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  • Rheumatism( acute rheumatic fever) - Causes, symptoms and treatment. MF.

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

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

    The cause of rheumatism

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

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

    - overcrowding in living and teaching;
    - low level of sanitary culture and medical care;
    - poor living conditions, insufficient food.

    Symptoms of rheumatism

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

    The fever rheumatism rises for 2-5 days and normalizes when arthritis subsides. Sometimes at the onset of the disease on the skin of the trunk and limbs appear unstable rashes. They look like pink rings - ring-shaped erythema. Rashes appear and disappear without leaving traces. Typical, for rheumatism, but extremely rare symptom( up to 3% of cases) - subcutaneous rheumatic nodules. They have a size from grain to pea, dense painless, localized on the affected joints, occiput.

    The main manifestation of rheumatism is cardiac damage, carditis, the severity of which determines the outcome of rheumatic fever. There are long stitching, aching pains in the region of the heart, shortness of breath with little physical exertion, palpitations, irregularities in 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 jerking of limbs and facial muscles, grimacing, speech indistinctness, violation of handwriting, inability to keep the spoon and fork with food. Symptoms completely disappear in a dream. Chorea with rheumatism lasts 2 - 3 months.

    The duration of rheumatic fever is on average 6-12 weeks. This is the time for which the acute inflammatory process passes through all stages. Rheumatic fever, lasting more than 6 months, is regarded as a prolonged course. A new episode of rheumatism often occurs in the first 5 years after the first attack, and over time the likelihood of it decreases. The emergence of new attacks depends on the occurrence of repeated streptococcal infections.

    Diagnosis of rheumatic fever.

    1. General analysis of blood - signs of inflammation( leukocytosis - increase in the number of leukocytes and accelerated ESR).
    2. Biochemical analysis of blood - an increase in the content of fibrinogen, C-reactive protein - the indicators of the acute phase of inflammation.
    3. Serological tests reveal anti-streptococcal antibodies in high titres.
    4. Bacteriological study: detection of beta-hemolytic streptococcus of Group A in smears from throat A.
    5. Electrocardiography - reveals disturbances of cardiac rhythm and conduction, increase( hypertrophy) of the heart.
    6. Echocardiography with Dopplerography, reveals signs of damage to the heart valves, pump function and myocardial contractility, the presence of pericarditis.

    Diagnosis of rheumatism is unquestionable in the presence of a formed heart defect. In the absence of heart failure, the following criteria are used:

    Large criteria Small criteria Evidence of previous
    streptococcal infection 1. Cardiitis.
    2. Polyarthritis.
    3. Chorea.
    4. Ring-shaped erythema.
    5. Subcutaneous rheumatic nodules.
    Clinical: joint pain( arthralgia);
    fever.
    Laboratory: signs of inflammation in a blood test.
    Instrumental: changes on the ECG.Positive A - Streptococcal culture isolated from throat or
    Positive test for rapid determination of A - streptococcal antigen. Increase the titer of anti-streptococcal antibodies.

    The presence of 2 large criteria or 1 large and 2 small criteria in combination with data confirming the preceding streptococcal infection indicates a high probability of rheumatism.

    Treatment of rheumatism.

    Success in the treatment of rheumatic fever and the prevention of heart disease is associated with early detection of the disease and individual treatment. Therefore, when the first signs of inflammation appear, consult a doctor( family doctor, pediatrician, therapist).Treatment of rheumatic fever is carried out in a hospital. If you suspect a carditis is mandatory bed rest. When rheumatism is prescribed a diet rich in vitamins and protein, with the restriction of salt and carbohydrates. Carry etiotropic( anti-streptococcal) treatment of rheumatism - prescribe antibiotics 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.

    Next stage - patients undergo rehabilitation( rehabilitation) treatment in a specialized center( sanatorium).

    The third stage is dispensary observation at the family doctor( pediatrician, therapist).Annually the patient is examined by a rheumatologist, ENT - by a doctor, laboratory tests are performed, ECG, echocardiography.

    Complications of rheumatism.

    The main complications include:

    1. The formation of heart disease.
    2. Development of congestive heart failure.
    3. Heart rate disturbance.
    4. Thromboembolism.
    5. The emergence of infectious endocarditis( inflammation of the inner shell of the heart).

    Chronic rheumatic heart disease( heart disease) - a disease in which the heart valves, its septa, leading to a violation of the function of the heart, the formation of heart failure are affected. Occurs after a rheumatic carditis. 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 referred to surgical treatment in specialized clinics.

    Prevention of rheumatism.

    Primary prevention of rheumatism - prevention of rheumatic fever in a healthy child. It includes measures aimed at improving immunity( nutrition, hardening, exercise), preventing the onset of streptococcal infection( healing people that surround the child, eliminating crowding), timely and complete treatment of streptococcal diseases.

    Secondary prevention of rheumatism is the prevention of recurrences and the progression of rheumatic fever that has already occurred. It includes: dispensary follow-up, timely treatment of foci of chronic infection, benzathine benzylpenicillin intramuscularly once every 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 suffered rheumatic fever without carditis and are life-long for patients with developed heart disease.

    Consultation of a doctor on the topic of rheumatism:

    Question: How is the treatment and prevention of rheumatic fever in pregnant women?
    Answer: The occurrence of acute rheumatic fever in pregnant women is extremely rare, but if a woman develops a disease, she should be urgently hospitalized in the therapeutic department of the hospital or in a specialized hospital for heart and vascular pathology. Secondary prophylaxis with penicillin to pregnant women with rheumatic fever is necessary, especially in the first trimester of pregnancy, when the probability of exacerbation of the disease is high.

    Doctor therapist Vostrykova IN