This disease has several names - rheumatism, Sokolsky-Buyo disease, rheumatic fever. The pathological process proceeds chronically, with a tendency to recurrent conditions, which are observed in most cases in autumn and spring. The share of rheumatic lesions of blood vessels and the heart accounts for about 80% of acquired heart anomalies. The rheumatic process often involves joints, skin, serous membranes, and the central nervous system. The incidence rate is approximately 0.3%-3%. Rheumatism usually develops in adolescence and childhood (7-15 years). Adults and preschool children fall ill much less often, and girls suffer from this pathology 3 times more often.
In the article, we will consider the methods of treatment and features of the prevention of rheumatism.
Mechanism and causes of the development of pathology
A rheumatic attack is usually preceded by a streptococcal infection caused byβ-hemolytic streptococcus group A. These are diseases such as tonsillitis, scarlet fever, puerperal fever, pharyngitis, acute otitis media, erysipelas. In 97% of patients who have previously had a streptococcal infection, strong immunity is formed to this infectious agent. In the rest of the population, a persistent immune response is not developed, and secondary infection with β-hemolytic streptococcus causes a complex inflammatory autoimmune reaction.
The development of this pathological condition is facilitated by: young age, reduced immunity, large groups (boarding schools, schools, hostels), unsatisfactory living and nutrition conditions, severe hypothermia, aggravated anamnesis in the family.
In response to the penetration of β-hemolytic streptococcus, a person begins the process of producing antistreptococcal antibodies (antistreptolysin-O, antistreptokinase, antistreptohyaluronidase, antideoxyribonuclease B), which, along with streptococcal antigens and components of the complement system, form immune complexes.
Stages
The process of disorganization of connective tissues during rheumatism takes place in several stages:
- mucoid swelling;
- changes in fibrinoid nature;
- granulomatosis;
- sclerosis.
With an early, reversible, degree of mucoid swelling, edema occurs, swelling and gradual splitting of collagen fibers. If at this stage the damage is not eliminated, then irreversible fibrinoid disorders appear, which are characterized by fibrinoid necrosis.collagen fibers and cells. At the garnulomatous stage of the rheumatic process, specific rheumatic granulomas form around the areas of necrosis. The last stage of sclerosis is considered the outcome of the granulomatous inflammatory process.
Duration of pathology
The duration of each of the stages of rheumatic lesions is approximately 1-2 months, and the entire cycle is about 6 months. Relapses of rheumatic attacks cause the development of repeated tissue lesions in areas of existing scars. In the heart valves, in which rheumatism is observed, deformation of the valves occurs, their fusion with each other, which is the most common cause of the development of heart defects, and secondary rheumatic attacks exacerbate destructive disorders.
Symptoms of disease
The symptoms of rheumatism are extremely polymorphic and depend on the severity and activity of the pathological process, as well as the involvement of various organs in it. A typical clinic of the disease has a direct relationship with streptococcal infection (tonsillitis, scarlet fever, pharyngitis) and develops 1-2 weeks after the acute period. Rheumatism begins with subfebrile temperature (38-39 ° C), acute weakness, headache, fatigue, excessive sweating.
One of the initial manifestations of rheumatism is arthralgia - pain in large or medium joints (ankle, knee, elbow, shoulder, wrist). Arthralgias are symmetrical, multiple and volatile (pains pass in some and occur inother joints) character. There is swelling, swelling, local temperature increase and redness, a pronounced limitation of the movements of these joints. Rheumatic polyarthritis proceeds, as a rule, benignly: the severity of pathological phenomena subsides after a few days, the articular structures are not deformed, and a moderate pain syndrome sometimes persists for a very long time.
Rheumatic heart disease
After 1-3 weeks, rheumatic heart disease begins: pain in the heart, palpitations, shortness of breath; then asthenic syndrome: lethargy, malaise, fatigue. Heart failure occurs in 70-85% of patients. With rheumatic heart disease, all or individual structures of the heart can become inflamed. Most often, there is simultaneous damage to the myocardium (endomyocarditis) and endocardium, sometimes simultaneously with the pericardium (pancarditis), it is also possible to develop isolated myocardial lesions (myocarditis). There are shortness of breath, interruptions in the rhythm and pain in the heart, circulatory failure, pulmonary edema or cardiac asthma. The pulse is tachyarrhythmic.
CNS damage
With rheumatism, the central nervous system can be affected, a sign of this is rheumatic chorea: hyperkinesis appears - involuntary muscle twitching, muscle and emotional weakness. Skin manifestations are less common: erythema annulare and rheumatoid nodules.
Involvement of the abdominal cavity, kidneys, lungs and other organs is very rare in severe forms.
Below, consider the treatment and prevention of rheumatism.
Treatment
Active stage of rheumatismrequires hospitalization and bed rest. Therapy is carried out by a cardiologist and a rheumatologist. Anti-inflammatory and hyposensitizing drugs, corticosteroid hormones, non-steroidal anti-inflammatory drugs (Indomethacin, Genilbutazone, Diclofenac, Ibuprofen), immunosuppressants (Chloroquine, Hydroxychloroquine, Azathioprine, Chlorbutin) are used.
Rehabilitation of foci of infection
Rehabilitation of foci of infection (caries, tonsillitis, sinusitis) includes their antibacterial and instrumental treatment. The use of antibiotics of the penicillin group ("Bicillin") in the treatment of rheumatism is additional in nature and is indicated for an infectious focus or obvious symptoms of a streptococcal infection.
Rheumatism Prevention
Preventive measures to prevent rheumatic pathologies associated with infection with streptococcal infection can be divided into primary and secondary. The main role should be played by general activities at the state level, such as the promotion of a proper lifestyle, sports, hardening. In addition, certain measures must be taken against crowding in kindergartens, schools, hospitals and other institutions. It is necessary to carry out timely sanitization, especially in places of high population density, to instruct children and adults in the prevention of rheumatism.
Special attention should be paid to the detection and elimination of infectious foci. All people who have had this disease can only go out into public placesafter a thorough examination. People with signs of streptococcal diseases (tonsillitis, pharyngitis, sinusitis, cholangitis, caries) require mandatory therapy. So, primary measures mean:
- Actions that are aimed at increasing the body's resistance and improving immunity.
- Sanitary and hygiene measures.
- Timely diagnosis and treatment of streptococcal infection.
Measures that are aimed at preventing a variety of exacerbations, relapses and subsequent progression of rheumatic processes are secondary prevention of rheumatism. It should be carried out by local therapists or rheumatologists. Due to the fact that this is a chronic pathology with a tendency to relapse, secondary prevention of rheumatism has been carried out for several years. If the patient has not developed a heart disease, then bicillin prophylaxis is carried out all year round for 3 years, and then seasonal prophylaxis for 2 years.
Secondary prevention of rheumatism implies:
- Quality and intensive treatment for patients with rheumatism.
- Timely prevention and treatment of nasopharyngeal infectious diseases.
- Bicillin prophylaxis, which is divided into 3 groups: year-round, seasonal and current.
According to A. I. Nesterov, during the primary prevention of rheumatism, four main tasks should be solved:
- Achieving a high level of human immunity, especially in children andteenagers.
- Elimination or reduction of the risk of developing streptococcal infection through the implementation of sanitary and hygienic measures, diagnosis and treatment of carriers of this infection.
- Organization and planned conduct of qualified treatment of an existing infection with accompanying allergic reactions.
- Planned implementation of streptococcal prophylaxis.
outbreaks, taking these people to the dispensary for observation.
Risk group
It is necessary to pay special attention to people who have a threat of rheumatism, i.e. those who, along with chronic foci of infection, have periodic or constant subfebrile temperature, fatigue, arthralgia, functional disorders in the cardiovascular system. These patients are given seasonal prophylaxis of rheumatism with "Bicillin" for 2-3 years.
Bicillin-drug prevention method
At the moment, all people who have undergone active forms of the rheumatic process in the next 5 years undergo bicillin-drug prophylaxis, regardless ofage and the presence of heart defects (patients with a disease more than five years old are given preventive therapy according to indications).
So, for the prevention of rheumatism, the drug "Bicillin" is used.
Distinguish between seasonal, year-round and current prevention. Year-round is carried out with the help of bicillin-1 or bicillin-5 (bicillin-3 is not used for such purposes).
For adults and schoolchildren, the antibiotic for the prevention of rheumatism bicillin-5 is administered intramuscularly at a dosage of 1,500,000 IU once a month, for preschoolers - once every 2-3 weeks at a dosage of 750,000 IU. Bicillin-1 is administered intramuscularly to adults and school-age children once every 3 weeks at a dose of 1,200,000 IU, to preschoolers - at a dose of 600,000 IU once every 2 weeks.
What other drugs are used to prevent rheumatism?
In addition, 2 times a year for 1-1.5 months, courses of anti-relapse therapy with salicylic acid preparations are carried out. The use of "Bicillin" is carried out in combination with vitamins, especially ascorbic acid.
Seasonal prophylaxis is carried out in the autumn and spring months, and the current prevention of rheumatism is for people at risk of this pathology.
