Rheumatic attack is an inflammatory disease of the heart and joints. It occurs as a complication after a streptococcal infection. Otherwise, this disease is called acute rheumatic fever. It most often occurs in children and young people. Pathology appears approximately 2-4 weeks after diseases caused by group A streptococcus. Such ailments include tonsillitis, scarlet fever and tonsillitis.
Causes of disease
Streptococcus itself is not the cause of an acute rheumatic attack. The disease occurs due to an autoimmune reaction. When bacteria enter the body, the immune system begins to produce antibodies against the microbes. However, streptococcal proteins are very similar in structure to the proteins of human cells. As a result, antibodies mistakenly begin to attack the body's own tissues. This becomes the cause of damage to the heart and joints, which occurs during acuterheumatic attack.
Provoking factors
Autoimmune disorders do not occur in all patients who have had a sore throat or scarlet fever. There are certain adverse factors that cause a malfunction in the body's defenses.
These include:
- hereditary predisposition to rheumatic diseases;
- damage to the body by certain strains of streptococcus (some types of bacteria often lead to immune failure);
- live in unsanitary conditions.
It has also been established that patients with untreated streptococcal infections are more susceptible to rheumatic fever. If a person followed all the doctor's recommendations during the treatment of angina or scarlet fever, then damage to the heart and joints is extremely rare. The risk of rheumatic complications increases if the patient has repeatedly had streptococcal pathologies.
Symptomatics
As already mentioned, the disease develops a few weeks after recovery from a sore throat or scarlet fever. Pathology is accompanied by inflammation of the membranes of the heart and joints. The disease begins acutely. At the initial stage, the following symptoms of a rheumatic attack appear:
- temperature increase to +39 degrees;
- increased sweat with a sour smell;
- increased heart rate;
- loss of appetite;
- thirst;
- general weakness and malaise.
Then there are signs of defeatjoints:
- severe pain;
- skin redness and swelling in affected areas;
- fluid accumulation in the joint cavity;
- inflammation areas become hot to the touch.
Most often there is a lesion of the ankle, elbow and knee joints, as well as the wrist. A rash appears on the epidermis. It looks like red rings with white patches of skin inside (erythema annulus). Sometimes small painless nodules can be felt under the skin.
Rheumatic attack is especially dangerous for the heart. The disease is accompanied by inflammation of the myocardium, pericardium, and sometimes the endocardium. The following signs of damage to cardiac tissues occur:
- shortness of breath;
- chest pain;
- very tired;
- dizziness.
Pathology also affects the central nervous system. The patient has involuntary muscle twitches (Sydenham's chorea). Such uncontrolled movements affect the muscles of the face and limbs. If a similar symptom occurs in childhood, then the parents take it for the usual grimacing of the child.
In children, the symptoms of the disease may be erased. Pain in the joints is often mild, parents can attribute this symptom to the rapid growth of the child. It often happens that a person suffered an acute rheumatic fever in childhood, which went unnoticed. And then, already in adolescence or adolescence, the patient is diagnosed with rheumatic heart disease. That's whyyou need to carefully monitor the he alth of children who have had a streptococcal infection.
Complications
Rheumatic attack can lead to serious complications if the disease is not treated in time:
- The patient may develop valvular disease leading to rheumatic heart disease.
- Often develops atrial fibrillation. This heart disease increases the risk of stroke.
- In advanced cases, heart failure occurs.
All this suggests that acute rheumatic fever must be treated immediately. If a child or an adult has pain in the joints after suffering a sore throat or scarlet fever, you should immediately consult a doctor. Arthralgia is usually followed by cardiac involvement.
Diagnosis
A rheumatologist deals with the diagnosis and treatment of a rheumatic attack. If the patient has heart disease, then a cardiologist should be consulted.
To confirm the diagnosis, the patient is prescribed research:
- nasopharyngeal swab for group A streptococcus;
- test for antibody titer to streptococcus;
- blood test for proteins;
- general blood and urine tests (to detect an inflammatory reaction);
- electrocardiogram;
- sonography of the heart;
- phonocardiography.
An analysis to determine the titer of antibodies to streptococcus must be taken several times during the course of treatment. It will helpevaluate the effectiveness of the prescribed therapy.
Treatment
The main treatment for rheumatic fever in adults and children is drug therapy. It is necessary to relieve inflammation, as well as destroy streptococcus. Treatment begins with the appointment of antibacterial drugs. Usually antibiotics of the penicillin group are used: "Bicillin", "Benzylpenicillin". Less commonly used cephalosporins: Cefadroxil, Cefuroxime.
Non-steroidal anti-inflammatory drugs are prescribed to relieve joint pain:
- "Diclofenac";
- "Celecoxib";
- "Aspirin".
In case of severe pain, the corticosteroid drug "Prednisolone" is prescribed.
Since the pathology is of an autoimmune origin, it is necessary to prescribe drugs that suppress the formation of antibodies. They are able to influence the pathogenesis of the disease. For this purpose, drugs are used:
- "Mabthera";
- "Remicade";
- "Orencia".
Symptomatic treatment of heart disorders is also carried out. Diuretics, antihypertensive drugs and cardiac glycosides are prescribed.
If the patient has involuntary movements and muscle twitches, then the appointment of sedatives and antipsychotics is recommended:
- "Droperidol";
- "Haloperidol";
- "Phenobarbital";
- "Midazolam".
Surgical treatment is used only in the formation of rheumatic heart disease and valve damage. In this case, cardiac surgery is recommended. Joint damage is usually amenable to conservative treatment, such pathological changes are reversible.
Prevention
Prevention of the consequences of streptococcal infection is the complete cure of tonsillitis, scarlet fever or tonsillitis. You must take all prescribed medications and follow the doctor's recommendations. After suffering a streptococcal disease, it is recommended to be observed by a rheumatologist and a cardiologist. If you experience symptoms such as joint pain, shortness of breath, muscle twitching, you should immediately undergo a diagnosis. Such manifestations may be signs of acute rheumatic fever.
