Timely detection of signs of any disease in the early stages is an important condition for its effective treatment, especially if there is a predisposition to this disease. The same applies to diseases such as rheumatism.
The correct diagnosis is also important, which is carried out using various diagnostic methods. In this article, we will consider what are the symptoms of rheumatism, the types of the disease, its treatment and prevention.
The concept of rheumatism
In modern medical sources, rheumatism is called an inflammatory disease of a systemic nature of the connective tissue, the pathological process of which is localized mainly in the membranes of the heart muscle or in the periarticular soft tissues, but can also affect other organs.
Most often this disease occurs in children. The younger the child, the worse the recurrence of the disease. It is necessary to identify the symptoms in time, and the treatment of rheumatism in children in this case will be more effective.
Rheumatism can manifest itself in the following varieties:
- rheumatic heart disease - an inflammatory lesion of all membranes of the heart muscle, including the myocardium;
- rheumatic pleurisy - damage to the respiratory organs;
- skin rheumatism - inflammation of the skin;
- rheumatic chorea - a pathology manifested by vasculitis of small vessels of the brain (more often in girls);
- rheumatic arthritis - inflammation of the joints.
With rheumatism, the organs of the digestive system are relatively rarely affected. In this case, acute pains in the abdomen may appear, which are associated with rheumatic peritonitis. Sometimes there is inflammation of the liver or kidneys.
The danger of the disease lies in the fact that if you ignore the symptoms of rheumatism and treatment, as well as systematic observation by a doctor, serious pathologies of the central nervous system and heart can develop.
Causes of disease
Genetic predisposition plays an important role in the occurrence of the disease.
Most often the symptoms of rheumatism appear one to three weeks after the following events:
- entering the body of β-hemolytic streptococcus group A;
- exacerbation of chronic forms of tonsillitis, pharyngitis, tonsillitis, otitis media;
- scarlet fever disease;
- puerperal fever.
The body of ninety-seven percent of those who have had a streptococcal infection forms a strong immunity. The rest develop an inflammatory response when reinfected.
The main factors that contribute to the occurrence of symptoms of rheumatism (photos of manifestations can be seen in the article) are:
- lowered immunity;
- collectives with a large number of people (schools, hostels and others);
- childhood and young age;
- negative social conditions of existence;
- prolonged hypothermia.
Clinical manifestations of rheumatic heart disease
This kind of rheumatism is dangerous because in twenty percent of cases it can end with a formed heart disease. And if adults are able to clearly describe the manifestations of the disease, then children, as a rule, do not pay attention to them.
Symptoms of heart rheumatism are as follows:
- weakness, fatigue, headaches;
- excessive sweating;
- sharp loss of appetite;
- pulling-stabbing pains in the region of the heart;
- temperature increase over 38 degrees Celsius;
- slight pressure drop;
- palpitations;
- Severe symptoms of heart failure and abnormal heart rhythms.
It is extremely important to identify the symptoms of heart rheumatism in time - the treatment of the disease in this case will be more effective.
Clinic of articular rheumatism
Articular form of acuterheumatism usually begins 1-3 weeks after suffering a sore throat or other infectious disease (flu, inflammation of the ear or paranasal sinuses). In this case, as a rule, children and young people suffer. Symptoms and treatment of rheumatism of the joints will be discussed next.
Patients complain about the following symptoms:
- severe joint pain, more often in large ones - shoulder, knee, ankle and others;
- swelling in the joints;
- impossibility of movement due to volatile pains;
- temperature rises to 38-39°C;
- severe sweating appears (especially sick people sweat at night and early in the morning);
- defeat appears symmetrically;
- appears weakness, weakness, bleeding from the sinuses.
More often the disease begins acutely, less often it develops gradually. When examining patients, their immobile position attracts attention - they avoid the slightest movements due to sharp pains in inflamed places. The symptoms of hand rheumatism are similar to those of other types of the disease.
Usually the affected joints are enlarged, the skin over them is somewhat hyperemic, hot to the touch, moist, sometimes covered with an erythematous rash.
In the early days of the cardiovascular system, except for moderate tachycardia, no changes are noted. Pain in the joints are volatile in nature, and it often manifests itself in young, strong people. The defeat of each new joint occurs within a few hours.
The symptoms of rheumatism in adults are manifested as follows: first, one or two joints are affected, then more and more are involved in the process. In some cases, eight joints can be inflamed at once, and sometimes more.
In severe cases, edematous fluid accumulates not only in the joint cavity, but also in the periarticular muscles and connective formations. When they are felt, the most painful are the places of attachment of fibrous fascia and tendons to the bones.
It should be emphasized that joints that have been ill can become inflamed again after a few days, so that some of them may be affected several times during acute rheumatism. This is especially true for rheumatism of the legs - the symptoms are similar to the general manifestations of other types of the disease.
Clinic for other forms of rheumatism
Each variety of rheumatism has its own characteristics. Consider them further.
Rheumochorrhea is characterized by the following symptoms:
- impaired fine motor skills, handwriting, coordination of movements - symptoms appear only during wakefulness;
- appearance of spontaneous grimaces, muscle weakness, inability to walk and sit;
- swallowing disorder;
- the patient's behavior changes in the direction of instability and variability - from aggressiveness and emotional instability the patient goes to absent-mindedness, passivity, he quickly gets tired.
The cutaneous form of the disease is manifested by the following symptoms:
- knottyerythema is characterized by limited compaction of skin areas (mainly on the lower extremities) with a color change to dark red, the size is from half a centimeter to four;
- erythema annulus is characterized by painless pale pink rashes in the form of annular rims;
- appearance of dense painless rheumatic nodules;
- in rare cases, with severe capillary permeability, small capillary hemorrhages may appear;
- pale skin;
- excessive sweating.
Nodules do not cause discomfort and disappear within two to three weeks.
It is important to know what symptoms of rheumatism are in order to consult a specialist in time to determine the type of disease.
Rheumatic pleurisy is characterized by the following features:
- increased body temperature;
- chest pain when breathing, worse when breathing in;
- dry cough;
- expressed shortness of breath;
- no breathing is heard on the affected side.
Symptoms of rheumatism in adults are mostly similar to those of children.
Diagnosis of disease
For the timely detection of the disease, it is necessary to consult a doctor in time, who will conduct the necessary examination. Its results will help to establish the correct diagnosis and prescribe treatment. The symptoms of hand rheumatism, like other varieties of the disease, are similar in nature, and therefore require careful analysis.
Laboratory andinstrumental research.
The first group includes:
- Blood test. The presence of the disease is indicated by the appearance of C-reactive protein, an increase in ESR, anemia, and a shift of the leukocyte formula to the left. The result helps to determine the degree of disease activity. The analysis also determines eosinophilia and anemia.
- Analysis of joint fluid. The result determines whether a serofibrinous exudate is present with a large number of endothelial cells, neutrophils, single erythrocytes and fibrin flakes.
- Analysis of pleural fluid. Shows the presence of a similar exudate containing a large number of mesothelial cells.
- Smear. Analysis with a large number of segmented neutrophils and lymphocytes, as well as neutrophils.
- Urine analysis. The disease confirms the presence of traces of protein and red blood cells.
- Diphenylamine (DPA) test detects increased levels of mucoproteins, antistreptokinase, antistreptolysin and antihyaluronidase titers.
Instrumental studies include:
- Electrocardiogram - shows a violation of the rhythm of the heart muscle.
- Ultrasound examination of the heart.
- FCG - determines the change in noise and heart sounds.
- X-ray - allows you to measure the dynamics of the size of the heart muscle, its configuration and contractile function.
Course of illness
The course of an active form of rheumatism is quite long, although joint lesions are often relatively quickly eliminated - from two to three weeks to three to six months.
Even with mild symptoms of rheumatism, the process in the heart and joints imperceptibly for the patient and often for the doctor continues inexorably. The tragedy of a patient with rheumatism lies in the fact that during this period the joints do not bother him, the discomfort in the heart area is very slight, the state of he alth improves, so people stop taking the necessary drugs. When, after a few years, patients seek medical help, the results of an objective examination state that they have a pronounced heart defect with the presence of endocarditis and inflammation of the circulatory system.
The most serious changes occur in the cardiovascular system. Rheumatism affects the myocardium, endocardium and pericardium. First of all, changes occur in the heart muscle. Clinically, seven to ten days after the onset of the disease, in the midst of joint pain, patients develop heart palpitations, shortness of breath, heaviness, discomfort and pain in the heart area.
The symptoms of rheumatism in children at the initial stage are sometimes difficult to determine, because the child cannot describe them correctly. Therefore, adults should pay attention to obvious signs in the form of temperature, weakness, joint swelling.
The following degrees of the course of the disease are distinguished depending on how pronounced the clinical symptoms of rheumatism are:
- sharp, continuously manifesting;
- subacute (moderate activity);
- latent, that is, sluggish, with minimal activity.
Rheumatism is characterized by repeated attacks - relapses resulting from external adverse effects: hypothermia, infections, physical overexertion. Clinical signs of repeated inflammations resemble the primary ones, but they are less pronounced, but the symptoms of heart damage, on the contrary, prevail.
Differential diagnosis of articular rheumatism
In severe cases, doctors have no difficulty in making a diagnosis, especially taking into account the pathology of the patient's heart.
First of all, it is necessary to distinguish rheumatic arthritis from rheumatoid (nonspecific, infectious). The similarity of these diseases lies in the fact that both of them can begin with the occurrence of tonsillitis or lesions of the accessory cavities of the nose, fever.
In addition to rheumatoid arthritis, rheumatic arthritis should also be differentiated from infectious specific polyarthritis of a certain etiology. Here we should keep in mind tuberculosis, gonorrhea, brucellosis, dysentery, syphilis, influenza, typhoid, sepsis and acute childhood infections.
Prognosis and primary prevention
Prognosis for the articular form of rheumatism is determined by the degree of heart damage.
Changes in the joints themselves most often end favorably, and residual changes in the form of tight mobility or ankylosis are rare.
With timely detection of symptoms and treatment of rheumatism, the disease lends itself well to therapeutic effects. The most difficult and unfavorablerecurring rheumatism occurs.
Great importance should be given to the living conditions in which the person who has recovered from the primary or acute form of the disease will be. It is important to fight against cold, dampness, drafts, overwork to prevent recurrence of rheumatism.
To broad preventive measures for the treatment of symptoms of rheumatism of the joints should include hardening of the body to increase its resistance to cooling, fluctuations in external temperature, dampness. Physical education and sports exercises will contribute to the necessary training and hardening of the body.
Drug prevention and treatment of comorbidities
Detection of all kinds of chronic infectious foci in the body requires immediate treatment. It is necessary to sanitize the oral cavity, remove carious teeth, treat chronic tonsillitis, inflammation of the ear and paranasal cavities.
The presence of chronic inflammatory foci not only can contribute to the widespread infection in the body, increase allergic reactions, but also change its reactivity and thereby create conditions for the onset of rheumatism.
One of the methods that allows the clinician to clarify the presence of allergies is the study of peripheral blood. An increase in the number of eosinophils over five percent should always attract attention and give rise to a thorough examination of the body, and, if necessary, to the use of desensitizing agents (diphenhydramine, diazolin, calcium chloride, and others).
As a preventive measureduring periods of exacerbation - in spring and autumn - they are treated with antimicrobial and anti-inflammatory drugs.
Secondary prevention
The following activities are typical for secondary prevention:
- With the active course of the disease, constant monitoring of the condition by a rheumatic cardiologist is necessary. At first, he is visited monthly for three months from the detection of symptoms of rheumatism, and after that - once a quarter. It is also mandatory to seek advice from such specialists as a neurologist, ENT, ophthalmologist, dentist, gynecologist.
- The necessary rule is to donate blood plasma once every two months, and urine once a quarter.
- Quarterly diagnostic activities.
- Four times a year donate blood for rheumatic tests.
- When the process is fading and turning into an inactive form, a rheumatic cardiologist is visited two to four times a year.
Rheumatism treatment
The active and acute phase of rheumatism is treated in a hospital with strict bed rest.
Patients are prescribed drugs with hyposensitizing and anti-inflammatory effects: non-steroidal anti-inflammatory drugs, corticosteroid hormones. Also, in the presence of infectious foci, antibiotics are prescribed with their simultaneous sanitation (carious teeth, tonsillitis, sinusitis).
In parallel with the main drug therapy, patients are prescribed immunomodulators and sedatives. In case of detected heart lesions, diuretics and cardiacglycosides.
Symptoms and treatment of rheumatism in adults is generally the same as in children.
Outpatient setting:
- patients should observe strict bed rest and be in a warm, dry room, in a calm environment;
- you need to provide good nutrition with enough vitamins (A, C, B1);
- recommended to introduce a sufficient amount of protein and carbohydrates with food;
- should limit the intake of table s alt (up to 3-4 g), which really has a positive effect on the course of the inflammatory process;
- due to the patient's sweating, fluid intake should not be limited.
In the weakening form of the disease from medications, the first place should be the use of salicylates in the form of salicylic sodium or aspirin, as well as antibiotics (penicillin). Instead of salicylic sodium, aspirin can be prescribed, but its effect will be somewhat weaker.
Hormonal preparations are also used - ACTH, cortisone and its derivatives. The effect in most cases is positive, since the listed drugs have a distinct anti-allergic effect and are able to suppress allergic reactivity and hyperergic tissue reactions in patients with rheumatism.
To the diet in these cases, in addition to s alt restriction, two to four grams of potassium chloride per day should be prescribed.
In the presence of exacerbation of chronic tonsillitis or other foci of infection, vigorous antibiotic therapy is indicated.
Physiotherapyprocedures, as well as ultraviolet irradiation, should be used for a protracted course of rheumatic fever, and physiotherapy exercises are indicated during the same period.
