Rheumatism - a serious systemic disease infectious-allergic nature of a lesion of many organs develop at any age.The many facets of clinical manifestations related to the fact that the rheumatism affects not specific organ, and connective tissue, which is present in all tissues and organs.Rheumatism in children dedicate this article. Content
Rheumatism causeshemolytic streptococcus, which causes scarlet fever, sore throat, acute respiratory infections.Pathogen gets into the child's body by airborne droplets.Rheumatic fever develops, usu
But rheumatism develops after streptococcal infection in only 0.3-3% recover - only those who have a defect in the immune system.Because of immune disorders in the body begins to produce antibodies against its own connective tissue cells.As a result of this infestation and the connective tissue of many organs.
source of infection for the baby is open to any member of the family having a streptococcal infection or being "healthy" carrier hemolytic streptococcus.Imperfect child's immune system is unable to cope with the resulting infection.
matters and the presence of a child in the body of chronic foci of infection (chronic tonsillitis, sinusitis, dental caries, otitis media, chronic infection of the urinary system).The threat of rheumatism there are children suffering from frequent colds.
There are other triggers for the occurrence of rheumatic fever:
Ill rheumatism child can at any age.The most susceptible to the disease in children aged 7-15 years.
There are 2 phases of rheumatic process - active and inactive.
When inactive phase after suffering rheumatism there is laboratory evidence of inflammation.The state of health and behavior of children are common, and hemodynamic disturbances appear only at considerable physical effort.
active phase of rheumatism has 3 degrees:
I - the minimum degree of activity: clinical, laboratory and instrumental signs of the disease are mild;
II - moderate degree of activity: clinical and instrumental signs expressed mild, fever may not be too blurred laboratory abnormalities;
III - has bright clinical manifestations of the disease in the form of signs of damage to the heart, joints;clear radiographic, and electrocardiographic changes fonokardiograficheskie, pronounced laboratory indicators of inflammation.
Rheumatic fever can occur at 5 variants of :
In rheumatoid arthritis destroy connective tissue in many organs at once.This explains the diversity of the clinical manifestations of the disease, depending on the type and severity of the process.In response to the pathogen in the body produces a special substance - C-reactive protein.It was he who causes inflammation and damage the connective tissue.
disease begins after 1-3 weeks after streptococcal infection.Getting sharp, with fever, severe weakness, deterioration in general health.
There are cardiac, joint and nervous forms of rheumatism.Often initially affected joints.
on higher temperature appear swelling and severe pain in the joints, difficulty in movement.
Features rheumatic joints:
articular form does not always appear so sharply.In some cases, both the temperature and no swelling of the joints.The child may complain of pain in one or the other joints.Sometimes heart disease is detected immediately, and rheumatism for a long time remain undiagnosed.At a young age, joint damage can occur after heart disease, and may be completely absent.
This form is able to begin acutely or develop gradually.The child is marked weakness, fatigue, he had difficulty climbing stairs - there is fatigue and palpitations.On examination, the doctor reveals increased heart rate, there may be a violation of rhythm, a heart murmur, and the expansion of its borders.
heart can be affected by rheumatism in varying degrees.Sometimes there expressed mild symptoms of myocardial (heart muscle).This inflammation may end without a trace.
In some cases, the process involves also the inner shell (endocarditis) with valvular - endocarditis usually ends with the formation of heart disease.In this case, the affected leaflet does not cover completely, and blood when the heart contracts back from the ventricle to the atrium.
But the most serious is the damage when inflamed and even the outer shell of the heart (pericardium) and developed pericarditis.This gives rise to severe pain in the heart, severe shortness of breath, appears bluish color of the lips, fingers in the nail phalanxes.The situation forced in bed - Half-upright.Pulse can be speeded up or delayed.Arrhythmia may occur.The boundaries of the heart greatly expanded, especially in the pericardial fluid accumulates.
Cardiac leads to severe heart failure and disability of the child.
In the case of recurrent course of rheumatic fever may develop recurrent rheumatic heart disease.Relapses may be associated with a new infection or to the activation of bacteria remaining in the body.With each new attack of rheumatic fever valve apparatus failure progresses.In early childhood recurrent rheumatic heart disease observed less frequently than in adolescence.
Rheumatism may begin with damage to the nervous system.Chorea is observed in 11-13% of cases of rheumatic fever, more frequent in girls.There are grimacing, involuntary twitching of muscles in the arms, legs, face, eyes.They look like a nervous tic.
Gusty involuntary movements aggravated by emotions.Muscle tone is lowered.Disturbed coordination of movements: the child drops objects from the hands;may fall from the chair;there is slowness, confusion and untidiness.
frequent changes of behavior and handwriting, confusion first noticed at school and are sometimes regarded as a prank.Change and emotional manifestations: the child becomes whiny and irritable.It may become muffled.In severe cases, paralysis may even appear.
Chorea may occur in isolation, but often the symptoms of chorea join signs of heart.
duration of symptoms of chorea is usually up to 1 month, but preschool children chorea may have prolonged or relapsing course.In severe lesions can develop not only inflammation of the meninges, but the substance of the brain, and peripheral nerves.
These manifestations are rare in the period of activity of the process.
period of activity of rheumatic fever lasts about 2 months.The remission of the child being good, if not developed heart failure.But the disease can come back.
The greater the attacks of rheumatic fever, the more severe consequences.The younger the child, the more severe the illness, and the more serious its complications.Therefore, at the slightest suspicion of rheumatic fever need to see a doctor and conduct the necessary tests.
for the diagnosis of rheumatic fever uses such methods:
confirmed diagnosis of "rheumatism" is a combination of one or more of the main manifestations of rheumatism (arthritis, carditis, chorea) and a number of additional laboratory and instrumental manifestations.
described methods of examination phase and help to clarify the localization process, the extent of its activity.
Treatment of rheumatic fever is carried out in 3 stages:
Stage 1 - inpatient treatment (4-6 weeks).
2nd stage - a spa treatment.
3rd stage - follow-up.
active phase of rheumatic fever requires compliance with bed rest, with a gradual expansion of the motor activity of the child.The period of bed rest determined by the doctor depending on the activity of the process.If Article II-III.Activity is appointed for 1-2 weeks with strict bed rest, followed by 2-3 weeks of bed rest with a resolution to participate in the games in bed and passive movements, breathing exercises.Only one and a half months allowed to gentle treatment: the ability to use the toilet, dining room;expanding and physiotherapy.
Treatment should be complex.Drug treatment includes antibiotics, NSAIDs, antiallergic agents, immunosuppressive drugs, if necessary - means heart, diuretics and other medications.
as antimicrobials used antibiotics penicillin in age doses for 2 weeks.In the case of allocation of streptococcus antibiotics are prescribed depending on the sensitivity of the pathogen to them.Because NSAIDs are used acetylsalicylic acid, Voltaren, Indomethacin, Amidopyrine, Phenylbutazone and other preparations pirazolonovogo series.
with continuous recurrent process used drugs quinoline series (Plaquenil, delagil).In severe cases, use of corticosteroids - the dosage and duration of the course determined by the physician.
duration of treatment in the hospital - an average of 1.5 months.When continuously recurrent rheumatism treatment may be longer.Used as physiotherapy treatments, physiotherapy.Extract is held with a pronounced positive dynamics of the process and laboratory values, show a decrease in activity of the process.
Rehabilitation of children (Stage 2) is carried out for 2-3 months in a local nursing home.At this stage, and follow-up care: therapeutic agents used in half dose.Used medical gymnastics, conditioning, nutrition, vitamin therapy.
Clinical supervision is conducted to identify the manifestations of the activation process of a year-round prevention of recurrence.Antibiotics are used long-acting (bicillin 5).Also carried out rehabilitation of foci of chronic infection, and is defined by the ability to study (for students).
complex treatment of children with rheumatism may take several years, given supportive treatment (prophylactic antibiotic prolonged spring and autumn).
suffering from rheumatism children should observe a diet.Food should be easily digestible, contain a sufficient amount of protein, vitamins (especially rutin, vitamin C and B), and potassium salts.The diet should definitely include fruits and vegetables.In the morning we can recommend to drink on an empty stomach with hot water juice of 1 lemon.
indigestible rich extractives products should be deleted.Circulatory failure is necessary to control the amount of salt (up to 5 g per day) and the liquid.In the case of II-III degree of circulatory failure, your doctor may recommend carrying out unloading days.
amount of carbohydrates (pastries, sweets, chocolate) should be limited, taking into account their allergenic effects on the body.Recommended fractional eating small portions.In each case, it is desirable to discuss the child's diet with your doctor.
Herbal treatment for rheumatism used since ancient times.But nowadays herbal medicine can be used only as a supplement to medical treatment and only in agreement with your doctor.For the treatment of rheumatism using willow bark collected in early spring flowers meadowsweet root Myl'nikov, black elderberry flowers Adonis spring, grass wild strawberry, heather, cinquefoil, birch buds, and many other plants.Used decoctions and infusions of plants, herbal baths.Recipes are so many fees.However, their use in the treatment of the child can be only with the permission of the doctor.
Distinguish primary and secondary prevention of rheumatic fever.
When primary prevention all measures aimed at preventing the occurrence of rheumatic fever.The complex of measures includes:
aim of secondary prevention is the prevention of relapses and disease progression, ie. E. The formation of valvular defect.Calibration is done after the treatment of rheumatic heart disease primary round bitsillinom-5 age dose for 3 years.In addition, a readjustment of foci of chronic infection, appointed vitamin, especially vitamin C.
In the next 2 years (if within three years there have been repeated attacks of rheumatic fever) is assigned to prophylactic course in the autumn and spring bitsillinom-5 and aspirin, or other drugspirazolonovogo series in age dosage.Bitsillin administered to children and also after any colds.
If the primary rheumatic heart disease ended the formation of heart disease, as well as children with recurrent rheumatic heart disease, prevention is carried out year-round for 5 years.Periodically, the children are sent to the local motels.
Currently, due to the effective treatment of streptococcal infection and conduct preventive treatment is much less marked for severe rheumatism.More than 30 times (compared to the 60-70 years of the last century) to reduce mortality due to severe heart failure in heart diseases.
mix and match heart defects are formed due to the repeated recurrence of rheumatic fever.In primary Rheumatic valvular formed in 10-15% of patients, and with the return - 40%.
particular danger for children with rheumatic fever is erased, mild clinical disease.Often parents or do not pay attention to children's complaints of pain in the hands and feet, or explain their bruises and fatigue of the child.Such errors lead to disease progression and the chance discovery of rheumatic fever at the time of the irreversible consequences of the process.
Rheumatic fever is a serious disease affecting multiple organs and systems.But the disease can be avoided if to follow the child's health and well implement all recommendations of the physician in any place, even harmless, according to parents, colds, and not to self-medicate.In the case of rheumatic fever in a child must remember that preventive treatment is not less important than the treatment of acute attacks.