Rheumatism: manifestation, diagnosis, treatment

Content

  • The manifestations of rheumatic fever
  • Diagnosis of rheumatic fever
  • Treatment: rheumatism
  • Prevention of rheumatic fever
  • Forecast for rheumatism


  • Rheumatism development is closely associated with acute or previous
    chronic nasopharyngeal infection caused by streptococcus.
    The important role of genetic factors is removed, as evidenced by
    a more frequent incidence of children from families in which one of the
    parents suffering from rheumatism.

    In the development of rheumatic fever
    Equally important is the direct or indirect damaging
    the impact of streptococcus components, its toxins on the body
    development of immune inflammation. During the electoral defeat of valves
    cardiac infarction and the development of the immune aseptic inflammation
    responsible protivostreptokokkovye antibodies cross-reacting with the
    heart tissue (molecular masking).



    The manifestations of rheumatic fever

    Rheumatism
    characterized by a variety of symptoms and flow variability. how
    Typically, it occurs at school age, and less common in preschool children
    practically does not occur in children younger than 3 years.

    In a typical
    cases, the first signs of rheumatic fever are detected 2-3 weeks after
    tonsillitis, pharyngitis as fever, signs of intoxication
    (Fatigue, weakness, headache), pains in the joints and other
    manifestations of the disease.

    One of the earliest signs
    rheumatic fever are joint pain, detected in 60-100% of cases.
    Rheumatoid arthritis tend to acute onset, the involvement of the major
    or medium-sized joints (usually the knee, ankle, elbow), fast
    reverse the development process.

    Signs of heart disease
    determined in 70-85% of cases. cardiac nature of the complaint (pain
    the heart, palpitations, shortness of breath) occur when expressed
    heart disorders. More often, especially early in the disease, there are
    various asthenic symptoms (lethargy, malaise, increased
    fatigue).

    For rarer symptoms of rheumatism concerns of annular rash and rheumatic nodules.

    of annular
    rash (erythema annulare) - dull pale pink rash in the form of
    thin annular rim, it not is rising above the surface of the skin and
    disappear when pressed. It is found in 7-10% of patients with
    rheumatism, mainly on the height and the disease is usually
    unstable character.

    The subcutaneous rheumatic nodules - rounded,
    dense, slow-moving, indolent, single or multiple
    education in the field of localization of large and medium-sized joints,
    the spinous processes of the vertebrae in the tendons. Currently
    It is rare, primarily in severe rheumatism
    persisting from days to 1-2 months.

    Stomach ache,
    lung, kidney, liver and other organs in rheumatism
    It is now extremely rare, mainly in his grave
    flow.



    Diagnosis of rheumatic fever

    • The ECG is often detected arrhythmias.
    • X-ray in addition to not always pronounced increase in heart
      determined by the evidence of an impairment of myocardial contractile function,
      configuration change of heart.
    • Ultrasound of the heart.
    • Laboratory findings.


    Treatment: rheumatism

    Treatment
    Rheumatism is based on the early appointment of combination therapy,
    aimed at suppressing the activity of streptococcal infection and
    inflammatory process, preventing development or progression
    heart disease. The implementation of these programs is carried out on the basis of
    phasing: Phase 1 - inpatient treatment, Stage 2 - follow-up care in
    local cardio-rheumatology Sanatorium, Stage 3 - dispensary
    observation in the clinic.

    Rheumatism: manifestation, diagnosis, treatment
    At the 1st stage, a hospital patient
    prescribe medication, food and medical correction
    physical education, which are determined individually taking into account features
    diseases and, above all, the severity of the heart. In connection with
    streptococcal nature rheumatism treatment is carried out with penicillin.
    Antirheumatic therapy provides one of the non-steroidal
    anti-inflammatory drugs, which is administered in isolation
    or in combination with hormones, depending on indications.

    Antimicrobial
    penicillin therapy is carried out for 10-14 days. In the presence of
    chronic tonsillitis, frequent exacerbations focal infection
    increased duration of treatment with penicillin, or additionally
    using another antibiotic - amoxicillin, macrolides (azithromycin,
    roxithromycin, clarithromycin), cefuroxime axetil, other cephalosporins
    in age dosage.

    Nonsteroidal
    anti-inflammatory drugs used for at least 1-1,5 months
    to eliminate the signs of activity. Prednisolone in initial
    dose administered for 10-14 days to obtain the effect, then
    reduce the daily dose of 2.5 mg every 5-7 days under controlled
    clinical and laboratory parameters, in subsequent drug overturned.

    duration
    treatment of quinoline drugs for rheumatism is from
    several months to 1-2 years or more, depending on the flow
    disease.

    In the hospital also carried out the removal of
    chronic foci of infection, in particular, the removal of the tonsils,
    carried through 2-2.5 months after the onset of the disease in the absence of
    signs of activity.

    The main objective in the second stage
    It is to achieve a complete remission and functional recovery
    capacity of the cardiovascular system. The resort continues begun
    hospital treatment, cure chronic infection, exercise
    the appropriate health and fitness regime with differentiated
    physical activity, physical therapy, tempering
    procedures.

    The third stage of the complex therapy of rheumatism
    It provides for the prevention of recurrence and progression. To this end
    use drugs prolonged action of penicillin, mainly
    bicillin 5, the first administration is carried out in the period
    patient treatment, and subsequently - 1 times in 2-4 weeks
    year-round. Regularly, 2 times a year, on an outpatient basis
    examination, including laboratory and instrumental techniques;
    prescribe the necessary corrective measures, medical
    physical education. Children who have had rheumatic heart disease, the presence of the valve
    bitsillinoprofilaktiku heart defect is performed before the age of 21
    year or more. In rheumatoid arthritis without involving bitsillinoprofilaktiku heart
    carried out for 5 years after the last attack. In spring and autumn
    period, together with the introduction of bitsillina shows month course of non-steroidal
    anti-inflammatory drugs.



    Prevention of rheumatic fever

    Prevention of rheumatic fever is divided into primary and secondary.


    Primary prevention is aimed at the prevention of rheumatism, and includes:

    • Increase immunity (hardening, alternating load and rest, good nutrition, etc.).
    • Detection and treatment of acute and chronic streptococcal infection.
    • Preventive measures in predisposed to the development of rheumatic fever
      Children from families in which there are cases of rheumatic fever or other
      rheumatic diseases; often suffering from nasopharyngeal infection;
      have or have had chronic tonsillitis acute streptococcal
      infection.

    Secondary prevention is aimed at preventing
    relapse and progression of disease in patients with rheumatic
    terms of follow-up.



    Forecast for rheumatism

    At the moment when time begun treatment of the primary lesion
    heart recovery ends. Formation of valvular
    heart, frequently with the development of mitral regurgitation determined in
    15-18% of cases at the first attack, especially in severe, protracted
    or latent disease course.

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