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. About 80% of acquired heart abnormalities account for rheumatic vascular and heart damage. In the rheumatic process, joints, skin, serous membranes, and the central nervous system are often involved. The incidence rate is approximately 0.3% -3%. Rheumatism usually develops in adolescence and childhood (7-15 years). Adults and preschool children get sick much less often, and 3 times more often girls suffer from this pathology.
In the article, we consider treatment methods and features of the prevention of rheumatism.
The mechanism and causes of the development of pathology
Rheumatic fever , as a rule, is preceded by infection with a streptococcal infection caused by Ξ²-hemolytic streptococcus of group A. These are diseases such as tonsillitis, scarlet fever, maternal fever, pharyngitis, acute otitis media, erysipelas. In 97% of patients who have previously had a streptococcal infection, a stable immunity is formed to this infectious pathogen. In other people, a stable immune response is not generated, and with a secondary infection with Ξ²-hemolytic streptococcus, a complex inflammatory autoimmune reaction occurs.
The development of this pathological condition is promoted by: young age, reduced immunity, large groups (boarding schools, schools, hostels), unsatisfactory living and nutrition conditions, severe hypothermia, burdened family history.
In response to the penetration of Ξ²-hemolytic streptococcus in humans, the process of producing antistreptococcal antibodies (antistreptolysin-O, antistreptokinase, antistreptogialuronidase, antideoxyribonuclease B) begins, which, together 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;
- fibrinoid changes;
- granulomatosis;
- sclerosis.
With an early, reversible, degree of mucoid swelling, edema, swelling and gradual cleavage of collagen fibers occur. If damage cannot be repaired at this stage, then irreversible fibrinoid disorders appear, which are characterized by fibrinoid necrosis of 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 a granulomatous inflammatory process.
Pathology duration
The duration of each of the stages of rheumatic fever 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, there is a deformation of the cusps, their fusion with each other, which is the most common cause of heart disease, and secondary rheumatic attacks exacerbate destructive disorders.
Symptoms of the disease
The symptomatology of rheumatism is extremely polymorphic and depends on the severity and activity of the pathological process, as well as the involvement of different 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 Β° 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). Arthralgia is symmetrical, multiple and volatile (pains pass in some and arise in other joints). There is swelling, swelling, local temperature increase and redness, a pronounced restriction of the movements of these joints. Rheumatic polyarthritis proceeds, as a rule, benignly: the severity of pathological phenomena subsides after a few days, the joint structures do not deform, and a moderate pain syndrome is sometimes very long lasting.
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 damage occurs in 70-85% of patients. With rheumatic heart disease, all or individual heart structures can become inflamed. Most often, there is a simultaneous damage to the myocardium (endomyocarditis) and endocardium, sometimes simultaneously with pericardium (pancarditis), the development of isolated myocardial lesions (myocarditis) is also possible. Shortness of breath, intermittent rhythm and pain in the heart, circulatory failure, pulmonary edema or cardiac asthma appear. 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. Less common are skin manifestations: annular erythema and rheumatoid nodules.
Damage to the abdominal cavity, kidneys, lungs and other organs is very rare in severe forms.
Below we consider the treatment and prevention of rheumatism.
Treatment
The active stage of rheumatism requires hospitalization and bed rest. Therapy is carried out by a cardiologist and rheumatologist. Anti-inflammatory and hypersensitizing drugs, corticosteroid hormones, non-steroidal anti-inflammatory drugs ("Indomethacin", "Genilbutazone", "Diclofenac", "Ibuprofen"), immunosuppressants ("Chloroquine", "Hydroxychlorothinbin") are used.
Remediation of foci of infection
Remediation 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 of an additional nature and is indicated for an infectious focus or obvious symptoms of 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 measures at the state level, such as the promotion of the right lifestyle, sports, and tempering. In addition, certain measures should be taken against crowding in kindergartens, schools, hospitals and other institutions. It is necessary to conduct timely sanitization, especially in places of high population density, instructing children and adults on the prevention of rheumatism.
Particular attention should be paid to the detection and elimination of infectious foci. All people who have had this disease can go to public places only after a thorough examination. People with signs of streptococcal diseases (tonsillitis, pharyngitis, sinusitis, cholangitis, caries) require mandatory therapy. So, the primary measures include:
- Actions that are aimed at increasing the body's resistance and enhancing immunity.
- Sanitary and hygiene measures.
- Timely diagnosis and therapy of streptococcal infection.
Measures that are aimed at preventing a variety of exacerbations, relapses and the subsequent progression of rheumatic processes are secondary prevention of rheumatism. It should be performed by community therapists or rheumatologists. Due to the fact that this is a chronic pathology with a tendency to relapse, secondary prevention of rheumatism is carried out for several years. If the patient does not have a heart defect, then bicillin prophylaxis is carried out year-round for 3 years, and then 2 years - seasonal prevention.
Secondary prevention of rheumatism involves:
- High-quality and intensive course of 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 and adolescents.
- 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 the accompanying allergic reactions.
- Planned implementation of anti-streptococcal prophylaxis.
To solve such problems, it is necessary to conduct comprehensive examinations by various specialists of large groups to timely identify among people carriers of infection or people suffering from focal chronic infection with allergic reactivity, their examination using modern immunological and biochemical research methods, rehabilitation of infectious foci, taking these people to the dispensary for observation.
Risk group
Particular attention should be paid to people who are at risk of rheumatism, i.e., those who, along with chronic foci of infection, have periodic or constant subfebrile temperature, increased fatigue, arthralgia, functional disorders in the cardiovascular system. These patients undergo seasonal prophylaxis of rheumatism "Bicillin" for 2-3 years.
Bicillin-drug prevention method
Currently, all people who have undergone active forms of the rheumatic process are given bicillin-drug prophylaxis over the next 5 years, regardless of age and presence of heart defects (for patients with a history of the disease for more than five years, prophylactic therapy is carried out 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 using bicillin-1 or bicillin-5 (bicillin-3 is not used for such purposes).
For adults and schoolchildren, antibiotic for the prevention of rheumatism bicillin-5 is administered intramuscularly at a dosage of 1,500,000 units once a month, for preschool children - once every 2-3 weeks at a dosage of 750,000 units. Bicillin-1 is administered intramuscularly to adults and schoolchildren once every 3 weeks at a dose of 1,200,000 units, preschoolers at a dose of 600,000 units once every 2 weeks.
What other drugs for the prevention of rheumatism are used?
In addition, 2 times a year for 1-1.5 months, courses of anti-relapse therapy with salicylic acid preparations are conducted. The use of "Bicillin" is carried out in combination with vitamins, especially ascorbic acid.
Seasonal prevention is carried out in the autumn and spring months, and the current prevention of rheumatism is carried out for people with a threat of this pathology.