavy flow.
Diagnosis of rheumatic fever
Often detected on ECG arrhythmias.
Radiographically (in addition to not always pronounced increase of the heart) are determined by the signs of decreasing myocardial contractility, change the configuration of the heart.
Ultrasound of the heart.
Laboratory parameters in patients with rheumatism reflect signs of streptococcal infection, the presence of inflammatory reactions and immunopathologic process.
The active phase is determined: leukocytosis with a left shift, increased erythrocyte sedimentation rate, often – anemia; increased rates of seromukoida, diphenylamino reactions; dysproteinemia with gipergammaglobulinemiej; increasing the LRA credits, ASLO, increased immunoglobulin (Ig) class A, M and G; C-reactive protein (CRP), circulating immune complexes, antibodies anticardiolipin.
The treatment of rheumatism
Treatment of rheumatic fever is based on the early appointment of a comprehensive therapy based on the inhibition of streptococcal infectiei inflammatory activity, and the prevention of development or progression of heart disease.
Implementation of these programmes are implemented by the sequence:
- phase I – inpatient treatment,
- phase II – follow-up care at a local cardio-rheumatology sanatoria,
- phase III – clinical supervision in the clinic.
1. At the first stage and in the hospital the patient is prescribed medication, correction of nutrition and exercise therapy, which are defined individually taking into account the characteristics of the disease and especially the severity of the damage to the heart.
Due to the nature of the streptococcal rheumatic fever treatment with penicillin.
- Antirheumatic therapy provides one of the nonsteroidal anti-inflammatory drugs (NSAIDs), which is administered alone or in combination with hormones in the statement.
- Antimicrobial therapy with penicillin should be performed within 10-14 days.
- In the presence of chronic tonsillitis with frequent exacerbations of focal infection the duration of treatment penicillin increase or additional use of another antibiotic – amoxicillin, macrolides (azithromycin, roxithromycin, clarithromycin), cefuroxime axetil, other cephalosporins in a dosage of age.
- NSAIDs are used at least 1-1. 5 months to eliminate signs of activity.
- Prednisone in an initial dose administered for 10-14 days to produce the effect, then reduce the daily dose by 2.5 mg every 5-7 days under the supervision of clinical and laboratory findings, follow-up, medication overturned.
- Length of treatment with quinoline drugs in rheumatoid arthritis ranges from a few months up to 1-2 years or more depending on the course of the disease.
In the hospital conducted a well as the elimination of chronic foci of infection, particularly surgery to remove the tonsils carried out in 2-2,5 months from the beginning of disease with no signs of activity.
2. The main task of phase II is to achieve complete remission and restore the functional capacity of the cardiovascular system.
The sanatorium continued in outpatient therapy, treating chronic infections, implement appropriate therapeutic regime with differentiated physical activity, therapeutic exercise, tempering procedures.
3. Stage III the treatment of rheumatism includes the prevention of relapses and of disease progression.
For this purpose, use drugs penicillin prolonged action, mainly bicillin 5, first, the introduction of which is carried out in the period of inpatient treatment, and in the future – 1 every 2-4 weeks year-round.
Regularly, 2 times a year, spend an outpatient examination, including laboratory and instrumental methods; prescribe the necessary recreational activities, exercise therapy.
In rheumatoid arthritis without involvement of the heart billingparadise conducted within 5 years after the last attack.
In the spring and autumn period along with the introduction bitsillina shown month course of NSAIDs.
Prevention of rheumatic fever
Prevention of rheumatic fever are divided into primary and secondary.
Primary prevention aims at prevention of rheumatic fever and includes:
1. Increasing the immunity (hardening, alternation of load and rest, good nutrition, etc.).
2. Identification and treatment of acute and chronic streptococcal infection.
3. Preventive measures at risk for developing rheumatic fever in children from families in which there have been cases of rheumatic fever or other rheumatic diseases; sickly nasopharyngeal infection; have chronic tonsillitis or after acute streptococcal infection.
Secondary prevention is aimed at preventing relapses and disease progression in patients with rheumatoid arthritis in terms of clinical supervision.