Rheumatic fever 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. Most often it occurs in children and young people. Pathology appears approximately 2-4 weeks after diseases caused by group A streptococcus. These diseases include tonsillitis, scarlet fever and tonsillitis.
Causes of the disease
Streptococcus alone is not the cause of acute rheumatic fever. The disease occurs due to an autoimmune reaction. When bacteria enter the body, immunity begins to produce antibodies against germs. However, streptococcus proteins are very similar in structure to the proteins of human cells. As a result, antibodies mistakenly begin to attack their own body tissues. This becomes the cause of damage to the heart and joints, which occurs during acute rheumatic fever.
Provocative factors
Autoimmune disorders do not occur in all patients who have had tonsillitis or scarlet fever. There are certain unfavorable 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);
- living in unsanitary conditions.
It was also established that rheumatic fever is more susceptible to patients with untreated streptococcal infection. If a person complied with 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.
Symptomatology
As already mentioned, the disease develops a few weeks after recovering 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 rheumatic fever appear:
- temperature increase to +39 degrees;
- increased sweating with a sour smell;
- increased heart rate;
- loss of appetite;
- thirst;
- general weakness and malaise.
Then there are signs of joint damage:
- severe pain;
- redness of the skin and swelling in the affected areas;
- accumulation of fluid in the joint cavity;
- areas of inflammation become hot to the touch.
Most often, damage to the ankle, elbow and knee joints, as well as the wrist, is noted. A rash appears on the epidermis. It looks like red rings with white patches of skin inside (ring-shaped erythema). Sometimes, under the skin, you can feel small painless nodules.
Rheumatic heart attack is especially dangerous. The disease is accompanied by inflammation of the myocardium, pericardium, and sometimes endocardium. The following signs of cardiac tissue damage occur:
- dyspnea;
- chest pain;
- severe tiredness;
- dizziness.
Pathology also affects the central nervous system. The patient develops involuntary muscle twitching (Sydenham chorea). Such uncontrolled movements affect the muscles of the face and limbs. If a similar symptom occurs in childhood, then the parents take this for the usual grimacing of the child.
In children, the symptoms of the disease may be erased. Joint pains are often mild, parents can attribute this symptom to the rapid growth of the child. It often happens that a person suffered acute rheumatic fever in childhood, which went unnoticed. And then, already in adolescence or adolescence, the patient has rheumatic heart disease. Therefore, you need to carefully monitor the health of children who have had streptococcal infection.
Complications
Rheumatic attack can lead to serious complications if the disease is not timely treated:
- The patient may experience damage to the heart valves, which leads to the development of rheumatic heart disease.
- Atrial fibrillation often develops. This cardiac pathology increases the risk of stroke.
- In advanced cases, heart failure occurs.
All this suggests that acute rheumatic fever should be treated immediately. If a child or an adult has had joint pain after suffering a sore throat or scarlet fever, then consult a doctor immediately. Arthralgia is usually followed by heart damage.
Diagnostics
A rheumatologist is involved in the diagnosis and treatment of rheumatic fever. If the patient has a heart lesion, then a cardiologist should be consulted.
To confirm the diagnosis, the patient is prescribed studies:
- smear from the nasopharynx on group A streptococcus;
- antibody titer test for streptococcus;
- blood test for proteins;
- general blood and urine tests (to detect an inflammatory reaction);
- electrocardiogram;
- echogram of the heart;
- phonocardiography.
An analysis to determine the titer of antibodies to streptococcus must be taken several times during treatment. This will help evaluate the effectiveness of the prescribed therapy.
Treatment
The main method of treating rheumatic attack in adults and children is drug therapy. It is necessary to remove inflammation, as well as destroy streptococcus. Treatment begins with the appointment of antibacterial drugs. Usually used antibiotics of the penicillin group: "Bicillin", "Benzylpenicillin." Cephalosporins are less commonly used: Cefadroxil, Cefuroxime.
To stop joint pain, non-steroidal anti-inflammatory drugs are prescribed:
- Diclofenac
- Celecoxib;
- "Aspirin".
In severe pain, the corticosteroid drug Prednisolone is prescribed.
Since the pathology is of 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, use drugs:
Symptomatic treatment of cardiac dysfunctions 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. It is necessary to take all prescribed medications and follow the doctor's recommendations. After a streptococcal disease, it is recommended to be observed by a rheumatologist and cardiologist. If symptoms such as joint pain, shortness of breath, muscle twitching occur, you should immediately be diagnosed. Such manifestations may be signs of acute rheumatic fever.