Treatment of rheumatic fever. Acute rheumatic fever (I00-I02). Medical therapy for rheumatism

Rheumatism or acute rheumatic fever in children and adults is characterized by an inflammatory reaction in the connective tissue. As a rule, the heart or vascular system is most often affected. In this condition, the patient's body temperature rises, multiple symmetrical pains in the movable joints occur, and polyarthritis develops. Only a doctor can confirm the diagnosis and choose the appropriate treatment based on the results of examinations.

With untimely detection of rheumatic fever, acute courses are formed on the skin, heart valves are damaged and other complications appear.

Etiology and pathogenesis

Acute and chronic rheumatic fever is caused by the activity of beta-hemolytic streptococci belonging to group A. The etiology of the disease highlights such negative factors that affect the development of pathology:

• Streptococcal infectious disease of acute or chronic course.
• Tonsillitis.
• Unfavorable living and working conditions.
• Seasonal weather changes.
• Age features. In children of 7-15 years of age, boys and women, rheumatic disease is observed more often than in other people.
• genetic predisposition.

The pathogenesis of acute rheumatic fever is quite complex and goes through several stages:

• mucoid swelling;
• fibrinoid changes;
• granulomatosis;
• sclerosis.

At the initial stage, the connective tissue swells, increases in size, and collagen fibers are split. Without treatment, the disease leads to fibrioid changes, as a result of which necrosis of fibers and cell elements is noted. In the third stage, rheumatoid arthritis provokes the appearance of rheumatic granulomas. The last stage is sclerosis with a granulomatous inflammatory reaction.

Classification

Acute rheumatic fever is divided into different forms and types, which depend on many indicators. When dividing the disease into types, the criteria for the activity of pathogens, the severity of the disease, and other parameters are taken into account. The table shows the main types of violation:

When a repeated fever occurs, the internal organs are significantly damaged, and irreversible processes occur.

Characteristic symptoms

In adults and children, acute rheumatic fever is manifested by different clinical signs. It is possible to detect a violation by the following symptoms:

• a sharp and unexpected increase in body temperature;
• symmetrical pain syndrome in the knee, shoulder, elbows and other parts of the body;
• swelling and redness in the tissues near the inflamed joints;
• inflammatory response in the components of the heart.

Pediatrics notes that in adolescent children, the disease manifests itself less acutely than in younger patients. The clinical picture differs depending on the form of acute rheumatic fever:

• Primary. Mostly, signs appear 21 days after infection with streptococci. The patient has a fever, increased sweat production, and a chilly feeling.
• Joint syndrome. It is characterized by swelling, pain in the damaged joint, which worries during exercise and at rest. As a rule, large symmetrical joints are damaged.
• Carditis. It proceeds with pain attacks in the zone of the heart, the heartbeat quickens, shortness of breath occurs even after minor physical activity.
• Rheumatic knots. Small balls are formed above the bone protrusions, which are more typical for children and pass on their own after 21-28 days.
• Annular erythema. The form of acute rheumatic fever is rare, and is characterized by pathological rashes on the skin. Pink spots are arranged in the form of a ring and soon disappear on their own.
• Rheumatic chorea. The nervous system is affected, because of which the muscles twitch in a person, speech becomes slurred and handwriting changes.

How is the diagnosis carried out?

It is sometimes difficult for doctors to identify acute rheumatic fever because the pathological signs are similar to those of other diseases. The examinations take into account different diagnostic criteria. To confirm the diagnosis, a comprehensive diagnosis is required, including such instrumental and laboratory studies as:

• echocardiogram using Doppler mode;
• an electrocardiogram that determines whether there are pathologies of contraction of the muscles of the heart;
• general blood test;
• analysis for antibodies against streptococcus;
• bacteriological smear from the oral cavity to determine the hemolytic streptococcal agent.

Equally important is the differential diagnosis, which makes it possible to distinguish the manifestations of acute rheumatic fever from the symptoms that occur with arthritis and other joint disorders. The doctor must differentiate the deviation from such pathologies:

• mitral valve prolapse;
• endocarditis;
• viral inflammation of the heart tissue;
• benign tumor in the atrium.

How to treat acute rheumatic fever?

Medical treatment

Complex therapy includes the use of drugs for acute rheumatic fever. The main groups of medicines:

• Antibiotics of the penicillin group. Used to eliminate the root cause of the disease. To achieve the result, you need to take funds for at least 10 days.
• Macrolides or lincosamides. Prescribed in case of allergy to penicillin. Roxithromycin or Clarithromycin is often used.
• Hormonal drugs or non-steroidal anti-inflammatory drugs. Required with a bright manifestation of carditis or serositis. Predominantly used "Prednisolone" until the elimination of pathological manifestations.

And also treatment includes the use of other means:

• "Diclofenac";
• "Digoxin";
• "Nandrolone";
• "Asparkam";
• "Inosine".

If during acute rheumatic fever there are disturbances in the work of the heart, then drugs for arrhythmia, nitrates, diuretic drugs are prescribed.

Acute rheumatic fever is one of the most severe complications (synonymous names for the pathology are rheumatic heart disease, Buino-Sokolsky's disease).

This disease is manifested by inflammatory damage to the connective tissue fibers and is characterized by lesions predominantly of the cardiac and articular tissues (lesions of the central nervous system and skin are rarely recorded at the moment).

It should be noted that the likelihood of developing the disease and the severity of its course largely depend on the presence of predispositions to the development of streptococcal infections. Also, the disease is 2.5 times more common in women.

Acute rheumatic fevers are one of the most common causes of hospitalization of patients under the age of twenty-four in cardiology departments. The most common acute rheumatic fever develops in patients from seven to fifteen years. In older patients, repeated attacks of fevers of rheumatic origin and chronic pathologies of the heart valves are more often recorded.

Attention. It should be noted that acquired heart defects, often resulting from acute rheumatic fever (ARF), are the leading causes of death in cardiac patients under the age of thirty-five.

For reference. Acute rheumatic fever is a post-infectious complication of streptococcal tonsillitis or pharyngitis, manifested as systemic inflammatory lesions of connective tissue fibers.

At the same time, ARF affects mainly the heart (carditis) and articular tissues (polyarthritis). Less common is the development of rheumatic chorea (damage to the tissues of the central nervous system) and annular erythema or rheumatic nodes (rheumatic lesions of the skin).

The development of ARF symptoms is a consequence of the development of autoimmune responses to antigens of streptococcal genesis, similar to the autoantigenic structures of the affected cells of the body.

Acute rheumatic fever - causes

The cause of the development of this disease is streptococci of beta-hemolytic types from group A.

For reference. At the same time, it must be taken into account that not all strains of streptococci are capable of leading to the development of ARF. Most often, ARF develops after suffering streptococcal diseases (tonsillitis, pharyngitis, etc.).

Streptococcal strains that cause streptococcal pyoderma of the impetigo type are unable to lead to the development of acute rheumatic fevers.

Usually, acute rheumatic fever in children is recorded much more often than in adults.

The symptoms of ARF have been described since ancient times, however, earlier this disease proceeded, as a rule, with the development of chorea. Modern acute rheumatic fever occurs mainly with:

• asymptomatic manifestations;
• a decrease in the incidence of severe lesions of the heart valves;
• isolated cases of damage to the central nervous system;
• low incidence of protracted and latent cases of the disease;
• an increase in the incidence of the disease among patients older than twenty years.

Risk factors for the formation of ARF are:

• the age of the patient is from five to twenty years;
• the presence of hereditary predispositions to the occurrence of diseases of streptococcal origin;
• living in areas with low temperatures and high levels of humidity;
• the presence of chronic foci of infection of streptococcal origin or the frequent development of acute infections;
• the presence of congenital pathologies of the cardiovascular system or autoimmune pathologies, accompanied by a systemic lesion of connective tissue fibers;
• burdened family history (frequent streptococcal infections in close relatives, pathologies of the cardiovascular system in relatives, family cases of acute rheumatic fevers, etc.);
• prematurity (in small and premature children, ARF is recorded more often in the future);
• the presence of carriage of B-lymphocyte alloantigens;
• the patient has the 2nd or 3rd blood group;
• the patient has high levels of neopretins and antibodies to cardiolipins;
• living in economically unfavorable regions;
• poor nutrition, beriberi, exhaustion;
• chronic lack of sleep and overwork;
• alcoholism or drug use, etc.

It should also be emphasized that due to irrational antibiotic therapy and the high frequency of self-treatment, there has been an increase in the number of antibiotic-resistant strains of beta-hemolytic streptococci.

Acute rheumatic fever - etiology

ARF develop after suffering diseases of streptococcal etiology. In most patients with ARF, in the most acute phases of the disease, high titers of antibodies to streptococcal agents are detected in the blood.

It should be noted that taking antibacterial agents with a high level of antistreptococcal activity helps prevent the development of repeated attacks of rheumatic fever.

In children in the neonatal period and patients under four years of age, infections of streptococcal etiology are rarely recorded.

Attention! The peak incidence is observed among patients from seven to fifteen years.

The transmission of infection of streptococcal origin is carried out by airborne droplets. The contact-household transmission mechanism (common household items, toys) is less commonly implemented.

Patients with acute streptococcal infections are the main source of infectious agents; less commonly, infection occurs from healthy carriers of streptococcal infections. The risk of infection from a healthy carrier is more often realized in people living with the carrier in the same apartment.

Rheumatism, Sokolsky's Disease - Buyo

Version: Directory of Diseases MedElement

Acute rheumatic fever (I00-I02)

Cardiology

general information

Short description

(ARF) is a systemic inflammatory disease of the connective tissue with a predominant lesion of the cardiovascular system, which develops in connection with acute A-streptococcal nasopharyngeal infection in persons predisposed to it.

Classification

Currently in use classification of the Association of Rheumatologists of Russia adopted in 2003.

Note.
* According to Strazhesko classification N.D. and Vasilenko V.Kh. .

** NYHA functional class.
*** The presence of post-inflammatory marginal fibrosis of the valve leaflets without regurgitation, which is specified using echocardiography.
**** In the presence of a newly diagnosed heart disease, it is necessary, if possible, to exclude other causes of its formation (infective endocarditis, primary antiphospholipid syndrome, degenerative valvular calcification, etc.).

Etiology and pathogenesis

The etiological factor is B-hemolytic streptococcus group A. The disease develops in connection with an acute or chronic nasopharyngeal infection. Of particular importance is M-protein, which is part of the cell wall of streptococcus. More than 80 varieties of M-protein are known, of which M-5, 6, 14, 18, 19, 24 are considered rheumatogenic. A necessary condition is also a hereditary predisposition (DR21, DR4, HLA antibodies; B-lymphocyte alloantigen D8 / 17) .

In the pathogenesis of rheumatism, the direct or indirect damaging effect of streptococcus on the body is important: streptolysin O, hyaluronidase, streptokinase have antigen properties. In response to the primary entry of these antigens into the blood, the body produces antibodies and restructures the immunological reactivity. The development of an allergic condition and impaired immunogenesis Immunogenesis - the process of formation of immunity
considered to be the main factors in the pathogenesis of rheumatism.
With new exacerbations of streptococcal infection, the accumulation of immune complexes in an increased amount occurs. In the process of circulation in the vascular system, they are fixed in the walls of the vessels of the microvasculature and damage them. Antigens at the same time come from the blood into the connective tissue and lead to its destruction (immediate type allergic reaction). Allergy is important in the pathogenesis of rheumatism. This is confirmed by the fact that the allergy does not begin during a sore throat, but 10-14 days or more after it.
Autoallergy is also important in the pathogenesis of rheumatism. The common antigenic structure of streptococcus and the connective tissue of the heart leads to damage to the membranes of the heart by immune reactions in them, with the formation of autoantigens and autoantibodies (molecular mimicry). Such autoantigens have a greater destructive effect on the endomyocardium than a single streptococcal antigen.
Due to the immune complex reaction, chronic inflammation develops in the heart. In addition to impaired humoral immunity (production of antibodies), cellular immunity also suffers with rheumatism. A clone of sensitized killer lymphocytes is formed, which carry fixed antibodies to the heart muscle and endocardium and damage them (delayed-type allergic reaction).

Epidemiology

The prevalence of rheumatic fever among children in different regions of the world is 0.3-18.6 per 1000 schoolchildren (according to WHO - 1999). The majority of patients with rheumatic heart disease are patients with acquired rheumatic heart disease.
Over the past 10 years, primary disability due to rheumatic fever is 0.5-0.9 per 10 thousand people (0.7 - in working age). This indicator does not tend to decrease.

Characteristic features of the modern course of ARF:
- relative stabilization of incidence in most countries;
- a tendency to increase the incidence at an older age (20-30 years);
- an increase in the frequency of cases with a protracted and latent course;
- asymptomatic and monoorganic lesions;
- reduction in the frequency of heart valve damage.

Factors and risk groups

- age 7-20 years;
- female (women get sick 2.6 times more often than men);
- heredity;
- prematurity;
- congenital anomalies of connective tissue, failure of collagen fibers;
- transferred acute streptococcal infection and frequent nasopharyngeal infections;
- unfavorable working conditions or living in a room with high humidity, low air temperature.

Clinical picture

Symptoms, course

The disease, as a rule, develops 2-3 weeks after a nasopharyngeal infection of streptococcal etiology. The severity of the debut depends on the age of the patient. In young children and schoolchildren, the onset of the disease is acute, in adolescence and older - gradual.

The main clinical manifestations of ARF:
- polyarthritis;
- carditis;
- chorea;
- erythema annulare Erythema - limited hyperemia (increased blood supply) of the skin
;

Carditis
It is the main clinical sign of ARF, which is observed in 90-95% of cases.
According to the recommendation of the American Heart Association (ACA), the main criterion for rheumatic heart disease is valvulitis. It presents as an organic heart murmur associated with myocarditis and/or pericarditis.
The leading symptom of rheumatic valvulitis is a prolonged blowing systolic murmur associated with the I tone and is a reflection of mitral regurgitation. Mitral regurgitation - mitral valve failure resulting in flow from the left ventricle into the left atrium during systole
. This murmur occupies most of systole, is best heard at the apex of the heart, and is usually conducted to the left axillary region. Noise can have different intensity (especially in the early stages of the disease); significant changes in the change of body position and breathing is not observed. The mitral valve is most commonly affected, followed by the aortic and rarely the tricuspid and pulmonic valves (see also I01.0, I01.1, I01.2 for details).

rheumatoid arthritis
It is noted in 75% of patients with the first attack of ARF.
The main characteristics of arthritis:
- short duration;
- good quality;
- volatility of the lesion with predominant involvement of large and medium joints.
Complete regression of inflammatory changes in the joints occurs within 2-3 weeks. With modern anti-inflammatory therapy, the regression time can be reduced to several hours or days (for more details, see subparagraph I00).

Chorea
It is a rheumatic lesion of the nervous system. It is observed mainly in children (less often in adolescents) in 6-30% of cases.
Clinical manifestations (pentad of syndromes):

Choreic hyperkinesis Hyperkinesis - pathological sudden involuntary movements in various muscle groups
;
- muscle hypotension up to muscle flabbiness with imitation of paralysis;
- static-coordination disorders;
- vascular dystonia Vascular dystonia - dystonia (pathological change in tone) of blood vessels, manifested by disorders of regional blood flow or general circulation
;
- psychopathological phenomena.
The diagnosis of rheumatic chorea in the absence of other criteria for ARF is carried out only after excluding other possible causes of damage to the nervous system: Hettington's chorea, systemic lupus erythematosus, Wilson's disease, drug reactions, etc. (for more information on differential diagnosis, see diseases of item I02).

Ring-shaped (annular) erythema
It occurs in 4-17% of cases. It manifests itself in the form of pale pink ring-shaped rashes, varying in size. Eruptions are mainly localized on the trunk and proximal extremities (but not on the face). Erythema is transient, migratory, not accompanied by itching or induration Induration - compaction of an organ or part of it as a result of some pathological process
and turns pale when pressed.

Rheumatic nodules
They occur in 1-3% of cases. They are round, painless, sedentary, quickly appearing and disappearing formations of various sizes on the extensor surface of the joints, in the area of ​​​​the ankles, Achilles tendons, spinous processes of the vertebrae, as well as in the occipital region of the hallea aponeurotica.

Children and adolescents with ARF may experience symptoms such as tachycardia without association with fever, abdominal pain, chest pain, malaise, anemia. These symptoms can serve as an additional confirmation of the diagnosis, but are not diagnostic criteria, as they are often found in many other diseases.

Diagnostics

Currently, in accordance with the WHO recommendations for ARF, the following apply as international Jones diagnostic criteria, revised by the American Heart Association in 1992.

Big Criteria:
- carditis;
- polyarthritis;
- chorea;
- annular erythema;
- subcutaneous rheumatic nodules.

Small Criteria:
- clinical: arthralgia, fever;
- laboratory: increased acute phase parameters: ESR and C-reactive protein;
- prolongation of the R-R interval on the ECG.

Data confirming a previous streptococcal A infection:
- a positive A-streptococcal culture isolated from the pharynx or a positive test for the rapid determination of A-streptococcal antigen;
- increased or rising titers of A-streptococcal antibodies.

The presence of two major criteria, or one major and two minor criteria, combined with evidence of prior infection with group A streptococci, indicates a high likelihood of ARF.

Instrumental Methods

1. ECG reveals rhythm and conduction disturbances, in the form of transient AV blockade of 1-2 degrees, extrasystole Extrasystole - a form of heart rhythm disturbance, characterized by the appearance of extrasystoles (a contraction of the heart or its departments that occurs earlier than the next contraction should normally occur)
, changes in the T wave in the form of a decrease in its amplitude and inversion. All ECG changes are unstable and change rapidly during treatment.

2. Phonocardiography used to clarify the nature of the noise detected during auscultation. With myocarditis, there is a decrease in the amplitude of the first tone, its deformation, pathological III and IV tones, systolic murmur, which occupies 1/2 systole.
In the presence of endocarditis, high-frequency systolic murmur, protodiastolic or presystolic murmur at the apex during the formation of mitral stenosis, protodiastolic murmur on the aorta during the formation of aortic valve insufficiency, diamond-shaped systolic murmur on the aorta during the formation of aortic stenosis are recorded.

3. Chest X-ray makes it possible to detect the presence of congestion in the pulmonary circulation (signs of heart failure) and cardiomegaly Cardiomegaly - a significant increase in the size of the heart due to its hypertrophy and dilatation
.

4. echocardiography is one of the most important diagnostic methods.

EchoCG signs of mitral valve damage:
- marginal thickening, friability, "shaggy" valve leaflets;
- restriction of mobility of the thickened rear sash;
- the presence of mitral regurgitation, the degree of which depends on the severity of the lesion;
- slight terminal prolapse Prolapse - downward displacement of any organ or tissue from its normal position; the cause of this displacement is usually the weakening of the surrounding and supporting tissues.
(2-4 mm) front or rear sash.

EchoCG signs of aortic valve damage:
- thickening, looseness of the echo signal of the aortic cusps, which is clearly visible in diastole from the parasternal position and in cross section;
- thickening of the right coronary leaflet is more often expressed;
- aortic regurgitation (direction of the jet to the anterior mitral leaflet);
- high-frequency flutter (flater) of the anterior mitral leaflet due to aortic regurgitation.

Laboratory diagnostics

There are no specific laboratory tests confirming the presence of rheumatism. However, based on laboratory tests, the activity of the rheumatic process can be assessed.

Determination of the titer of streptococcal antibodies- one of the important laboratory tests to confirm the presence of streptococcal infection. Already in the early stages of acute rheumatism, the levels of such antibodies increase. However, an elevated antibody titer does not in itself reflect the activity of the rheumatic process.

The most widely used test for the detection of streptococcal antibodies is determination of antistreptolysin O. In a single study, titers of at least 250 Todd units in adults and 333 units in children older than 5 years are considered elevated.

Also used for diagnostics isolation of group A streptococci from the nasopharynx by taking crops. Compared with the determination of the level of antibodies, this method is less sensitive.

Most commonly identified hematological indicators of the acute phase of rheumatism- ESR and C-reactive protein. In patients with acute rheumatic fever, these indicators will always be increased, with the exception of patients with chorea.

It should be borne in mind that all known biochemical indicators of the activity of the rheumatic process are nonspecific and unsuitable for nosological diagnosis. It is possible to judge the degree of disease activity (but not its presence) using a complex of these indicators in the case when the diagnosis of rheumatism is justified by clinical and instrumental data.

Significant biochemical parameters for diagnosis:
- plasma fibrinogen level above 4 g/l;
- alpha globulins - above 10%;
- gamma globulins - above 20%;
- hexoses - above 1.25 gm;
- seromukoid - above 0.16 gm;
- ceruloplasmin - above 9.25 gm;
- the appearance of C-reactive protein in the blood.

In most cases, biochemical indicators of activity are parallel to the values ​​of ESR.

Differential Diagnosis

The main diseases with which it is necessary to differentiate acute rheumatic fever

1. Non-rheumatic myocarditis(bacterial, viral).
Typical signs:
- the presence of a chronological relationship with acute nasopharyngeal (mainly viral) infection;
- shortening (less than 5-7 days) or lack of a latent period;
- in the debut of the disease, symptoms of asthenia, violations of thermoregulation are manifested;

Gradual development of the disease;
- arthritis and severe arthralgia are absent;
- cardiac complaints are active and emotionally colored;

There are clear clinical, ECG and EchoCG symptoms of myocarditis;
- valvulitis is absent;

Dissociation of clinical and laboratory parameters;

Slow dynamics under the influence of anti-inflammatory therapy.

2. Post-streptococcal arthritis.
May occur in middle-aged people. It has a relatively short latent period (2-4 days) from the moment of GABHS infection of the pharynx (group A beta-hemolytic streptococcus) and persists for a longer time (about 2 months). The disease is not accompanied by carditis, does not respond optimally to therapy with anti-inflammatory drugs, and completely regresses without residual changes.

3. Endocarditis in systemic lupus erythematosus, rheumatoid arthritis and some other rheumatic diseases.
These diseases are characterized by characteristic features of extracardiac manifestations. With systemic lupus erythematosus, specific immunological phenomena are detected - antibodies to DNA and other nuclear substances.

4. Idiopathic mitral valve prolapse.
With this disease, most patients have an asthenic type of constitution and phenotypic signs indicating congenital connective tissue dysplasia (funnel chest deformity, scoliosis of the thoracic spine, joint hypermobility syndrome, etc.). A thorough analysis of the clinical features of non-cardiac manifestations of the disease and Doppler echocardiography data help to make the correct diagnosis. For endocarditis, the variability of the auscultatory picture is characteristic.

5. Infective endocarditis.
The febrile syndrome in infective endocarditis, unlike ARF, is not completely stopped only by the appointment of NSAIDs, destructive changes in valves progress rapidly, and symptoms of heart failure increase. During Echo-KG, vegetations are found on the valves. Characteristic is the isolation of a positive blood culture. Viridescent streptococci, staphylococci and other gram-negative microorganisms are verified as pathogens.

6. Tick-borne erythema migrans.
It is a pathognomonic sign of early Lyme disease. In contrast to anular erythema, it is usually large (6-20 cm in diameter). In children, it often appears in the head and face, proceeds with itching and burning, regional lymphadenopathy.

7. PANDAS syndrome.

In contrast to rheumatic chorea, this syndrome is characterized by the severity of psychiatric aspects (a combination of obsessive thoughts and obsessive movements), as well as a significantly faster regression of the symptoms of the disease against the background of adequate antistreptococcal therapy alone.

Complications

Complications occur with a severe, protracted and continuously relapsing course. In the active stage, complications are atrial fibrillation Atrial fibrillation - an arrhythmia characterized by fibrillation (rapid contraction) of the atria with a complete irregularity of the intervals between heartbeats and the force of contractions of the ventricles of the heart
and circulatory failure. In the future - myocardiosclerosis (outcome of myocarditis) and the formation of valvular defects.

Treatment abroad

Acute rheumatic fever or rheumatism is an inflammatory disease of the connective tissue caused by group A beta-hemolytic streptococcus in genetically predisposed individuals. Most often, children and young people from 7 to 20 years old get sick.

The term " rheumatism" was officially replaced by " acute rheumatic fever"to emphasize that this is an acute inflammatory process that begins after a streptococcal infection (tonsillitis, pharyngitis, scarlet fever) and is its complication.

Cause of rheumatism

The trigger for the development of rheumatism is group A beta-hemolytic streptococcus. Streptococcal infection has a direct toxic effect on the heart and triggers an autoimmune process when the body produces antibodies against its own tissues, primarily the heart and cells of the vascular wall. But this can only happen in an organism genetically predisposed to rheumatic fever. Girls and women (up to 70%) and first-degree relatives get sick more often.

In economically developed countries, the incidence of rheumatism is negligible. Among the social conditions contributing to the occurrence of the disease include:

Crowding during living and learning;
- low level of sanitary culture and medical care;
- Poor material and living conditions, insufficient food.

Symptoms of rheumatism

In typical cases, the first attack of rheumatic fever begins 2-3 weeks after a streptococcal infection. Suddenly or gradually, against the background of general malaise, the body temperature rises to 37 degrees, the temperature quickly rises to 38-39 degrees. Temperature rises in rheumatism are accompanied by chills, sweating. There are signs of polyarthritis (inflammation of the joints): swelling, redness of the joints, pain at rest and during movement. Rheumatism affects large joints (knee, ankle, elbow, shoulder). Rheumatic polyarthritis is characterized by: symmetry (both knee or both ankle joints are simultaneously affected), the sequence and volatility of the lesion (inflammation quickly passes from one joint to another). Complete reversibility of joint inflammation, restoration of joint function within 2 days after taking NSAIDs (aspirin).

The temperature increase in rheumatism lasts 2-5 days and normalizes when the arthritis subsides. Sometimes at the beginning of the disease, unstable rashes appear on the skin of the trunk and extremities. They look like pink rings - annular erythema. Rashes appear and disappear without leaving traces. A characteristic, for rheumatism, but extremely rare symptom (up to 3% of cases) is subcutaneous rheumatic nodules. They have a size from a grain to a pea, dense, painless, localized on the affected joints, the back of the head.

The main manifestation of rheumatism is heart damage - carditis, the severity of which depends on the outcome of rheumatic fever. There are prolonged stabbing, aching pains in the region of the heart, shortness of breath with little physical exertion, palpitations, and disturbances in the work of the heart. The outcome of carditis in 25% of cases is the formation of heart disease.

Rheumatic chorea is a manifestation of damage to the nervous system. There are chaotic involuntary twitching of the limbs and mimic muscles, grimacing, slurring of speech, impaired handwriting, inability to hold a spoon and fork while eating. Symptoms completely disappear during sleep. Chorea with rheumatism lasts 2-3 months.

The duration of rheumatic fever averages 6-12 weeks. This is the period during which the acute inflammatory process goes through all stages. Rheumatic fever lasting more than 6 months is considered to be protracted. A new episode of rheumatism often occurs in the first 5 years after the first attack, and over time, its likelihood decreases. The emergence of new attacks depends on the occurrence of repeated streptococcal infections.

Diagnosis of rheumatism.

1. Complete blood count - signs of inflammation (leukocytosis - an increase in the number of leukocytes and accelerated ESR).
2. Biochemical analysis of blood - an increase in the content of fibrinogen, C-reactive protein - indicators of the acute phase of inflammation.
3. Serological studies reveal antistreptococcal antibodies in high titers.
4. Bacteriological examination: detection of group A beta-hemolytic streptococcus in throat swabs.
5. Electrocardiography - reveals violations of the heart rhythm and conduction, an increase (hypertrophy) of the heart.
6. Doppler echocardiography reveals signs of damage to the heart valves, pumping function and myocardial contractility, the presence of pericarditis.

Diagnosis of rheumatism is undoubted in the presence of a formed heart disease. In the absence of heart disease, the following criteria are used:

The presence of 2 major criteria or 1 major and 2 minor criteria, combined with evidence of a previous streptococcal infection, suggests a high likelihood of rheumatism.

Treatment of rheumatism.

Success in the treatment of rheumatic fever and the prevention of heart disease development is associated with early detection of the disease and individualized treatment. Therefore, it is necessary to contact your doctor (family doctor, pediatrician, therapist) when the first signs of inflammation appear. Treatment of rheumatic fever is carried out in a hospital. If carditis is suspected, bed rest is mandatory. In rheumatism, a diet rich in vitamins and protein is prescribed, with restriction of salt and carbohydrates. Etiotropic (antistreptococcal) treatment of rheumatism is carried out - antibiotics are prescribed according to the developed schemes.

Anti-inflammatory treatment - hormones (glucocorticoids - prednisolone) and NSAIDs (non-specific anti-inflammatory drugs - aspirin, diclofenac), depending on the degree of activity of the process.

The next stage - patients undergo rehabilitation (restorative) treatment in a specialized center (sanatorium).

The third stage is dispensary observation by a family doctor (pediatrician, therapist). Every year the patient is examined by a rheumatologist, an ENT doctor, laboratory tests, ECG, echocardiography are carried out.

Complications of rheumatism.

The main complications include:

1. Formation of heart disease.
2. Development of congestive heart failure.
3. Violation of the heart rhythm.
4. Thromboembolism.
5. The occurrence of infective endocarditis (inflammation of the inner lining of the heart).

Chronic rheumatic heart disease (heart disease) is a disease in which the valves of the heart, its partitions are affected, leading to dysfunction of the heart, the formation of heart failure. Occurs after rheumatic carditis. The progression of heart disease can occur under the influence of repeated attacks of rheumatic fever. All patients with heart defects are consulted by cardiac surgeons and are subject to referral for surgical treatment to specialized clinics.

Primary prevention of rheumatism is the prevention of the onset of rheumatic fever in a healthy child. It includes measures aimed at increasing immunity (good nutrition, hardening, physical education), prevention of streptococcal infections (improvement of people who surround the child, elimination of crowding), timely and complete treatment of streptococcal diseases.

Secondary prevention of rheumatism is the prevention of recurrence and progression of rheumatic fever that has already occurred. It includes: dispensary observation, timely treatment of foci of chronic infection, administration of benzathine benzylpenicillin intramuscularly 1 time in 3 weeks. The duration of secondary prevention for each patient is set strictly individually, but not less than 5 years after the last attack, for patients who have had rheumatic fever without carditis and for life for patients with a formed heart disease.

Consultation of a doctor on the topic of rheumatism:

Question: How is the treatment and prevention of rheumatism in pregnant women carried out?
Answer: The occurrence of acute rheumatic fever in pregnant women is extremely rare, but if a disease occurs, a woman must be urgently hospitalized in the therapeutic department of a hospital or in a maternity hospital specialized in cardiovascular pathology. Secondary prophylaxis with penicillin in pregnant women who have had rheumatic fever is necessary, especially in the first trimester of pregnancy, when the likelihood of an exacerbation of the disease is high.

Therapist Vostrenkova I.N.

Acute rheumatic fever occurs after a person has had a respiratory tract infection caused by group A B-hemolytic streptococcus.

The main diseases, the course of which is complicated with acute rheumatic fever

It is important to note that rheumatic fever appears only after infection of the lymphoid structures of the pharynx. The skin, soft tissues, and other areas of the body can also be affected by hemolytic streptococci. But there is no complication of acute rheumatic fever.

There are differences in the body's immune responses. The processes are activated in response to the deformation of the pharynx and skin, as well as after various antigenic compositions of streptococci, which are involved in the formation of these infectious diseases.

Rheumatic fever may appear due to:

1. Acute tonsillitis - tonsillitis. Tonsillitis is an inflammation of the lymphoid structures of the pharynx of an infectious nature. First of all, the tonsils suffer. The disease begins with an increase in general temperature and obvious pain in the throat. Then there is reddening of the mucosa of the palatine tonsils. Ulcers or a white coating may appear on the tonsils.
2. Pharyngitis is an inflammation of the pharyngeal mucosa, which appears as a result of streptococcus entering the nasopharynx. When pharyngitis tickles in the throat, there is a dry and painful cough. Body temperature rises to 38.5 degrees.
3. Scarlet fever is an infectious disease that is manifested by a frequent rash on the skin, as well as symptoms of intoxication: chills, fever, headaches. In addition, the lymphoid structures of the pharynx are affected by the type of acute tonsillitis.

All of these diseases can be caused by other causes - viruses and bacteria.

The mucous membrane of the pharynx becomes inflamed when hot or hot air or chemicals are inhaled. But ARF appears only after infection with group A B-hemolytic streptococcus.

Today, calling the disease “rheumatism” is not entirely correct, since this definition can be applied to any primary heart lesion. Instead, the term "acute rheumatic fever" or Sokolsky-Buyo disease has come into use, which indicates the connection of the disease with infection. But, if we use the "old" version in the article, everyone will know what is at stake.

Acute rheumatic fever or rheumatism is a systemic disease that develops as a complication of a respiratory infection - tonsillitis, pharyngitis, and other forms, the causative agent of which is beta-hemolytic streptococcus A.

The pathological process affects the connective tissue and has a systemic nature of the lesion. Rheumatism affects mainly the cardiovascular system, joints, brain and skin.

Rheumatism (Sokolsky-Buyo disease) is a systemic inflammatory disease of the connective tissue with a predominant localization of the process in the cardiovascular system, which develops in connection with an acute infection (group A hemolytic streptococcus) in predisposed individuals, mainly children and adolescents (7-15 years old).

Causes and mechanism of development of rheumatism

Causes of rheumatism

Complications of acute respiratory disease caused by certain strains of group A hemolytic streptococcus. Poor living conditions, unsanitary conditions lead to greater susceptibility to infections. Malnutrition, malnutrition is a predisposing factor for infection.

Fever, joint pain, painful, enlarged joints (most often knees, ankles, but elbows and wrists can also be affected). Soreness and swelling may disappear in some joints and appear in others. Subcutaneous nodules in places of bony prominences. Rash on trunk, arms and legs. Rapid involuntary contractions of the muscles of the face, arms and legs.

The first attack of rheumatic fever, as well as relapses of this disease, are associated with the action of group A beta hemolytic streptococcus. This pathogen acts on connective tissue cells with its toxins, which leads to the production of antibodies by the body against its own organs.

Predisposing factors for this disease are:

• heredity;
• transferred streptococcal diseases;
• a history of frequent respiratory colds;
• young age;
• hypothermia.

Rheumatism is a disease that is infectious in nature. In rheumatism, beta-hemolytic group A streptococcus causes disease when it enters the human body and provokes primary bacterial diseases (scarlet fever, pharyngitis, tonsillitis, etc.). Although it should be noted that rheumatism in the body due to streptococcus does not develop in everyone, but in certain cases.

Rheumatism is caused by the previously mentioned streptococcal infection. There are certain strains of beta-hemolytic streptococcus A that can cause rheumatic fever. With regard to rheumatism, the term "molecular mimicry" or cross-reactivity is used. This concept explains the "similarity" of the pathogen with the cells of the connective tissue of the body.

Therefore, when a person’s immunity begins to fight an infection, it “gets” not only the cause of all troubles - streptococcus, but also the connective tissue. The immune system begins to fight with its own body.

Rheumatism is for the young. It occurs most frequently among young people aged 8 to 15 years.

Girls get sick more often than boys. The disease occurs at an earlier and older age.

Rheumatism is included in the group of difficult to understand diseases - autoimmune systemic lesions. Science has not yet fully figured out the true causes of these diseases.

But there is scientific evidence that shows a clear relationship between rheumatism and streptococcal infection (group A streptococci).

The following data testify to the streptococcal etiology of the rheumatic process:

• the first attack of rheumatism occurs in the period after a streptococcal infection - tonsillitis, pharyngitis, streptoderma, etc. (the first symptoms usually develop after 10-14 days);
• morbidity increases with epidemic outbreaks of respiratory infections;
• increase in the titer of antistreptococcal antibodies in the blood of patients.

Streptococcal etiology most often have classic forms of rheumatism, which occur with obligatory damage to the joints of the legs and arms. But there are cases when the primary attack of the disease proceeds hidden and without damage to the articular apparatus.

The cause of such variants of the disease are other pathogens, respiratory viruses will play a large role.

In such cases, the disease is often diagnosed already at the stage of a formed heart disease. Therefore, articular rheumatism is a kind of warning to the body that something has gone wrong and it is necessary to act.

Individual sensitivity to an infectious agent also plays an important role, because not everyone who has a sore throat develops rheumatism. Here the genetic predisposition of a person plays a role, as well as the individual characteristics of the immune system, its tendency to hyperactivation with the development of allergic and autoimmune reactions.

It is very difficult to explain the mechanism of damage to the membranes of the joints and heart in rheumatic inflammation. By some mechanism, pathogenic microorganisms “force” the human immune system to “work against itself”.

As a result, autoantibodies are formed that affect the own membranes of the joints with the development of rheumatoid arthritis and the membranes of the heart with the development of rheumatic heart disease, resulting in the formation of heart defects.

It's important to know! Rheumatism ranks first among the causes of acquired heart defects. And it is young people who suffer the most.

The causes of acute rheumatic fever have been established (this is what distinguishes it from other rheumatic diseases). The reason for it is in a special microorganism called "group A beta-hemolytic streptococcus." After weeks of streptococcal infection (pharyngitis, tonsillitis, scarlet fever), some patients develop acute rheumatic fever.

It is important to know that acute rheumatic fever is not an infectious disease (such as intestinal infections, influenza, etc.)

The consequence of infection is a disruption of the immune system (there is an opinion that a number of streptococcal proteins are similar in structure to articular proteins and heart valve proteins; the consequence of the immune response to streptococcus is an erroneous "attack" of the body's own tissues in which inflammation occurs), which is the cause of the disease.

The triggering factor of rheumatism is the transferred diseases caused by group A β-hemolytic streptococcus.

In the pathogenesis of the development of true rheumatism, the participation of autoimmune mechanisms is assumed, as indicated by the presence of cross-reactivity between the antigens of streptococcus and human heart tissue, as well as the presence of cross-reactive "anti-heart" antibodies in patients, the cardiotoxic effect of a number of streptococcal enzymes.

The tissue changes are based on the processes of systemic disorganization of the connective tissue in combination with specific proliferative and non-specific exudative-proliferative reactions in the tissues surrounding small vessels, with damage to the vessels of the microcirculatory bed.

Rheumatism is the main cause of heart disease with subsequent disability, especially in young people of working age. In Russia, for many years, a deep scientific study of the causes of this disease, the influence of external factors and the mechanism of damage in rheumatism of internal organs has been fruitfully carried out.

Methods for the prevention and early effective treatment of rheumatism have been scientifically developed, especially by improving the working conditions of the professions most affected by rheumatism and identifying early forms of the disease in adolescents with their inpatient treatment, and further treatment with physio-balneotherapy methods in sanatoriums and resorts with long medical examinations.

All these measures, widely used in our country by the health authorities, have ensured significant success in the fight against rheumatic fever.

Rheumatism is a general disease that affects the whole body and especially its mesonchymal formations. The main clinical triad in rheumatism is the defeat of the heart, joints and serous membranes.

Etiology and pathogenesis. Initially, rheumatism was understood as a volatile lesion of many joints (from the Greek rheum a, rheo-toku), but more than 100 years ago, Buyo and Sokolsky quite convincingly established a natural lesion in this heart disease (which is why rheumatism is proposed to be called Sokolsky-Buyo disease).

In a monograph on chest diseases, already in 1838, the domestic therapist Sokolsky gives a separate chapter "Rheumatism of the heart."

From the first decades of this century, the doctrine of rheumatism has been established as a specific chronic disease of the internal organs with peculiar morphological changes and, accordingly, the clinical picture changing in connection with the development of the disease.

Morphologically, rheumatism is characterized by specific changes, mainly of a productive nature - rheumatic granulomas - and non-specific, predominantly exudative, lesions of parenchymal and any other organs.

Rheumatic granuloma, according to the studies of 15. T. Talalaeva, goes through three stages for 5-6 months:

• alterative-exudative with a particularly characteristic fibrinoid swelling of the intercellular substance;
• the formation of the actual granuloma;
• development of sclerosis.

In all stages, including the stage of long-term sclerosis, due to the peculiarities of its small-focal location, these tissue changes make it possible to accurately recognize the morphologically rheumatic nature of the disease.

Nonspecific exudative changes are located around the granule, causing, with significant development, the special severity of myocardial damage, often characteristic of childhood and adolescence.

Exudative phenomena form the basis of rheumatic polyarthritis and pleurisy, which give such a vivid clinical picture. In the absence of an exudative reaction, the tissue rheumatic process can proceed latently, nevertheless leading over the years to rheumatic sclerosis with disfigurement of the heart valves (rheumatic heart disease), infection of the heart bag, etc.

In etiological terms, rheumatism is associated with infection with hemolytic streptococcus and a kind of allergic (hyperergic) reaction of the body, which is why it is more correct to attribute rheumatism to infectious-allergic diseases.

Therefore, the proposed names of the disease, characterizing only its infectious side (rheumatic infection, rheumatic fever), as well as characterizing only specific morphological changes (rheumatic granulomatosis), cannot be considered rational.

Unlike other diseases of the joints, rheumatism is also called true rheumatism, acute rheumatism; however, the term "rheumatism" in the correct, narrower modern sense should be recognized as clear enough.

Patients with rheumatism form antibodies and streptococcus, and phenomena of hypersensitivity to the streptococcal antigen are found. By long-term administration of sulfonamide preparations, as well as penicillin to a certain extent, apparently, it is possible to prevent the progression of rheumatism, the recurrence of articular attacks and relapses of carditis.

There are two main causes of rheumatic fever.

Aggression of beta-hemolytic streptococcus A - type

The main factor causing the disease is a strain of streptococcal infection A - type. Most often this occurs against the background of transferred ENT - diseases:

• purulent tonsillitis;
• scarlet fever;
• pharyngitis.

hereditary factor

Despite the high pathogenicity of the strain, not everyone is at risk of getting rheumatism. And only those who have a specific antigen in the body, thereby determining a hereditary predisposition to acute rheumatic fever.

Allocate the main causes and additional factors for the development of fever.

Aggression of beta-hemolytic streptococcus A-type

Rheumatic fever typically develops 3 to 4 weeks after scarlet fever, tonsillitis, or pharyngitis, caused by certain strains of Gram-positive streptococcus that are highly contagious. After the introduction of the pathogen into the blood, the normal functioning of the body's immune complexes is disrupted.

4Clinical picture

The first symptoms of rheumatism appear 1-3 weeks after the infection of the upper respiratory tract. If the patient is recurrently ill with acute rheumatic fever, the period of development of clinical manifestations is reduced. In view of the variety of clinical manifestations, it is advisable to divide them into systems.

The insidiousness of acute rheumatic fever is that it "bites" the heart. There is a concept of chronic rheumatic heart disease, when a heart defect is formed - mitral insufficiency, less often aortic valve.

3Classification

By
downstream:

1. chronic
   (recurrent and pessimistic)

By
localization:

tonsillitis

pharyngitis

stomatitis

gingivitis, etc.

• According to clinical variants, there are: primary and repeated fever;
• According to clinical manifestations: carditis, arthritis, rheumatic chorea, skin erythema, rheumatic nodules;
• According to the degree of activity, rheumatic fever is:

1. minimum
2. moderate,
3. high;

• Outcome: recovery, transition to rheumatic heart disease with or without heart defects;
• According to the degree of chronic heart failure: 4 functional classes (I-IV).

The first thing to clarify is that the term “rheumatism” was changed to “rheumatic fever” in 2003, but in modern literature you can find 2 names of the disease. There are 2 clinical variants of the disease:

1. Acute rheumatic fever.
2. Recurrent (repeated) rheumatic fever (according to the old classification, a recurrent attack of rheumatic fever).

It is also mandatory to determine the activity of inflammation using a set of laboratory tests (inactive phase, minimal, medium and high activity).

In the case of the formation of heart disease, rheumatic heart disease is isolated separately with the definition of its type and stage, as well as the stage of heart failure.

ORL is classified according to several indicators:

• depending on the phase of the disease;
• according to clinical indicators;
• according to the degree of involvement in the inflammatory process of various body systems.

Primary and recurrent rheumatic fever

The primary form of the disease begins suddenly, has pronounced symptoms and an active inflammatory process. If timely therapeutic help is provided, treatment can be quick and effective.

Re-infection as a result of hypothermia, stress causes a relapse and a progressive course of rheumatism.

Classification according to the manifestations of the disease

How does rheumatic fever progress in children?

Acute rheumatic fever in children is more severe than in adults and often has complications. Basically, the heart and joints suffer, irreversible processes develop, which in the future can cause disability. Children are more likely to develop heart disease, carditis and stenosis.

Unfortunately, rheumatism in most cases chooses children and adolescents as its victim, while in these same patients in adulthood and old age the disease usually recurs, and inflicts a new blow on the joints and heart.

A baby with acute rheumatism usually has to be placed in a hospital for a long (1.5-2 months) course of treatment. The therapeutic strategy is selected individually, based on the location, severity of the inflammatory process and the degree of destructive effect on the heart.

Healing rheumatism in children is not only taking medication, but also special physiotherapy procedures and a special diet. But first things first.

Analgin or amidopyrine - 0.15-0.2 grams for each year of the baby's life per day, but less than 2.5 grams;

Aspirin (acetylsalicylic acid) - 0.2-0.25 grams per year of life per day;

Sodium salicylate - 0.5 grams per year of life per day, the dose is divided into 4-6 doses and after the acute symptoms of rheumatism subside, they are evenly reduced, but not earlier than a month after the first registered attack of the disease;

Butadion - for children under 7 years old, 0.05 g three times a day, from 8 to 10 years old - 0.08 g each, and for children over 10 years old - 0.1-0.12 g each.

In modern practice for the treatment of rheumatism in children, combined preparations of pyrabutol and reopyrin are often used, which contain both amidopyrine and butadion at the same time. The dose is also calculated based on the age of the small patient.

At the first, acute stage of the course of rheumatism, it is possible to overcome the inflammatory process and prevent irreversible damage to the membranes of the heart only with the help of synthetic hormones - corticosteroids. The most popular representatives of this class of medicines for the treatment of rheumatism are Voltaren and Indomethacin (Metindol). Hormone therapy is carried out for more than a month.

Therapy of sluggish rheumatism in children

If the disease develops very slowly, and until it causes tangible damage to the heart muscle, it is realistic to avoid the purpose of glucocorticoids, and instead of hormones, use drugs from the chloroquine group - Plaquenil or Delagil. The dose is calculated based on body weight: 0.5-10 mg per kilogram.

A child over 7 years old is still purposefully prescribed a hormonal product to suppress the inflammatory process: prednisolone, dexamethasone, triamcinolone at a dose of 10 to 20 mg per day, depending on age, weight and the nature of the course of rheumatism.

If there are parallel infectious processes in the body, for example, a cold, then in addition to corticosteroids, a 14-day course of drugs is prescribed. The choice of product is at the discretion of the treating doctor and depends on the type of infection.

In addition to medical treatment, dry heat, solux heating, ultraviolet and UHF irradiation are used. Sluggish rheumatism in babies does not require a permanent stay in the hospital - usually the child is treated at home and visits the treatment room.

Therapy of acute rheumatism in children

If the baby is diagnosed with pathological changes in the cardiovascular system and circulatory deficiency, he is shown treatment with products of the glycoside group: 0.05% strophanine, foxglove extract (0.03-0.075 g three times a day), 0.06% -ny substance of corglicon. In addition to glycosides, diuretics are used to treat acute rheumatism in children: phonurite and aminophylline.

With rheumatic fever, it is purposeful to add B vitamins to the standard set of drugs and corticosteroids (first, pyridoxine 50 mg per day), as well as vitamin C in a glucose solution (1 ml of a 5% solution for 10-15 ml of a 20% solution) for maintenance of the body; the introduction is carried out intramuscularly, the course is 10 days.

To relieve pain and dull the severity of symptoms in the treatment of acute childhood rheumatism, novocaine and drugs of the antihistamine group are used: claritin, cetrin, loratadine.

The course of treatment of acute rheumatism in children takes on average from one and a half to 2 months. Then the baby is sent for another couple of months to a sanatorium and resort institution, to gain strength and recover from a serious illness.

Despite the final cure, all children who have had rheumatism are given an unusual medical card form No. 30, which is kept in the hospital by the local pediatrician and serves as an invariable reminder of the special status of a small patient.

Modern methods of treating rheumatism allow in 85-90% of cases to count on a complete cure for the baby, but still, 10-15% of babies cannot avoid the development of heart disease. If such a misfortune happened, you will have to avoid physical activity for the rest of your life, adhere to a special diet and take maintenance drugs.

That is why it is so important to sound the alarm in time and consult a doctor at the first sign of a serious illness.

The most experienced rheumatologist at the first step in the treatment of rheumatism throws all his strength into the suppression of streptococcal infection, since it was she who served as the main prerequisite for the development of the disease. The second most important after bactericidal therapy is hormonal therapy, since the current inflammatory process is very active and threatens with irreversible destructive changes in the heart.

The third most important place can be put on immunomodulatory therapy, spa and physiotherapy treatment, dispensary observation, hardening - in a word, all the measures necessary to prevent relapses of rheumatism and return the patient to a healthy, active life.

Therapy in a hospital (1.5-3 months);

Healing in a special sanatorium with a cardio-rheumatological direction;

Constant visits to the hospital for dispensary records.

Medical therapy for rheumatism

Antimicrobial, anti-inflammatory, corticosteroid, antihistamines are included in the basic composition of the antirheumatic program. painkillers, immunomodulating drugs, also cardiac glycosides, NSAIDs (non-steroidal anti-inflammatory drugs of the latest generation), vitamins, potassium and magnesium.

The main goal of hormone therapy is to avoid the development of pancarditis, a complete defeat of all membranes of the heart. To stop an acute inflammatory process, a patient under constant dynamic ECG monitoring is administered corticosteroids for 10-14 days: prednisolone or methylprednisolone.

You can enhance the anti-inflammatory effect with products such as diclofenac: diclobene, dicloran, voltaren. They are taken either orally (in pills) or rectally (in suppositories).

A new word in the non-hormonal treatment of rheumatism is NSAIDs (non-steroidal anti-inflammatory drugs): aertal, ketonal, nemulid, ambene, nimasil, celebrex. The latter product at a dose of 200-400 mg/day is a good choice, as it combines the highest efficiency and complete safety within itself - Celebrex practically does not give side effects from the gastrointestinal tract, unlike other anti-inflammatory drugs.

Amoxicillin - 1.5 g three times a day;

Benzathinepenicillin - injectable in case of severe side effects from the gastrointestinal tract with oral administration of penicillins;

Cefadroxil - or another antibiotic from the cephalosporin group, 1 g twice a day in case of intolerance to penicillins.

Treatment of protracted and often recurrent rheumatism is carried out with the introduction of cytostatic immunosuppressants: azathioprine (Imuran), chlorbutin, endoxan, 6-mercaptopurine. Chlorbutin is prescribed at 5-10 mg per day, and the calculation of other drugs in this group is based on the patient's body weight: 0.1-1.5 mg / 1 kg.

Immunosuppressants are the last measure that has to be taken in order to suppress the inadequate immune hyperreaction to the infectious agent.

There are many ways of alternative medicine to get rid of this pathology. According to doctors, such methods are quite effective, but in terms of effectiveness they cannot be compared with drug treatment. Therefore, it is better to use them in parallel.

Rheumatic fever and pregnancy

According to statistics, women are more prone to rheumatism, so not a single representative of the weaker sex is immune from this disease, especially at a young age.

If infection occurs during pregnancy, doctors recommend interrupting it, as the consequences can be unpredictable for both the fetus and the mother.

Previous ARF may present with complications during pregnancy. An increasing load on the heart with an increase in the term can worsen the condition of the pregnant woman and cause pulmonary edema during childbirth. The greatest danger is valvular heart disease, which can develop during pregnancy.

In order to minimize the risks during gestation and delivery, pregnancy planning is necessary. As a rule, such women undergo a caesarean section, and throughout the pregnancy they are observed in a hospital. Contraindication for pregnancy and childbirth is only the acute phase of the disease.

The main symptoms and signs of current rheumatism

As a rule, rheumatism in children or adults develops acutely, a few weeks after suffering tonsillitis or pharyngitis of streptococcal etiology.

When the child, it would seem, has almost recovered and is ready to return to the educational and labor process, his temperature rises sharply to 38-39 degrees.

There are complaints of symmetrical pains in large joints (most often knees), which are clearly migratory in nature (today my knees hurt, tomorrow my elbows, then my shoulders, etc.). Soon pain in the heart, shortness of breath, palpitations join.

Rheumatic carditis

Damage to the heart during the first rheumatic attack is observed in 90-95% of all patients. In this case, all three walls of the heart can be affected - endocardium, myocardium and pericardium. In 20-25% of cases, rheumatic carditis ends with a formed heart disease.

The main feature of heart damage in rheumatism in children and adults is the extreme scarcity of manifestations. Patients complain of discomfort in the region of the heart, shortness of breath and cough after exercise, pain and interruptions in the region of the heart.

As a rule, children are silent about these complaints, not attaching serious importance to them. Therefore, heart damage is most often detected already during physical and instrumental examination.

rheumatoid arthritis

Very often, joint damage in rheumatism comes to the fore. As a rule, the inflammatory process in the joints begins acutely, with severe pain, swelling and redness of the joints, an increase in temperature above them, and restriction of movement.

Joint rheumatism is characterized by damage to joints of large and medium caliber: elbow, shoulder, knee, radius, etc. Under the influence of treatment, all symptoms quickly disappear without consequences.

Rheumatism affects the heart (carditis), joints (polyarthritis), brain (small chorea, encephalopathy, meningoencephalitis), eyes (myositis, episcleritis, scleritis, keratitis, uveitis, secondary glaucoma, retinovasculitis, neuritis), skin and other organs (pleurisy , abdominal syndrome, etc.).

The clinical symptoms of true rheumatism are extremely diverse. There are several periods of development of the rheumatic process.

I period (latent period of the disease) includes the interval between the end of a sore throat, acute respiratory disease or other acute infection and the initial symptoms of rheumatism; lasts from 2 to 4 weeks, proceeding either asymptomatically or as a state of prolonged convalescence.

II period - rheumatic attack.

III period is manifested by various forms of recurrent rheumatism. More often, protracted and continuously recurrent variants of the course of the disease are found, leading to progressive circulatory failure, as well as to other complications that determine the unfavorable outcome of rheumatism.

Eye symptoms of rheumatism

Involvement in the pathological process of the eyes in patients with rheumatism occurs in the form of rheumatic tenonitis, myositis, episcleritis and scleritis, sclerosing keratitis, uveitis, retinovasculitis.

Symptoms of rheumatism

The first symptoms of ARF appear 2-2.5 weeks after the illness, usually after tonsillitis or pyoderma. A person's general well-being worsens, body temperature can rise to 38-40 degrees, joints hurt and swell, the skin turns red.

Palpation is painful, as is movement of the joints. Usually the large joints of the body (knee and elbow) are affected, rarely the joints of the hands and feet.

Inflammation of the joints is usually observed simultaneously on two limbs.

In this case, the pain is migratory, that is, it can move from one joint to another. These are manifestations of arthritis, which lasts no more than 10 days.

After some time, the signs of arthritis disappear, more often in children, and in adults sometimes arthritis can develop into Jacques syndrome, characterized by deformation of the bones of the hands without compromising the functions of the joints. As a result of repeated attacks, arthritis affects more joints, becoming chronic.

Simultaneously with the symptoms of arthritis, rheumatic heart disease (heart damage) also develops. Sometimes there are no symptoms, but more often there is arrhythmia, shortness of breath, aching pain in the heart and swelling.

Even with a mild course of rheumatic heart disease, the heart valves are affected, they shrink and lose their elasticity. This leads to the fact that they either do not open completely or do not close tightly, and valvular defect is formed.

Usually, rheumatic heart disease occurs at a young age of 15 to 25 years, and almost 25% of patients suffer from rheumatic heart disease as a result, especially in the absence of adequate treatment. By the way, ARF accounts for approximately 80% of acquired heart defects.

Many have a monosymptomatic course of ARF, with a predominance of symptoms of arthritis or rheumatic heart disease.

Rheumatism cannot be considered a single disease - harmful substances that enter the body from streptococcus affect almost all systems and organs. Therefore, the first signs of rheumatism do not make it possible to correctly diagnose rheumatism - if it developed after a cold / infectious disease, then the symptoms will be similar to those that have already been, many patients take them for a “relapsing” disease.

Judge for yourself what refers to the first symptoms of acute rheumatism:

• increased heart rate;
• an increase in body temperature up to 40 degrees;
• swelling and pain in the joints;
• general weakness and constant drowsiness.

The main symptoms of acute rheumatic fever are:

• increase in body temperature;
• an increase in volume and soreness, swelling more often of the knee, ankle joints, less often of the elbow, wrist;
• the appearance of subcutaneous nodules;
• the presence of a rash on the body;
• unconscious contraction of the muscles of the body.

Signs of rheumatism are very diverse and depend primarily on the activity of the process and the damage to various organs. As a rule, a person becomes ill 2-3 weeks after a respiratory infection.

The disease begins with an increase in temperature to high values, general malaise, signs of an intoxication syndrome, sharp pains in the joints of the arms or legs.

Symptoms of joint damage in rheumatism:

• rheumatic pains in the joints are characterized by a pronounced intensity, as a rule, the pain is so severe that patients do not move even a millimeter of the affected limb;
• joint damage is asymmetric;
• as a rule, large joints are drawn into the pathological process;
• pain is characterized by a symptom of migration (gradually, one after another, all the large joints of the body hurt);
• the joints swell, the skin over them becomes red and hot to the touch;
• movement in the joints is limited due to pain.

As a rule, the symptoms of acute rheumatic fever appear two to three weeks after the infection caused by streptococci (in most cases - tonsillitis, less often - skin infections - pyoderma).

The state of health worsens, the temperature rises, soreness, redness and swelling of the joints (arthritis) appear. As a rule, medium and large joints are involved (knee, shoulder, elbow), in rare cases, small joints of the feet and hands.

Migratory pains may appear (they change location, may be in different joints). The duration of inflammation of the joints (arthritis) is no more than one week - ten days.

Simultaneously with arthritis, rheumatic heart disease develops - joint damage. In this case, both minor changes can appear, which can be detected only with a special examination, and severe lesions, accompanied by palpitations, shortness of breath, swelling, pain in the heart.

The danger of rheumatic heart disease is that even when the disease is mild, inflammation affects the heart valves (structures inside the heart that separate the heart chambers necessary for proper blood flow).

Wrinkling, loss of elasticity and destruction of the valves occur. The result of this is that the valves either cannot fully open or do not close tightly.

As a result, valvular disease develops. Most often, the development of rheumatic heart disease occurs in the age period of 12-25 years.

At a later age, primary rheumatic valvular disease is very rare.

General signs

In more than half of children and adolescents, the onset of an attack of rheumatic fever manifests itself:

• an unexpected and sharp jump in temperature of the type of "flash";
• the appearance of symmetrical pain in the knee, elbow, hip joints, usually changing localization;
• swelling and redness of the tissues around the inflamed joints;
• signs of rheumatic heart disease - inflammation of the structures of the heart (pain behind the sternum, high fatigue, weak pulse with rhythm failure and acceleration, stretching of the heart cavities, lowering pressure).

Sometimes the course of the pathology comes with pronounced symptoms of only arthritis or only rheumatic heart disease (rarely).

In young patients 15-19 years old, the onset of the disease is usually not as acute as in younger children:

• the temperature, as a rule, does not reach 38.5 C;
• arthralgia (pain) in large joints is not accompanied by severe inflammation and swelling;
• manifestations of carditis - moderate.

Specific symptoms for different forms of the disease

Acute rheumatic fever has dozens of different forms, it is characterized by blurring and non-specific symptoms, so the doctor cannot always make the only correct diagnosis and prescribe an unmistakable treatment for the pathology.

In children, rheumatism of the heart and joints can be expected 14-21 days after the treatment of angina or pharyngitis, against the background of streptococcal infection. Register a sharp and significant jump in temperature and joint pain, often localized in the area in the lower extremities).

In children of the teenage group, rheumatism of the heart and joints develops gradually. After the infection of the nasopharynx subsides, subfebrile condition, aches and joint pains affecting large bone joints, moderately severe symptoms of myocardial damage remain.

An exacerbation of rheumatism is usually provoked by β-hemolytic streptococcus, it manifests itself in the form of carditis or polyarthritis. Body temperature varies from subfebrile numbers to severe fever.

Rheumatism of the heart and joints usually affects the knees, but sometimes the disease does not spare the ankles, elbows, wrists.

Rheumatic carditis is the most common manifestation of the disease (occurs in 90-95% of patients). It usually occurs in the form of inflammation (valvulitis) of the mitral, less commonly, aortic valve.

Then the pathological process spreads to various membranes of the myocardium with the further development of endocarditis, pericarditis or myocarditis. Clinically, such a condition manifests itself in the form of pain behind the sternum, shortness of breath, intolerance to physical exertion, interruptions in the rhythm of the heartbeat.

5Diagnosis

Diagnosis of rheumatic fever is carried out by a rheumatologist, and is based on an analysis of the overall picture of the disease. It is important to correctly establish the fact of streptococcal infection at least a week before the damage to the joints. Acute rheumatic fever is usually not difficult to diagnose if articular and cardiac symptoms are present.

A general clinical and immunological blood test is prescribed. Laboratory tests also help to make a correct diagnosis.

In patients with rheumatism, the development of neutrophilic leukocytosis and an increase in the erythrocyte sedimentation rate (above 40 mm / h) are observed, and persists for a long time. Microhematuria is sometimes found in the urine.

When analyzing serial cultures from the pharynx and from the tonsils, β-hemolytic streptococcus is found. Joint biopsy and arthroscopy may be performed.

Cardiac ultrasound and electrocardiography are useful for detecting heart defects.

Laboratory methods

• An increase in the number of leukocytes and an acceleration of ESR in the general blood test
• Changes in the parameters of a biochemical blood test: the presence of signs of inflammation (increased levels of fibrinogen and C-reactive protein)
• Detection of antistreptococcal blood antibodies
• The presence of beta-hemolytic streptococcus in a swab taken from the pharynx.

Instrumental Methods

Electrocardiography and echocardiography (ultrasound of the heart) - to determine the various lesions of the heart.

Diagnosis of rheumatism is based on the confirmation of the existing Kisel-Jones criteria. There are "large" and "small" criteria. Major criteria: carditis, polyarthritis, chorea, erythema annulare, subcutaneous rheumatic nodules. "Small" criteria: pain in the joints, fever above 38 degrees.

Laboratory "small" signs of rheumatism:

• increase in ESR over 30 mm/hour;
• C-reactive protein, exceeding the norm by 2 times or more.

Instrumental criteria:

• ECG diagnostics - prolongation of the PR interval more than 0.2 s;
• EchoCG (ultrasound of the heart) - mitral or aortic regurgitation (reverse reflux of blood due to incomplete closure of the affected valve).

For the diagnosis of acute rheumatic fever, it is also important to establish the presence of a pre-existing upper respiratory tract infection. This can be done with a throat swab that is inoculated onto a nutrient medium.

A positive response indicates a previous streptococcal infection. Laboratory determination of elevated titers of antistreptococcal antibodies - antistreptolysin O.

If there are 2 "large" and data on past infection, the likelihood of acute rheumatic fever is high. A high probability of the disease and with a combination of 1 "major", 2 "small" criteria and data for streptococcal infection.

To establish the diagnosis of rheumatism, the following methods are used:

• clinical examination;
• laboratory examinations;
• Ultrasound of the heart;
• puncture of the joint with the study of synovial fluid;
• x-ray examination of the joints.

In general, the diagnosis of rheumatism is clinical and is based on the definition of major and minor criteria (polyarthritis, heart disease, chorea in children, characteristic skin rash, subcutaneous nodules, fever, joint pain, laboratory signs of inflammation and streptococcal infection).

The detection of acute rheumatic fever is based in most cases on the analysis of the clinical picture of the disease. It is very important to determine a streptococcal infection (skin infection, sore throat) no later than six weeks before the onset of joint damage. A rather specific sign of acute rheumatic fever is a combination of articular and cardiac symptoms.

It is extremely important to find the causative agent of the disease, for which it is necessary to carry out sowing of the tonsils, etc.

The following laboratory tests are required: an increase in the content of C-reactive protein in the blood, an increase in ESR - the erythrocyte sedimentation rate.

If the so-called "rheumatic tests" (antibodies to the bacterial component - streptolysin O - ASL-O) show a positive result, this can only indicate an existing streptococcal infection, but does not indicate the diagnosis of "acute rheumatic fever".

To confirm the diagnosis, it is very important to conduct an ECG - electrocardiography and echocardiography - a study of the heart using ultrasound.

6Treatment

Treatment of the disease is carried out by a rheumatologist exclusively in a specialized inpatient department. Hospitalization is a mandatory measure even if this fever is suspected.

To confirm the diagnosis, a complex of additional studies will be required, delay in their implementation and at the beginning of treatment is fraught with various serious complications.

If a pronounced inflammatory process affects the heart, joints and central nervous system, then patients need bed rest for 5-14 days. The regimen can be increased if the symptoms of such diseases as are eliminated:

• carditis,
• polyarthritis,
• chorea.

The patient is discharged from the hospital only after the disappearance of clinical manifestations and the registration of normal laboratory parameters: the ESR and proteins of the acute phase of inflammation should decrease.

The patient needs to perform sanatorium and outpatient treatment. He must systematically visit his attending physician to constantly monitor the recovery process and prevent the development of complications.

This type of treatment is prescribed by a doctor after the acute inflammation subsides, which is confirmed by clinical and laboratory studies. The doctor registers the normalization of ESR, acute phase proteins, as well as a decrease in the total volume of leukocytes.

The patient is sent to a special rheumatological sanatorium, where he must stay for about two months. There the patient carries out antistaphylococcal, as well as anti-inflammatory treatment.

In addition, a special diet is developed for each person, as well as an individual set of therapeutic exercises aimed at improving the functioning of the pulmonary and cardiovascular systems. The work is also aimed at stopping further destruction of blood vessels.

Sanatorium treatment cannot be carried out:

1. acute phase of rheumatic fever,
2. if there is an active infectious process in the nasopharynx, then the patient acts as a distributor and carrier of infection,
3. with severe damage to systems and organs, for example, with pulmonary edema or heart failure,
4. with the development of serious concomitant diseases, for example, tuberculosis, tumors or mental illness.

All people who have had acute rheumatic fever must continue their treatment at home, while regularly seeing a doctor and passing several tests:

• general blood analysis,
• general urine analysis,
• bakposev from the nasopharynx.

Analyzes are given at intervals of 1 time in 3 - 6 months.

In addition, patients should take preventive doses of antibiotics for several years to prevent recurrence and recurrence of the disease.

It is necessary to administer to the patient intramuscularly benzathine benzylpenicillin, with a frequency of 1 time in three weeks. For adults, the dosage is 2.4 million units, for children weighing less than 25 kg - 600 thousand units, if the child's body weight exceeds 25 kg, 1.2 million units are administered.

The duration of drug treatment after rheumatic fever in the middle form is at least 5 years, if there is a heart disease, then treatment can last 10 years or more, in some cases, therapy should be carried out for life.

Treatment of the disease in question is necessarily carried out under the supervision of a specialist and most often the patient is placed in a medical institution. There are a number of drugs that are necessarily prescribed to patients as part of therapy for rheumatism. These include:

To prevent recurrence of the disease in question, bicillin can be prescribed to patients for another 5-6 years, but in minimal dosages - one injection every 3 weeks.

home or
stationary mode depending on
severity of the patient, social conditions

patient isolation

bed rest

sparing
milk and vegetable fortified
diet

antibacterial
therapy. Penicillin preparations
series (phenoxymethylpenicillin 100
mg/kg/day in 4 doses peros, amoxicillin 30-60
mg/kg/day in 3 divided doses peros), cephalosporins 1-2
generations (cefazolin 100 mg/kg/day at 3
IM administration, cefuroxime axetil up to 2 years
- 125 mg 2 times a day, children and adolescents
250-500 mg 2 times a day, adults
500 mg 2 times a day peros).
If available for the above
allergic reaction drugs
macrolides (azithromycin 10 mg/kg/day in
1 reception 5 daysperos,
clarithromycin 7.5 mg/kg/day in 2 divided doses
10 daysperos).
If the patient received antibiotics in
the previous month, then the drug
choice is amoxicillin
clavulanic acid (40 mg/kg/day in
2-3 doses 10 days peros).

detoxification
therapy. For mild disease
- plentiful warm drink (cowberry fruit drinks,
cranberry, mineral water, compotes).
With severe course and the development of complications
– infusion therapy (glucose-salt
solutions).

nonsteroidal
anti-inflammatory drugs in
as an antipyretic and pain reliever
drugs (paracetamol, ortofen, nurofen
and etc.).

antihistamines
drugs are given to patients with
susceptibility to allergic reactions
(loratadine, desloratadine, cyterizine).

Local
anti-inflammatory treatment.
Oropharyngeal rinse with 2% alkaline and
salt solutions, decoctions of herbs
calendula, chamomile, kashkar. Local
use of antiseptics and antibiotics
in the form of various dosage forms.
Compress with dimexide solution,
diluted 1:4 with water, semi-alcoholic
compress on the submandibular area
lymph nodes at normal temperature
body.

• mandatory hospitalization and bed rest;
• food enriched with protein and a complex of vitamins;
• prescribing antibiotics against streptococcus according to the scheme;
• non-steroidal anti-inflammatory drugs or hormones (glucocorticoids) are indicated to eliminate the inflammatory process.

The treatment of rheumatism is complex. Therapy is aimed at eradication (eradication) of streptococcus from the body, interruption of the links of the pathological process, relief of symptoms and rehabilitation measures.

In the first weeks, it is important to observe bed rest, enrich the diet with protein foods - at least 1 gram per 1 kg of body weight. It is important to reduce the load on the cardiovascular system as much as possible - to limit the amount of table salt consumed.

Eradication of streptococcal infection consists in the use of penicillin preparations or other antibacterial agents in case of intolerance to the first. If there are carious teeth, chronic tonsillitis, it is very important to sanitize the infectious focus. An important place in the treatment of rheumatism is occupied by pathogenetic therapy - interruption of the links of the pathological process.

In clinical practice, glucocorticoid and non-steroidal anti-inflammatory drugs can be used. No less important is the maintenance of metabolism in the connective tissue - preparations of potassium and magnesium, riboxin, etc. are prescribed. When the nervous system is involved in the process, drugs that have a stabilizing effect on the nervous system - antipsychotics and psychostimulants, anticonvulsants are used with efficiency.

With existing chronic rheumatic heart disease with heart failure, diuretics, calcium channel blockers, beta-blockers, cardiac glycosides are used. Rehabilitation measures after the main treatment include physiotherapy exercises, sanatorium-and-spa treatment aimed at restoring impaired body functions.

In the treatment of this difficult disease called rheumatism, the following groups of drugs are used:

NSAIDs should be taken for at least a month, with a gradual dose reduction. Under their influence, there is a rapid disappearance of pain in the joints, chorea, shortness of breath, positive dynamics in the ECG picture.

However, when treating NSAIDs, one should always remember about their negative impact on the gastrointestinal tract.

• Glucocorticoids. Applied with severe carditis, a significant accumulation of fluid in the cavity of the heart bag, severe joint pain.
• Metabolic therapy and vitamins. Large doses of ascorbic acid are prescribed, with the development of chorea - vitamins B1 and B6. To restore damaged cells of the heart muscle, riboxin, mildronate, neoton, etc. are used.

The main answer to the question of how to treat joint rheumatism is timely and comprehensively. Conservative therapy includes:

• strict bed rest;
• diet No. 10 according to Pevzner with the restriction of spicy, smoked foods, it is also necessary to limit the use of table salt to 4-5 grams per day;
• antibiotics are the basis of etiotropic treatment, drugs from the penicillin group (penicillin G, retarpen) are used, cephalosporins of the 1st and 4th generations (cefazolin, cefpirome, cefepime) are also used;
• to reduce pain and eliminate inflammatory changes in the joints, drugs from the group of NSAIDs and salicylates (diclofenac, ibuprofen, ketoprofen, meloxicam, nimesulide, celecoxib) are used, they are prescribed both systemically (tablets, injections) and locally (ointment, gel);
• glucocorticoid hormones are used only for severe heart damage (prednisolone, methylprednisolone);
• metabolic therapy (riboxin, ATP, preductal).

Surgical treatment is performed for patients with rheumatic heart disease (valvular plasty or dissection of adhesions between them).

Popular treatment of rheumatoid arthritis and folk remedies. But it is necessary to remember the main condition - it is possible to treat articular syndrome with traditional medicine recipes only with the permission of the doctor and not as the main method, but in addition to drug therapy.

Methods for the treatment of rheumatoid arthritis folk remedies

The basis of the treatment of acute rheumatic fever is strict adherence to the regimen (if the disease is active, strict bed rest is prescribed) and the use of various medications in order to get rid of symptoms and prevent relapses (repeated attacks). If the patient has carditis (heart inflammation), they may need to reduce their salt intake.

To get rid of the microorganism streptococcus, which is the cause of the disease, antibiotics are prescribed. Use antibiotics of the penicillin series; if the patient has intolerance to this group, macrolides are prescribed.

Long-acting antibiotics should be taken for the next five years from the moment the disease activity is suppressed.

An important part of the treatment of rheumatism are non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, which reduce the activity of inflammation.

The dosage of drugs and the duration of their use are negotiated in each case and depend on the condition of the patient.

If fluid is retained in the body, diuretics (diuretics) are prescribed.

Formed defects are treated depending on their severity, the presence of heart failure, valve damage, and so on. Often, antiarrhythmic drugs are used that eliminate or prevent heart rhythm disturbances, nitrates, diuretics, etc.

If the defect is severe, it is necessary to perform an operation on the heart valves - plastic surgery or prosthetics of the affected valve.

The goal of treatment is to:

• eliminate the cause of the disease;
• normalize metabolic processes in the body and stabilize the work of damaged organs, as well as significantly increase immunity;
• affect the patient's condition by eliminating the symptoms.

Most patients are hospitalized, especially children. They require strict bed rest for 21 days and a dietary diet. Depending on the patient's condition, the doctor prescribes medication and physiotherapy. In severe cases, surgery may be required.

Medical

For streptococcal infections, only antibiotics are used. These can be penicillin preparations, and in case of individual intolerance they are replaced with macrolides or lincosamides.

The first 10 days, antibiotics are used as injections, and then tablets are prescribed.

If carditis is diagnosed, hormonal therapy using glucocorticosteroids is used. This is done under the strict supervision of a doctor.

For symptomatic treatment, the following drugs are used:

• Diclofenac - to eliminate pain and inflammation in the joints, the course of treatment can last up to 2 months;
• Digoxin - as a stimulant for the normalization of myocardial function;
• Asparkam - with dystrophic changes in the heart;
• Lasix - as a diuretic for swelling of tissues;
• Immunostimulants to improve the protective reactions of the body.

The duration of treatment and dosage is determined by the doctor. It depends on the condition and age of the patient.

Surgical intervention

Operative treatment is carried out only in case of severe heart disease. Then the attending physician decides on the need for surgical treatment. The patient may undergo plastic surgery or prosthetic heart valves.

Physiotherapy

Physiotherapy procedures are carried out in parallel with the main treatment:

• paraffin and mud applications;
• UHF heating;
• treatment with infrared rays;
• radon and oxygen baths.

At the stage of recovery, a course of therapeutic massage is prescribed, which should be carried out by a specialist.

In the treatment of ARF, a complex scheme is provided, which includes:

• etiotropic therapy (elimination of the cause);
• pathogenetic (correction of dysfunction of organs, stabilization of metabolic processes, increase in the body's immune resistance), symptomatic (mitigation of symptoms).

Usually, all patients (especially children) are placed in a hospital with the appointment of strict bed rest for 3 weeks. The inclusion of proteins in the diet, restriction of salt is envisaged.

• To eliminate the cause of the disease - to destroy beta-streptococcus - antibiotics of the penicillin group are used (from the age of 14, benzylpenicillin at a dosage of 2–4 million units; children under 14 years old from 400 to 600 thousand units). The course is not less than 10 days. Or a more “advanced” amoxicillin is used.
• With penicillin allergy, drugs from a number of macrolides (Roxithromycin, Clarithromycin) or lincosamides are prescribed. After completing the course of injections, antibiotics are prescribed in long-acting tablets.
• Pathogenetic therapy of ARF consists in the use of hormonal drugs and NSAIDs. With severe carditis and serositis, Prednisolone is used for at least 18-22 days at a dose of 20-30 mg per day until a pronounced therapeutic effect is obtained. After that, the dosage of glucocorticosteroid is slowly reduced (2.5 mg per week).

Elimination of symptoms:

1. In the treatment of rheumatic arthritis, choreas are prescribed Diclofenac, which reduces inflammation of the joints, in a daily dosage of 100-150 mg per course lasting 45-60 days.
2. If signs of rheumatic heart disease are observed, means are necessarily prescribed to stimulate myocardial activity (Digoxin).
3. Hormones specifically affect metabolic processes, therefore, given the degree of dystrophic changes in the heart, medications are used:

• Nandrolone course of 10 injections of 100 mg once a week;
• Asparkam 2 tablets 3 times a day for a course of 30 days;
• Inosine three times a day 0.2 - 0.4 g, a course lasting 1 month.

1. With emerging edema, indicating fluid retention in the tissues, diuretics such as Lasix are used. Use immune system stimulants.

Heart defects formed during rheumatic heart disease are treated with drugs for arrhythmia, nitrates, moderate use of diuretics. The duration and specificity of cardiotherapy depends on the degree of violation of the structure of the myocardium, the severity of symptoms and the degree of insufficiency of heart function.

Surgical

If a severe heart defect is detected during the diagnosis of ARF, the task is to perform an operation on the valves, the possibility of plastic surgery and valve prosthetics is assessed.

Simultaneously with the use of medications, the treatment of ARF provides for a course of physiotherapy:

• UHF heating,
• application of therapeutic mud and paraffin applications,
• infrared radiation,
• use of oxygen and radon baths,
• therapeutic massage (after recovery).

Therapy for acute rheumatic fever should be carried out in the early stages of the pathology and usually last up to 3-4 months. Begin treatment of rheumatism in a hospital.

To eliminate foci of pathological infection, various antibacterial drugs are prescribed:

• Benzylpenicillin in a daily dosage of 1.5 - 4 million units, the drug is administered intramuscularly in four divided doses;
• Azithromycin, Spiramycin, Roxithromycin, Clarithromycin, Midecamycin (the dosage is selected individually);
• Lincomycin - 0.5 g up to 4 times a day;
• Clindamycin - 0.15 - 0.45 g 4 times a day.

With a pronounced inflammatory process that captures myocardial tissue, the treatment of rheumatism is accompanied by the use of corticosteroids. As a rule, Prednisolone is prescribed at a dosage of 20 mg per day in one dose for 2 weeks. Then this amount is gradually reduced to complete abolition. In general, the course of hormone therapy lasts up to 2 months.

Non-steroidal anti-inflammatory drugs are indicated for mild damage to the muscle tissue of the heart or polyarthritis without manifestations of carditis. They are sometimes prescribed after a course of corticosteroids after active inflammation subsides and ESR decreases to less than 30 mm/hour.

Also, NSAIDs are used for a repeated episode of acute rheumatic fever. Treatment of rheumatism is carried out with Artrosilene, Naproxen, Diclofenac.

To suppress the hyperactivity of the immune system, drugs obtained using genetic engineering methods are currently widely used. It's Remicade or Mabthera.

To eliminate the symptoms of damage to the cardiovascular system in the treatment of rheumatism include:

• cardiac glycosides;
• loop or potassium-sparing diuretics;
• calcium channel blockers;
• blockers of β-adrenergic receptors.

After relief of acute symptoms, the patient is discharged from the hospital with appropriate recommendations to continue therapy at home. But over the next six months, the patient passes the entire range of necessary tests, sometimes they recommend ultrasound of the ankle, knee and other joints.

To prevent the resumption of streptococcal infection, antibiotic treatment of rheumatism is prescribed. For several months (and sometimes years), once every three weeks, a person is given injections of benzylpenicillin in the appropriate dosage.

Prevention of rheumatism in adults, prognosis, alternative therapy recipes

Drug treatment is the mainstay of therapy for acute rheumatic fever. As part of the therapy, tools are used that:

1. reduce the activity of inflammation,
2. prevent further destruction of organs and tissues (this includes antibiotic therapy, which is aimed at eliminating B-hemolytic streptococcus).

It must be remembered that the sooner treatment is started correctly, the more likely it will be effective and the less the risk of complications. If there are first signs of acute rheumatic fever, it is important to consult a doctor immediately.

As a rule, the defeat of various systems and organs does not require special treatment, and the problem is solved with the use of anti-inflammatory treatment. But in some cases, for example, if the work of the heart is disturbed or if there are obvious neurological symptoms, it is necessary to prescribe a whole complex of drugs.

Heart failure is treated with the following drugs:

• diuretics - spironolactone and furosemide,
• cardiac glycosides - digitoxin and digoxin,
• blood pressure lowering agents - atenolol and lisinopril,
• with arrhythmia, antiarrhythmic drugs are indicated - amidarone and lidocaine.

Treatment of chorea minor involves the use of:

1. sedatives - phenobarbital and midazolam,
2. antipsychotics - droperidol and haloperidol,
3. nootropics - drugs that improve mental activity, for example, piracetam.
4. psychotherapy.

Healing rheumatism with traditional remedies

Turmeric relieves pain

Birch leaves. Gather more new birch trees�
� leaves, fill them with linen trousers from pajamas, put them on yourself and go to bed in this form under a warm blanket.

To achieve a good healing effect, you need to sweat a lot. Dried leaves will work for this recipe, but fresh leaves will work best.

Sleeping in "birch pants" until the morning is not at all necessary - just lie down for 3 hours. In the summer in the country, you can use another, even more effective method of healing rheumatism with birch leaves - a bath.

Throw a mountain of foliage into an old cast-iron bath or a huge wooden tub, put it in the sun, wait a couple of hours until the leaves rise, undress and dig in there waist-deep for an hour.

Salt. Regular table salt is great for relieving joint pain in rheumatism.

Dissolve a tablespoon of salt (sea or iodized - even better) in a glass of evenly warm water, soak a clean cloth or gauze in the saline solution, apply it to an unhealthy place, wrap it with cellophane and a warm scarf and leave for a couple of hours.

There is also an anhydrous method of curing rheumatism with salt - with the help of linen bags, into which salt heated in a frying pan is poured. But remember that warming unhealthy joints with anything is allowed only in the stage of remission of rheumatism, when there is no active inflammatory process.

Article creator: Igor Muravitsky, rheumatologist; Sokolova Nina Vladimirovna, phytotherapist, specially for the website ayzdorov.ru

Complications of acute rheumatic fever

Brain damage. Rheumatic heart diseases such as myocarditis (inflammation of the heart muscle), endocarditis (inflammation of the inner lining of the heart), and pericarditis (inflammation of the outer lining of the heart). Fatal outcome.

Preventive measures

See your doctor if you have a sore throat for more than a week. It is advisable to avoid crowded places and ensure good sanitary conditions in your place of residence. Support the body's natural defenses. Wash your hands before preparing food, especially if you cough or sneeze. Thus, you prevent the spread of bacteria that cause sore throats.

Prevention of the development of ARF consists in the timely and correct treatment of various streptococcal infections (tonsillitis, pharyngitis, skin infections) by prescribing antibiotics. Usually treatment lasts at least one and a half weeks. For the treatment of tonsillitis caused by streptococcal infection, biseptol, ofloxacin are used.

Prevention of acute rheumatic fever after infectious diseases includes a number of therapeutic measures. First of all, prolonged-acting antibiotics are prescribed, bicillin prophylaxis (extencillin and retarpen), for a period of about 5 years. For more than 5 years, treatment continues for those who have had rheumatic heart disease.

It is necessary to follow the correct daily routine, eat regularly, play sports, stop smoking and drinking alcohol, harden the body, walk in the fresh air. Do not forget that there are a lot of pathogenic organisms, and especially streptococci, in the environment, they are found in dust and dirty things, so it is necessary to frequently carry out wet cleaning and ventilate the room.

And also do not leave untreated carious teeth, tonsillitis, sinusitis and sinusitis.

Rheumatism is a rather dangerous disease, which in 87% of cases leads to disability of the patient. To avoid such a sad development of events, you need to carefully “listen” to your own body, quickly respond to the slightest changes in well-being and undergo full treatment for any diseases.

Tsygankova Yana Alexandrovna, medical observer, therapist of the highest qualification category

Prevention of acute rheumatic fever is not only to prevent the development of the disease, but also to prevent relapse. Necessary:

• boost immunity,
• treat infections caused by streptococcus in a timely manner,
• see a doctor after suffering from rheumatic fever.

Primary (non-specific) prevention of rheumatic disease is aimed at preventing the development of the rheumatic process in the body and includes a set of general strengthening measures: hardening, sports, balanced nutrition, etc.

Secondary (specific) - prevention of repeated relapses of rheumatism. This is achieved by the introduction of prolonged preparations of penicillin. It is possible to introduce imported analogues - retarpen, pendepon, etc.

According to WHO recommendations, the prevention of rheumatism with bicillin should be carried out at least 3 years after the last attack, but not earlier than reaching 18 years of age. With carditis - 25 years. Persons with established heart failure should take preventive measures throughout their lives.

Important fact: Diseases of the joints and excess weight are always associated with each other. If you effectively reduce weight, then your health will improve. Moreover, this year it is much easier to reduce weight. After all, a remedy has appeared that ... Says a famous doctor

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why the Internet sell ah?

Yulek26 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. Yes, and now everything is sold on the Internet - from clothes to TVs, furniture and cars.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official website. Be healthy!