Rheumatism ( acute rheumatic fever ) - Causes, Symptoms and Treatment .MF .
Acute rheumatic fever or rheumatic disease - an inflammatory disease of connective tissue, caused by beta-hemolytic group A streptokkokom in genetically predisposed to it people.Most often affects children and young people from 7 to 20 years.
term « rheumatism » was officially replaced by « acute rheumatic fever » to emphasize that this is an acute inflammatory process that begins after undergoing streptokkokovoy infection (tonsillitis, pharyngitis, scarlet fever) and is its complication.
cause of rheumatism
The trigger mechanism for the development of rheumatic fever is a beta-hemolytic streptococcus group A. Streptokkovaya infection has a direct toxic effect on the heart and triggers an autoimmune process in which the body produces antibodies against its own tissues, especially the heart and the cells of the vascular wall.But this can happen only in the genetic predisposition to rheumatic fever body.More common in girls and women (70%) and first-degree relatives.
In economically developed countri
- crowding at the accommodation and training;
- a low level of health culture and health care;
- poor material living conditions, malnutrition.
symptoms of rheumatism
Typically, the first attack of rheumatic fever starts 2-3 weeks after undergoing streptokkokovoy infection.Suddenly or gradually, on a background of general malaise, increased body temperature to 37 degrees, the temperature rapidly rises to 38-39 degrees.temperature rise of rheumatism accompanied by chills, sweating.There are signs of polyarthritis (inflammation of the joints): swelling, redness of joints, pain at rest and during movement.Rheumatism affects large joints (knee, ankle, elbow, shoulder).For rheumatoid arthritis is characterized by: symmetry (simultaneously affects both knees or both ankles), consistency and volatility lesions (inflammation moves quickly from one joint to another).Full reversibility of joint inflammation, restore joint function within 2 days after taking NSAIDs (aspirin).
Rising temperatures rheumatism kept 2-5 days and normal when calms down arthritis.Sometimes at the beginning of the disease in the skin of the trunk and limbs appear unstable lesions.They look like pink rings - annular erythema.Rashes appear and disappear, leaving no trace.Characteristic for rheumatism, but an extremely rare symptom (up to 3% of cases) - subcutaneous rheumatic nodules.They range in size from a pea to a grain, dense painless, localized to the affected joints, back of the head.
main manifestation of rheumatic fever - heart failure - cardio, on the severity of which depends on the outcome of rheumatic fever.There are long-stabbing, aching pain in the heart, shortness of breath with little exertion, heart attacks, disturbances of the heart.Exodus carditis in 25% of cases is the formation of heart disease.
Rheumatic chorea - a manifestation of the nervous system.There are chaotic involuntary jerking of the limbs and facial muscles, grimacing, slurred speech, violation of handwriting, the inability to hold a spoon and fork while eating.Symptoms disappear completely during sleep.Chorea in rheumatic disease lasts 2 - 3 months.
duration of rheumatic fever is an average of 6-12 weeks.This period in which acute inflammation passes all stages.Rheumatic fever lasting more than 6 months, is viewed as a prolonged duration.A new episode of rheumatic fever usually occurs in the first 5 years after the first attack, and the likelihood of it dropping over time.The emergence of new attacks depends on the occurrence of repeated infections streptokkokovyh.
diagnosis of rheumatic fever.
1. Complete blood count - signs of inflammation (leukocytosis - increase in the number of white blood cells and accelerated ESR).
2. Biochemical analysis of blood - an increase of fibrinogen, protein C -reaktivnogo - indicators of the acute phase of inflammation.
3. Serological studies reveal antistreptokkokovye antibodies in high titers.
4. Bacteriological examination: identification of smears from the throat of beta-hemolytic group A. streptokkoka
5. Electrocardiography - reveals abnormal heart rhythm and conduction, increase (hypertrophy) of the heart.
6. Echocardiography with dopplerography reveals signs of damage to the heart valves, pump function and myocardial contractility, the presence of pericarditis.
diagnosis of rheumatic fever is doubtless formed in the presence of heart disease.In the absence of heart disease, the following criteria are used:
|Large||criteria Minor criteria|| Evidence of previous infection streptokkokovuyu |
| 1.Kardit. |
4. Annular erythema.
5. subcutaneous rheumatic nodules.
| Clinical: pain in the joints (arthralgia); |
Lab: signs of inflammation in the blood analysis.
| Tool: ECG changes.A Positive - streptokkokovaya culture isolated from the throat or |
positive test A quick definition - streptokkokovogo antigen.Increased antibody titers protivostreptokkokovyh.
presence of 2 large criteria or 1 large and 2 minor criteria combined with the data confirming the preceding streptokkokovuyu infection, indicating a high probability of rheumatic fever.
treatment of rheumatism.
success in the treatment of rheumatic fever and prevention of heart disease is associated with early detection of the disease and carrying out individual treatment.Therefore it is necessary at the first sign of inflammation contact your doctor (family physician, pediatrician, general practitioner).Treatment of rheumatic fever is carried out in a hospital.If you suspect a carditis mandatory bed rest.In rheumatoid arthritis is prescribed a diet rich in vitamins and protein, with the restriction of salt and carbohydrates.Spend etiotropic (antistreptokkokovoe) treatment of rheumatism - prescribe antibiotics according to the developed schemes.Anti-inflammatory treatment
- hormones (glucocorticoids - prednisone) and NSAIDs (non-specific anti-inflammatory drugs - aspirin, diclofenac), depending on the process activity.
next stage - the patients undergo rehabilitation (restorative) treatment in a specialized center (sanatorium).
Tritium stage - medical check-up at the family doctor (pediatrician, general practitioner).Each year, the patient is examined by a rheumatologist, ENT - physician, conducted laboratory tests, ECG, echocardiography.
complications of rheumatic fever.
The main complications include:
1. Formation of heart disease.
2. The development of congestive heart failure.
3. Irregular heartbeat.
5. The emergence of infective endocarditis (inflammation of the inner lining of the heart).
Chronic rheumatic heart disease (heart disease) - a disease that affects the heart valves, its walls, leading to cardiac dysfunction, heart failure formation.There after suffering rheumatic carditis.The progression of heart disease can occur under the influence of recurrent attacks of rheumatic fever.All patients with heart disease, consult surgeons and may be taken for surgical treatment in specialized clinics.
prevention of rheumatic fever.
Primary prevention of rheumatic fever - prevention of rheumatic fever in a healthy child.It includes activities aimed at increasing immunity (nutrition, hardening, physical education), the prevention of infection streptokkokovoy (improvement of people that surround the child, the elimination of congestion), full and timely treatment streptokkokovyh diseases.
Secondary prevention of rheumatic fever - is prevention of recurrence and progression of rheumatic fever, which has already occurred.It includes: medical check-up, the timely treatment of chronic infection, taking benzathine penicillin intramuscularly 1 every 3 weeks.The duration of secondary prophylaxis for each patient is established strictly individual, but not less than 5 years after the last attack, in patients who have had rheumatic fever without carditis and for life for patients with heart shaped defect.
Doctor's consultation on rheumatism:
Question: How is the treatment and prevention of rheumatic fever in pregnant women?
A: Occurrence of acute rheumatic fever in pregnant women is extremely rare, but in the event of illness a woman urgently need to be hospitalized in the therapeutic department of the hospital or a specialist for cardio - vascular disease hospital.Secondary prophylaxis with penicillin for pregnant women who have had rheumatic fever, it is necessary, especially in the first trimester of pregnancy, when the likely exacerbation of the disease.
therapists Vostrenkova IN