Rheumatism in children
Rheumatism in children is an infectious and allergic disease that occurs with a systemic lesion of the connective tissue of the cardiovascular system, joint synovial membranes, serous membranes of the central nervous system, liver, kidneys, lungs, eyes, and skin. With rheumatism, children can develop rheumatic polyarthritis, rheumatic carditis, small chorea, rheumatic nodules, annular erythema, pneumonia, nephritis. Diagnosis of rheumatic fever in children is based on clinical criteria, their connection with a transmitted streptococcal infection, confirmed by laboratory tests and markers. In the treatment of rheumatism in children, glucocorticoids, NSAIDs, preparations of quinoline and penicillin series are used.
Rheumatism in children
Rheumatism in children( rheumatic fever, Sokolsky-Buyo disease) is a systemic inflammatory disease characterized by affection of the connective tissue of various organs and aetiologically associated with streptococcal infection. In pediatrics, rheumatism is diagnosed mainly in children of school age( 7-15 years).The average population frequency is 0.3 cases of rheumatism per 1000 children. Rheumatism in children is characterized by an acute onset, often prolonged, over the years, with a course with alternating periods of exacerbations and remissions. Rheumatism in children is a common cause of the formation of acquired heart defects and disability.
Causes of rheumatism in children
The experience accumulated in rheumatology allows rheumatism in children to be attributed to an infectious and allergic disease, which is based on infection caused by β-hemolytic streptococcus of group A( M-serotype) and altered organism reactivity. Thus, the incidence of a child with rheumatism is always preceded by a streptococcal infection: tonsillitis, tonsillitis, pharyngitis, scarlet fever. The etiological significance of β-hemolytic streptococcus in the development of rheumatism in children is confirmed by the detection in the blood of the majority of patients of anti-streptococcal antibodies - ASL-O, antistreptokinase, antistreptogialuronidase, antidexoxyribonuclease B, with tropism to connective tissue.
An important role in the development of rheumatism in children is assigned to hereditary and constitutional predispositions. In a number of cases, a family history of rheumatism can be traced, and the fact that only 1-3% of children and adults who have experienced streptococcal infection get sick with rheumatic fever allows one to talk about the existence of so-called "rheumatic diathesis".
The leading factors in the virulence of β-hemolytic streptococcus are its exotoxins( streptolysin-O, erythrogenic toxin, hyaluronidase, proteinase) that cause pyrogenic, cytotoxic and immune reactions that cause damage to the heart muscle with the development of endomyocarditis, contractility and myocardial conduction.
In addition, the proteins of the cell wall of streptococcus( lipoteichoic acid peptidoglycan, polysaccharide) initiate and support the inflammatory process in the myocardium, liver, synovial membranes. The M-protein of the cell wall suppresses phagocytosis, exerts a nephrotoxic effect, stimulates the formation of anticardium antibodies, etc. The basis of skin and subcutaneous tissue damage in rheumatism in children is vasculitis;Rheumatic chorea is caused by the defeat of subcortical nuclei.
Classification of rheumatism in children
In the development of rheumatism in children, the active and inactive phases are isolated. Criteria for the activity of the rheumatic process are the severity of clinical manifestations and changes in laboratory markers, in connection with which three degrees are distinguished:
- I( minimal activity) - absence of exudative component of inflammation;weak severity of clinical and laboratory signs of rheumatism in children;
- II( moderate activity) - all signs of rheumatism in children( clinical, electrocardiographic, radiographic, laboratory) are not pronounced;
- III( maximum activity) - predominance of the exudative component of inflammation, the presence of high fever, signs of rheumatic carditis, articular syndrome, polyserositis. The presence of distinct X-ray, electro- and phonocardiographic signs of carditis. Sharp changes in laboratory parameters - high neutrophilic leukocytosis. Sharply positive CRP, a high level of serum globulins, a significant increase in anti-streptococcal antibody titres, etc.
Inactive phase of rheumatic fever in children is noted during the interictal period and is characterized by normalization of the child's well-being, instrumental and laboratory indicators. Sometimes between attacks of rheumatic fever is preserved subfebrile and malaise, there is a progression of carditis with the formation of valvular heart disease or cardiosclerosis. Inactive phase of rheumatism in children can last from several months to several years.
The course of rheumatism in children may be acute( up to 3 months), subacute( 3 to 6 months), prolonged( more than 6 months), continuously-relapsing( without clear periods of remission of up to 1 year or more), latent( secretly leading to the formation of valvular heart disease).
Symptoms of rheumatism in children
Clinical manifestations of rheumatism in children are diverse and variable. The main clinical syndromes include rheumatic carditis, polyarthritis, small chorea, anuricular erythema and rheumatic nodules. For all forms of rheumatism, children manifest a clinical manifestation 1.5-4 weeks after the previous streptococcal infection.
The defeat of the heart for rheumatism in children( rheumatic carditis) occurs always;in 70-85% of cases - primarily. With rheumatism, children may experience endocarditis, myocarditis, pericarditis, or pancarditis. Rheumatic carditis is accompanied by lethargy, fatigue of the child, subfebrile condition, tachycardia( rarely bradycardia), shortness of breath, pain in the heart.
Repeated attack of rheumatic heart disease usually occurs after 10-12 months and is more severe with symptoms of intoxication, arthritis, uveitis, etc. As a result of repeated attacks of rheumatic fever, all children are diagnosed with acquired heart defects: mitral insufficiency, mitral stenosis, aortic insufficiency, stenosis of the aortic estuary, mitral valve prolapse, mitral-aortic defect.
In 40-60% of children with rheumatism, polyarthritis develops, both in isolation and in combination with rheumatic carditis. Typical signs of polyarthritis in rheumatism in children are the predominant lesion of medium and large joints( knee, ankle, elbow, shoulder, rarely - wrist);symmetry of arthralgia, migratory nature of pain, rapid and complete reverse development of joint syndrome.
Cerebral form of rheumatism in children( small chorea) accounts for 7-10% of cases. This syndrome, mainly, develops in girls and is manifested by emotional disorders( crying, irritability, mood swings) and gradually increasing motor impairments. First, handwriting and gait change, then there are hyperkinesis, accompanied by a violation of the intelligibility of speech, and sometimes - the inability to eat and self-serve independently. The signs of chorea completely regress after 2-3 months, but tend to recur.
Manifestations of rheumatism in the form of anuricular( annular) erythema and rheumatic nodules are typical for childhood. Ring-shaped erythema is a kind of rash in the form of rings of pale pink color, localized on the skin of the stomach and chest. Itching, pigmentation and peeling of the skin are absent. Rheumatic nodules can be found in the active phase of rheumatism in children in the occipital region and in the region of the joints, in the places of attachment of tendons. They have the appearance of subcutaneous formations 1-2 mm in diameter.
Visceral lesions in rheumatism in children( rheumatic pneumonia, nephritis, peritonitis, etc.) are practically not found at present.
Diagnosis of rheumatism in children
Rheumatism in a child may be suspected by a pediatrician or a children's rheumatologist based on the following clinical criteria: the presence of one or more clinical syndromes( carditis, polyarthritis, chorea, subcutaneous nodules or annular erythema), the association of the disease with streptococcal infection,"Rheumatic anamnesis" in the family, improving the child's well-being after specific treatment.
Reliability of the diagnosis of rheumatism in children must be confirmed by laboratory tests. Changes in the hemogram in the acute phase are characterized by neutrophilic leukocytosis, acceleration of ESR, anemia. Biochemical blood analysis demonstrates hyperfibrinogenemia, the emergence of CRP, an increase in the fractions of α2 and γ-globulins and serum mucoproteins. Immunological examination of blood reveals an increase in the levels of ASG, ASL-O, ASA;an increase in the CIC, immunoglobulins A, M, G, anticardial antibodies.
When rheumatic carditis in children, chest radiography reveals cardiomegaly, mitral or aortic configuration of the heart. Electrocardiography with rheumatism in children can detect various arrhythmias and conduction disorders( bradycardia, sinus tachycardia, atrioventricular blockades, atrial fibrillation and flutter).Phonocardiography allows you to record changes in heart sounds and noise, indicating the defeat of the valve apparatus. Echocardiography plays a crucial role in the detection of acquired heart defects in rheumatism in children.
Differential diagnosis of rheumatic heart disease is performed with non-rheumatic carditis in children, congenital heart defects, infective endocarditis. Rheumatic polyarthritis should be distinguished from arthritis of another etiology, hemorrhagic vasculitis, SLE.The presence of cerebral syndrome in a child requires the involvement of a neurologist and the exclusion of neurosis, Tourette's syndrome, brain tumors, etc.
Treatment of rheumatism in children
Therapy of rheumatism in children should be comprehensive, continuous, long-term and gradual.
The acute phase shows inpatient treatment with physical activity restriction: bed rest( with rheumatic carditis) or sparing regimen for other forms of rheumatism in children. To combat streptococcal infection, antibacterial therapy with penicillin drugs is given for 10-14 days. In order to suppress the active inflammatory process, non-steroid( ibuprofen, diclofenac) and steroidal anti-inflammatory drugs( prednisolone) are prescribed. With a prolonged course of rheumatism in children, complex preparations of quinoline series( plakvenil, delagil) are included in complex therapy.
In the second stage, the treatment of rheumatism in children continues in the rheumatological sanatorium, where general restorative therapy, exercise therapy, mud therapy, sanitation of foci of infection. At the third stage, the supervision of the child by specialists( a children's cardiologist, a rheumatologist, a children's dentist, a children's otolaryngologist) is organized in a polyclinic. The most important direction of dispensary observation is the antibiotic prophylaxis of relapses of rheumatism in children.
Prognosis and prevention of rheumatism in children
Primary episode of rheumatic heart disease is accompanied by the formation of heart defects in 20-25% of cases;However, recurrent rheumatic carditis does not leave a chance to avoid damage to the heart valves, which requires subsequent cardiac surgery. Mortality from heart failure, due to heart defects, reaches 0.4-0.1%.The outcome of rheumatism in children is largely determined by the timing of the onset and the adequacy of therapy.
Primary prevention of rheumatism in children involves hardening, nutrition, rational physical culture, sanation of chronic foci of infection( in particular, timely tonsillectomy).Secondary prevention measures are aimed at preventing the progression of rheumatic fever in children who have suffered rheumatic fever and include the administration of penicillin prolonged action.
krasotaimedicina.ruIn order to recognize rheumatism in children in time, it is not necessary to be a doctor. It is enough to be good parents and to know the main signs, at the appearance of which it is necessary to consult a specialist.
The causes of the disease have not been studied so far. But most scientists believe that it is caused by streptococci, especially if the body is sensitive to the infection.
In children and adolescents, the disease is diagnosed more often than in adults. Rheumatism in adults is a complication or continuation of the disease, which was formed in childhood or adolescence. Can lead to the development of congenital heart disease, cardiomyopathy.
Rheumatism is a disease that affects the organs and systems of the child's body. But the main targets are the cardiovascular system and joints.
The onset of the disease
More than half of the cases of rheumatic fever occur at the age of 8-15 years, before rheumatism is rarely diagnosed. The disease is characterized by the development of severe complications.
The later the disease is diagnosed, the harder it is.
Signs of children's rheumatism
The main symptom is joint damage, which develops against the background of infectious diseases( influenza, scarlet fever, sore throat): a child may get rheumatism immediately or after 15-20 days. Parents should be alerted if, following a previous ORZ, the following symptoms appear on the background of recovery:
- swelling and tenderness of the joints( elbows, knees, ankles), with a rise in body temperature;
- subsequent adherence and pain in smaller joints( foot, hand)
- migrating pain and swelling: first appear in one joint, then pain and swelling subsiding, but arise elsewhere, then next.
Such lesions can occur against the background of a satisfactory general condition of the child.
A complaint for parents should be the complaint of the child, even for pain in one joint or in several, without raising the temperature and swelling. In the future, the pain completely disappears, in order to appear again after a while.
For a while, this form of rheumatic fever may be asymptomatic, or its onset may be of an increasing nature.
It is necessary to pay attention if the child complains:
- for fast fatigue
- for a feeling of weakness after physical exertion( running, walking)
- , when you get up you have shortness of breath, palpitations increase.
- In severe cases it is noted:
- pain and noise in the heart region
- shortness of breath takes a more malignant character.
- fingers and toes acquire blueness
- forced position( the child takes a pose in which it does not hurt to lie, sit).
- Heart disorders in rheumatism in children are different:
- myocarditis( the lesion can pass on its own)
- endocarditis( can lead to heart defects)
- pericarditis( the most dangerous lesion).
Girls are more often ill. The parts of the brain are affected, which causes the symptoms:
- changes the behavior of the child: it becomes emotionally labile( mood swings, tearfulness, irritability, often causeless)
- the child keeps objects in his hands worse( even a spoon or pen), begins to write illegibly
- speech is brokenand coordination of movements( can not lace up shoes, in severe cases can reach paralysis).
The fight against this complex disease must be entrusted to doctors. No self-treatment!
Recovery depends on timely hospitalization, correct medical treatment in an acute period( in hospital) and following recommendations after discharge:
Once it was believed that rheumatism of joints is a disease of elderly people. But today more and more pediatricians put such a diagnosis to young children. What are the causes of such an "adult" disease in toddlers? What should parents do to get rid of such an ailment? It is necessary to understand this issue in more detail.
Causes of joint rheumatism in children
The main reason is a decrease in immunity after a viral disease. Surely, you noticed that a child who started to attend a preschool institution became more sick. It should be noted that earlier rheumatic fever only affected the joints, and the patient felt acute pain.
Now the disease is more general. Of course, joint pain is most pronounced, but the heart and nervous system also suffer. Many children are diagnosed as:
- mixed rheumatic form.
Symptoms of joint rheumatism in children
If your child has been ill a few weeks ago with flu, sore throat, pharyngitis or another similar disease, and today he complained of joint pain, and you observe a tumor, you should immediately consult a doctor. It is these symptoms of joint rheumatism that are primary in children.
It is difficult for a child to move his limbs, and the temperature rises sharply and unexpectedly. The disease makes itself felt from the large and medium joints, and later unpleasant sensations pass to the joints of the hands and feet.
Rheumatism is an insidious disease, because sometimes the temperature of the baby remains normal, and there are no tumors, but the child complains of pain in one place, then in another.
Do not delay the visit to the doctor, because rheumatic joints in children can cause pain for a short period of time, then the problems subsided. You must understand that the joints rheumatism will not pass by itself, this illness moves from one joint to another. Such movements can be observed even for a month and a half. After such a period of time everything gets better, the child feels well.
Should I worry about my parents?
Of course, the disease will not lead to disability and at the moment will not create additional difficulties for the child in movement. But you must always think about the consequences.
Most often, the disease occurs in children from one to five years. Rheumatism occurs in newborns, but very rarely.
Rheumatic carditis is a heart attack that sometimes causes joint rheumatism. Heart valves already at an early age lose their elasticity and deform. The result is heart disease.
Treatment of rheumatism in a child
Not so long ago, pediatricians began to refer the articular form of rheumatism to a particular disease. What is prescribed with this diagnosis?
- strict bed rest, which must be observed until the inflammation subsides;
- needs a diet with a rejection of salty foods, cocoa and foods that are heavily digested;
- if a child is suffering severe pain, then doctors prescribe such anti-inflammatory drugs as Aspirin;
- , depending on the course of the disease, sometimes treatment with antibiotics of the penicillin group is necessary;
- after the pain passes, the child must be written down for a course of physiotherapy procedures. Among them: electrophoresis, UHF, heating of vessels with infrared rays;
Prevention of joint rheumatism in children
Of course, children always want to prevent rheumatism. How to do it? There is nothing very complicated:
- it is impossible to supercool the body. The feet of a toddler must always be warm;
- needs to provide the child with all the necessary vitamins and minerals, as well as the right balanced diet;
- parents should monitor oral hygiene and tonsils. Avoiding diseases such as sore throats or colds is very difficult. But you should always be on a check;
- can consult a doctor about taking immunostimulant medications if a growing body needs them;
- at detection of the first signs of inflammatory diseases, it is necessary to comply with bed rest and provide a warm warm drink to the baby. The liquid will help to remove germs from the body;
- it is not necessary to neglect the reference to experts. The work of the baby's heart should be checked periodically.
And finally, we suggest you watch a video on how to deal with rheumatism.
Rheumatism in children symptoms and treatment |How to treat rheumatism
Rheumatism( rheumatismus) or Sokolsky-Buoyu disease of children is a systemic inflammatory disease of the connective tissue with a predominant cardiovascular damage that is etiologically associated with group A P-hemolytic streptococcus.
From this article you will learn the main causes and symptoms of rheumatismin children, about how rheumatism is treated in children and what preventive measures you can take to protect your child from this disease.
Treatment of rheumatism in children
A harmonious system of measures has been developed in our country, including the provision of medical and preventive care to the population at various stages of the pathological process. The key to successful treatment is early diagnosis, which means the recognition of rheumatism in the first 7-10 days from the onset of the attack, as well as the early initiation of therapy( from 10-14 days).The main principles of pathogenetic therapy of rheumatism are the fight against streptococcal infection, active influence on the current inflammatory process and suppression of the hyperimmune reaction of the child's body.
How to treat rheumatism in children?
Treatment of rheumatism is carried out in 3 stages:
Every child with active rheumatism is treated in a hospital( 1st stage).It is extremely important to properly organize the motor regime. Patients with rheumatic carditis II-III degree of activity should be for 1-2 weeks on strict bed rest, and then 2 - 3 weeks - on bed rest with possible participation in board games in bed. During this period, breathing exercises and passive movements are shown. After 1 - 1/2 months( taking into account the results of functional tests), children are transferred to a sparing regime with permission to use a dining room, a toilet;the complex of therapeutic physical training is expanding. Later in the sanatorium( 2 nd stage) children are transferred to the training regime. The diet should be easily digestible, enriched with protein, vitamins and products containing potassium salts. Limit table salt to 5 -6 g per day and liquid, especially in case of circulatory failure. To treat rheumatism recommended fractional meals( 5 - 6 times a day).Difficult to digest products, pickles, extractives are excluded. Sometimes there are fasting days( with circulatory failure of II - III degree).
Treatment of rheumatism in children
Drug therapy includes antibacterial, aimed at eliminating streptococcal infection, non-steroidal anti-inflammatory and immunosuppressive agents, as well as symptomatic( diuretics, cardiac) and corrective drugs. Assign penicillin or its analogs in the age-appropriate dose for 12 to 15 days. At the same time, use acetylsalicylic acid or preparations of the pyrazolone series. Acetylsalicylic acid is prescribed at the rate of 0.2 g, amidopirin - 0.15-0.2 g for 1 year of life of the child per day.
Corticosteroids have a rapid anti-inflammatory and antiallergic effect, which are especially indicated in primary rheumatic carditis and a pronounced exudative component of inflammation. Usually, prednisolone is used, administered at a dose of about 0.75 to 1 mg / kg per day. The duration of application of the maximum daily dose of prednisone is determined by the results of treatment. Its decrease begins when the patient's condition improves, fever, exudative component is eliminated, ESR normalization. The total duration of the course of treatment is 30-40 days, with a continuously-recurrent course of rheumatism it can be more. In recent years, new anti-inflammatory non-steroidal drugs - voltaren and indomethacin have been used, which are successfully used in the general treatment complex. With prolonged and continuously-recurrent course in children, a long-term use of quinoline-based drugs( delagil, plakvinil) at 5-10 mg / kg per day is shown.
An extract from the hospital is made after 11/2 ~ 2 months with the condition of improvement of well-being, a clear positive dynamics of the pathological process and a decrease in its activity.
Aftercare and rehabilitation of patients( stage 2) are carried out at a local sanatorium for 2 to 3 months. At this stage, treatment with drugs in a half dose continues, the amount of physical exertion is increased, therapeutic gymnastics, restorative measures, aeration are carried out.children receive high-grade food, vitamins.
Further follow-up( 3rd stage) is carried out by a district( city) rheumatologist who regularly examines every child suffering from rheumatism in order to identify signs of disease activation, and performs secondary all-the-year-round prophylaxis( relapse) with the help of bicillin-5.If necessary, sanitize the foci of chronic infection, determine the conditions of the regime and work of schoolchildren. Clinical follow-up of children with rheumatism is carried out until they are transmitted for observation in the adolescent office.
Complex therapy of rheumatism in children
The complex method of primary rheumatic therapy includes the simultaneous administration of small doses( 0.5-0.7 mg / kg / day) of glucocorticoids and NSAIDs.
Doses of glucocorticoids to treat rheumatism are chosen depending on the severity of the pathological process and the severity of changes in the heart. Usually, prednisolone is used in a dose of 15-25 mg / day, with 1 / 2-1 / 3 of the daily dose prescribed in the morning. The initial dose is gradually reduced to complete cancellation on average after 1.5 months.
Of the NSAIDs most often prescribed indomethacin and diclofenac. NSAIDs are combined with glucocorticoids and one of the basic drugs, especially with a prolonged course of the disease and the formation of heart disease.
- Indomethacin: 23 mg / kg / day in 2-3 doses for 1-1.5 months.
- Diclofenac: 23 mg / kg / day in 2-3 doses for 11.5 months.
As a basic therapy, quinoline derivatives are used:
- Chloroquine( hingamine, delagil) at a dose of 0.060.25 g, depending on the age of 1 times a day after dinner;duration of treatment from several months to several years;
- Hydroxychloroquine( plakvenil) in a dose of 0.05-0.2 g, depending on the age of 1 times a day after dinner;duration of treatment from several months to several years.
Given the streptococcal nature of rheumatism, during the first 10-14 days of therapy prescribe benzylpenicillin or its analogues for 0.75-1 million units / day. The complex therapy includes also sanation of foci of chronic infection, in particular chronic tonsillitis. With decompensated chronic tonsillitis requires tonsillectomy. After 6-8 months after an acute period, sanatorium treatment is recommended.
Prevention of rheumatism in children
Primary prevention includes a set of measures aimed at preventing the development of rheumatism( improving living conditions and labor, eliminating crowding in schools, taking two shifts, etc.) and fighting streptococcal infection( use of antibiotics in anginaand other acute diseases of the nasopharynx with control after 10 days of blood and urine, sanation of foci of infection).
It is important to temper and improve the children's collective.
WHO recommendations( 1989) on the prevention of rheumatic fever and its relapse include the following activities.1.
Primary prevention - activities that ensure the correct development of the child:
- hardening from the first months of life;
- full nutrition with sufficient vitamins;
- rational physical education and sports;
- control of infection caused by group A streptococcus( angina, scarlet fever), including administration of penicillin preparations at a dose of 0.75-1.5 million units / day for 10-14 days. The recommended drug is phenoxymethylpenicillin( ospene).
Secondary prevention is aimed at preventing recurrence and progression of the disease. The most optimal year-round prevention, carried out monthly for at least 5 years. All children who have suffered rheumatism are prescribed:
- benzathine benzylpenicillin + benzylpenicillin procaine( bicillin5) at a dose of 1.5 million units once every 4 weeks to school-age children;
- bicillin5 at a dose of 0.75 million units 1 time in 2 weeks of patients of preschool age.
Secondary prevention is aimed at preventing the progression and recurrence of rheumatism. All-the-year-round bicillin prophylaxis is performed for at least 3 years in the absence of relapses. Bicillin-5 is used once every 3 weeks at a dose of 600,000 units for preschool children and at a dose of 1,200,000-1,500,000 units once every 4 weeks for children older than 8 years and for adolescents. In addition, after each intercurrent disease, as well as in spring and autumn for 3 to 4 weeks, acetylsalicylic acid courses are administered at the age-related dosage.
In the following 2 years, only seasonal prophylaxis is performed for 6 to 8 weeks( bicillin-5 and acetylsalicylic acid).Periodically, children are sent to a specialized local sanatorium.
Prognosis of treatment. In recent decades, significantly improved due to effective measures to combat streptococcal infection and effective pathogenetic therapy. Rarely began to occur cases of severe rheumatism accompanied by violent exudation. Lethality decreased from 11 - 12% to 0.4 - 0.1%.It is determined by heart failure, which develops in acute course with high activity as a result of severe myocarditis or with prolonged rheumatism due to a formed heart defect with hemodynamic disorders. Combined defects and combined damage to the heart valves are usually observed as a result of repeated relapses of the disease. Primary rheumatic carditis leads to the formation of valvular heart disease in only 10-15% of patients, whereas recurrent - in 40% of patients.
Symptoms of rheumatism in children
Clinical picture of rheumatism
The disease most often develops in 2 to 4 weeks after suffering angina, scarlet fever or acute nasopharyngitis. Diffuse lesion of connective tissue causes a pronounced polymorphism of the clinical picture. The most typical manifestations of the disease in children are carditis( rheumatic carditis), polyarthritis, chorea.
The onset may be acute or gradual and even inconspicuous( in such cases, the diagnosis is made retrospectively on the basis of carditis or heart disease detected).The first signs of the disease in most children are fever, malaise, joint pain. The examination reveals changes in the heart, leukocytosis, increased ESR, anemia. Sometimes rheumatism in children begins with chorea. The clinical severity of individual symptoms and their combination can be very different, depending on the nature of the course and the degree of activity of rheumatism.
Primary rheumatic carditis - this defeat of the heart determines the severity of the course and the prognosis of the disease. Early manifestations in children are fever and general malaise. Very rarely there are complaints of pain or discomfort in the heart.
Objective symptoms are determined by the primary lesion of the myocardium, endocardium or pericardium. In children, myocarditis is the most frequent, and sometimes the only manifestation of cardiac pathology with rheumatism( 100% of cases).Clinically in 75 - 80% of children moderate and mild rheumatic heart disease predominates, and in 20 - 25% - pronounced( most often in the pubertal period).
With objective examination, tachycardia and bradycardia can be noted, in one third of patients the heart rate is normal. In the majority of patients( up to 85%), cardiac enlargement is noted, mainly to the left( clinically and radiologically), with a weakening of cardiac tones. Almost all listen to systolic noise, often at the V point or at the apex, not conducted beyond the heart area.
With a pronounced myocarditis, the exudative component of inflammation with diffuse changes in myocardial interstitium predominates. The general condition of the child is severe, pallor, dyspnea, cyanosis, a weak pulse, a decrease in blood pressure, and rhythm disturbances are noted. The boundaries of the heart are greatly expanded, the heart tones are sharply weakened. There are also signs of heart failure.
On the ECG the most often observed homotopic rhythm disturbances, retardation of atrioventricular conduction, as well as changes in bioelectric processes in the myocardium( decrease and deformation of the G wave, ST segment down, elongation of the electric systole).The severity of ECG changes corresponds to the severity of rheumatic carditis.
The decrease in the amplitude, expansion and deformation of the I tone is noted at the PCG.Pathological III and IV tones can be determined, the systolic murmur is fixed in the muscle.
Endocarditis almost always combines with myocarditis and is observed in 50 - 55% of sick children. The most frequent development of valvulitis, mainly of the mitral valve, the signs of which often appear from the first days of the disease.
The main clinical symptom is a systolic "blowing" noise in the area of the projection of the mitral valve( apex, V point).With the passage of time, as well as in the prone position, on the left side and under physical exertion, its intensity increases. Noise is well carried out in the armpit.
On the PCG, it is recorded as high- and mid-frequency pansystolic or protosystolic murmur of small or medium amplitude with an epicenter at the tip. On radiographs, in addition to widening the left border, the mitral configuration of the heart is determined.
Approximately 10% of patients are affected by the aortic valve, which is manifested by diastolic noise along the left edge of the sternum with a possible decrease in diastolic pressure. In this case, a high-frequency - proto-diastolic - noise of the same localization is recorded on the PCG.
Echocardiography fixes the thickening of the mitral valve, changes in the nature of echoes( "shaggy") from its valves and chords, signs of mitral and aortic regurgitation, dilatation of the left chambers of the heart.
Pericarditis is always observed simultaneously with endo- and myocarditis and is considered as part of rheumatic polyserositis. Clinically diagnosed rarely( 1 - 1.5%), radiologically - in 40% of cases;In a complex instrumental study, including echocardiography, this percentage is much higher. By nature, it can be dry, fibrinous and effusive - exudative. With fibrinous pericarditis pain syndrome is possible and the pericardial friction noise along the left edge of the sternum is intermittent( not constant), which is compared with the rustling of silk or the crunch of snow underfoot.
In a serial ECG study, the pointed pins P and the typical dynamics of changes in the ST-interval and the T wave are identified. Echocardiograms show thickenings and separation of the epi- and pericardium sheets.
The exudate serous-fibrinous pericarditis affects the general condition of the patients. It sharply worsens, attention is paid to pallor, and with a large accumulation of exudate - the puffiness of the patient's face, cervical veins swelling, shortness of breath, forced semi-sitting position in bed. There may be retrosternal pains, the signs of hemodynamic disorders rapidly increase, amplifying in the horizontal position of the patient. Pulse is frequent, small filling, blood pressure is lowered. Sometimes the heart region swells, the apical impulse is not determined. The borders of the heart are considerably expanded, the voids are deaf. ECG showed a decrease in myocardial electrical activity. On the roentgenogram, along with the expansion of the boundaries and small amplitude of pulsations, the contours of the heart are smoothed, its shadow often acquires the shape of a ball or trapezium.
An echocardiogram is used to determine the echo-negative space separating the epi- and pericardium, the size of which can be used to judge the amount of exudate in the hearth's cavity.
Thus, primary rheumatic carditis in childhood develops after the transferred beta-streptococcal infection, has moderately or poorly expressed clinical and functional manifestations in most children, is characterized by a common combination of lesions of all three heart membranes.
Recurrent rheumatic heart disease. Under unfavorable conditions that facilitate the recurrence of the process, it is possible to develop repeated attacks with the formation of recurrent rheumatic heart disease. In childhood, it is less common than in adolescents and adults. Recurrent rheumatic carditis is usually characterized by a mild exsudative component of inflammation, proceeds in the form of recurrent myocarditis with progression of valvular lesion. In the clinical picture there is a change in the sonority of cardiac tones, an increase in intensity or the appearance of new noises with the development of signs of heart failure and a possible rhythm disturbance.
Rheumatic polyarthritis. It is characterized by a multiple symmetrical lesion of predominantly large joints with severe pain syndrome. At the heart of the joint process - acute or subacute synovitis with unstable, volatile nature, inflammatory changes. However, at present, true polyarthritis with edema, hyperemia and abrupt function disorder is rare. The articular syndrome predominates in the form of polyartralgia, the duration of which is from several days to 2 - 3 weeks;relapses are possible.
Chorea( small). This is a manifestation of rheumatic brain damage, predominantly of the striopallidal region. Developed in 11-13% of children with rheumatic fever. It often takes place in isolation with the subsequent addition of carditis, more often during the first attack. It usually starts gradually: the state of health worsens, sleep, school performance, the child is irritable, tearful, distracted. After 1 - 2 weeks, the main signs of chorea develop:
- hyperkinesis - involuntary impetuous excess movements of various muscle groups, amplified by emotions, external stimuli and disappearing in sleep;
- muscle hypotension;
- movement coordination disorder;
- disturbance of the emotional sphere. The behavior of the child changes, there is grimacing, slovenliness, handwriting changes.
Sometimes the number of hyperkinesis is so great that they speak of a "motor storm".The mass of involuntary movements prevents a child from walking, lying, eating, he can not service himself. Sharp muscle hypotension can lead to a decrease or elimination of hyperkinesis and the development of the so-called paralytic, or "soft", form of chorea, which Filatov described. Characteristic violations of tendon and skin reflexes in the form of asymmetry, unevenness, easy exhaustion, the appearance of Gordon's symptom( the topical contraction of the quadriceps muscle when the knee reflex is called).The period of hyperkinesis can last from several weeks to 2-4 months.
At present, small chorea often has an atypical, prolonged recurrent course, especially at preschool age, with poorly expressed clinical signs, asthenia, and vegetovascular dystonia.
In severe rheumatic nerve damage, acute and chronic meningoencephalitis, arachnoiditis, mental disorders, polyneuritis are possible.
Other annoying manifestations of rheumatism in childhood( which are currently rare and only in the active period of the disease) include annular erythema, rheumatic nodules, rheumatic pneumonia, nephritis, hepatitis, and polyserositis. Reflex poliserozita may be abdominal syndrome, characterized by pain in the abdomen, sometimes with signs of irritation of the peritoneum.
Causes of rheumatism in children
Most often( 80%) rheumatic fever develops in childhood( 7-15 years), in 30% of cases is of a family nature. The disease is observed in about 1% of schoolchildren, at an early age( up to 2 years) almost never occurs. Rheumatism is the main cause of acquired heart disease in children. Growth of well-being, improvement of living conditions, as well as organization of a system of specialized care and comprehensive prevention of rheumatism, led to a significant decrease in the incidence - up to 0.18 per 1,000 children.
In the development of the problem of childhood rheumatism, Russian pediatricians - VI Molchanov, AA Kisel, MA Skvortsov, AB Volovik, VP Bisyarina, AV Dolgopolova and others - made a great contribution.
Epidemiology. The relationship between the onset of the disease and the transmitted streptococcal infection was established, mainly in the form of angina( exacerbation of chronic tonsillitis), nasopharyngitis, sinuititis, otitis. Important is the fact that rheumatism in children is more often recorded where there is an increased population density( among urban schoolchildren) and the possibility of transmitting infection from one person to another is great. Various diseases of streptococcal nature( scarlet fever, glomerulonephritis, rheumatism, upper respiratory catarrh, septic foci, etc.) occur in 10-20% of school-age children and more often in closed groups. The source of infection is a patient whose streptococci fall on household items. The greatest infectivity is observed in the first 24-48 hours, but the patient remains dangerous to others for 3 weeks. In the spread of infection, the carriage of virulent strains of group A streptococcus is also important. In the external environment, it is relatively stable: under the influence of appropriate conditions it is possible to transform it into L-forms( non-envelope forms of streptococcus).Infected persons often suffer a streptococcal infection in an erased form or almost asymptomatically( in 20-40% of cases), and they also develop rheumatism.
Etiology. The main etiological factor is currently considered beta-hemolytic streptococcus group A. In favor of this concept indirectly indicates the presence in the serum of blood in the majority of patients with active rheumatism( 70%) streptococcal antigen and elevated antibody titres to streptococcal toxins - antistreptolysin-O( ASL-O), anti-streptogialuronidase( ASH), antistreptokinase( ASA), and antideodeson-xiribonuclease B, which can be considered as streptococcal aggression. A good effect of anti-streptococcal therapy of angina and nasopharyngeal diseases in the prevention of rheumatism also confirms this theory. Insufficient treatment of angina and prolonged carriage of streptococcus are one of the conditions for the development of the disease. Relapses of rheumatism and its prolonged course can be caused by both streptococcal reinfection and activation of persistent L-forms in the body.
Pathogenesis. In the development of rheumatism, the massiveness and duration of the effects of streptococcal infection, as well as the peculiarities of the response of the macroorganism, are important.
The main role in pathogenesis belongs to immune reactions of immediate and delayed type with the subsequent development of immune inflammation. Numerous antigens( shell, membrane, cytoplasmic) and streptococcal enzymes cause the formation of specific antibodies, some of which cross react with tissue antigens of the body. Damage to them of the antigenic structure of myocardial sarcolemma and certain components of connective tissue( fibroblasts, glycoproteins, proteoglycans) leads to the formation of autoantibodies. Circulating in the blood of antibodies and immune complexes containing antistreptolysin-O and C4-complement components, damage the microcirculatory bed, promote the activation of inflammatory mediators.
Confirmation of the participation of immunopathological reactions in the pathogenesis of inflammation is the detection of deposits in myocardial tissue( immune complexes antigen-antibody-complement), as well as the frequency of detected circulating immune complexes in the development of carditis and chorea.
The development of the immunopathological process is undoubtedly associated with the reactivity of the macroorganism, in particular with the duration of the anti-streptococcal hyperimmune response and the defect in eliminating streptococcus from the body. At present, great importance is attached to a genetically determined predisposition to rheumatism, which basically boils down to the inheritance of the characteristics of immune responses. This is confirmed by widely known facts of increased frequency of rheumatic diseases in certain families and observations of identical twins( with the development of rheumatism in one of them, the risk of disease in another is much higher than in the same situation in one of the twins).Apparently, under the influence of the same external factors, the rheumatic process is realized precisely in persons with an immunological predisposition to this.
Pathological anatomy. Morphologically rheumatism in children is characterized by systemic disorganization of connective tissue, including mucoid swelling, fibrinoid changes, up to necrosis, and a proliferative reaction( the formation of the granuloma Ashot-Talalayev).Nonspecific changes of exudative character( mucoid swelling, fibrinoid) develop as manifestations of immediate type hypersensitivity( antigen-antibody reaction) and mainly determine the clinical and laboratory activity of the pathological process. Cellular reactions are a reflection of delayed type hypersensitivity. The formation of granulomas in the interstitium of the myocardium, endocardium, pericardium, periarticularly, under synovia is a specific morphological sign for rheumatism. One and the same patient can meet all three stages of change simultaneously, which indicates the continuity of the process. The development of fibrinoid necrosis ends with sclerosing.
An important link in morphogenesis is the diffuse lesion of the vessels of the microcirculatory bed( destructive-productive vasculitis).
It should be emphasized that in childhood, nonspecific - exudative - components of inflammation are most pronounced, which determines the brightness of the clinic and the greater effectiveness of anti-inflammatory therapy provided that a timely diagnosis is made.
Currently, the following working classification of rheumatism is adopted.
Classification of rheumatism in children
The current classification and nomenclature of rheumatism is AI.Nesterov( Table).The classification is made taking into account the phase of the disease, clinicoanatomical damage to organs, the nature of the course of the disease and the state of the circulation.
Table. Working Classification and Nomenclature of Rheumatism
Phase and Activity Level of Rheumatism
Clinical Anatomical Characteristic of Lesion
The disease is an inflammatory pathology of connective tissue that is mainly localized within the cardiovascular system.
Rheumatism is a disease that develops, as a rule, against the background of an exacerbation of a certain infection in people with an increased degree of predisposition to such pathologies. Rheumatism most often affects children, as well as adolescents( the age range is seven to fifteen years).
The main factor causing the appearance of rheumatism is hemolytic streptococcus( group A).It often affects the upper respiratory tract and provokes joint rheumatism.
The condition for the development of the disease is the presence of streptococcal infection in the nasopharyngeal zone or untimely, incorrect treatment. A confirmation that the etiology of rheumatism is directly related to streptococcus is that rheumatism often develops and spreads at the first stages of the formation of so-called "closed collectives".
The pathology of leg joints is due to the presence of a significant number of toxins and antigens that affect connective tissues, causing complications of rheumatism.
Streptococcus infection plays an important role in the occurrence of age-related rheumatic carditis. In this situation, immunity does not work, and this, in turn, serves as a reason for finding other factors that fit into the problem of rheumatism: etiology.
In the situation of resolving the issue of the origin of rheumatism, there are two main aspects:
- the role of group A streptococcal infection;
- study of predisposition to the disease with rheumatism of leg joints.
To develop chronic rheumatism, a subjective, increased immune response to streptococcal type antigens is required, as well as the extent of this reaction. This is evidenced by some signs of rheumatism of the joints of the legs with a dynamic study of antibodies to streptococcus.
The mechanism for starting the disease begins with the effect on the body of bacteria - beta-hemolytic streptococci( group A).They can provoke:
Chronic rheumatism occurs only when the patient has defects related to the functioning of the immune system. So, statistics show that only from 0, 3 to 3 percent of people who have suffered infectious diseases caused by streptococcus( photo), subsequently face rheumatism.
Rheumatism of the joints of the legs is characterized by the presence of risk factors that should be considered:
- the presence of rheumatism or diseases affecting the connective tissues of family members of the first degree of kinship - sisters or brothers. Parents;
- belonging to the female sex;
- age range from 7 to 15 years;
- regular infections in the nasopharynx, streptococcus;
- rheumatism of the legs arises because of the presence in the human body of a specific protein - a B-cell marker type D8 / 17.
Rheumatism in children affects the joints of the feet, when, when streptococcus enters the body, it begins to fight the infection with the production of special antibodies. Cells recognize bacteria through molecules that are on their surface.
In the presence of predisposition to rheumatism, in the cardiac muscle there are structural units similar in structure to streptococcus.
Chronic rheumatism is associated with an attack of antibodies of "native" cells of the body. So there is an inflammatory process, develops rheumatism of the joints of the legs. The connective tissue can be deformed - heart defects develop, the morphological structure of the joints changes, and rheumatism arises.
There is a certain classification of rheumatic fever, several types of disease are distinguished:
- Polyarthritis, it is also articular rheumatism. Often affects the knees, elbows, shoulders, rarely - toes and hands. The acute form of the disease is characterized by swelling, the presence of an inflammatory process in the zone affected by rheumatism. Sweating, general weakness in the whole body, increased fever can be observed.
- Rheumatic carditis is another type of rheumatism;is manifested by the presence of a general intoxication of the body, heart pain of varying intensity, tachycardia may manifest itself.
- Rheumatism is fraught with the appearance of lesions of the smallest vessels in the brain, a disease called rheumatic chorea. The main signs - the violation of coordination of movement, psycho-emotional disorders.
- Classification of rheumatism involves the isolation of skin manifestations of diseases. These are specific nodules and erythema.
- Pleurisy rheumatic - severe pains in the chest area are observed, respiratory activity becomes more difficult. The temperature can rise, there is a cough and shortness of breath.
The initial signs of rheumatism appear several weeks after the patient has transferred an infectious disease - for example, pharyngitis or sore throat.
At first the patient experiences weakness, joints begin to ache, hyperthermia is observed.
Rheumatism in children can develop in a latent form: so, a small fever can rise, there is a slight general malaise, cardiac work is not broken, joint pains are absent. In such cases, rheumatism of the joints ends with chronic arthritis. Rheumatism in children affects the middle, as well as large joints. There are such signs of the disease:
- pain in the drains;
- tingling in the elbows and wrists;
- pain in the knees.
Rheumatism of the joints can have blurred symptoms - they then disappear, then reappear. Nevertheless, you can not relax - rheumatism in children should be diagnosed in time and appropriate therapy is prescribed.
Additional signs of rheumatism - pronounced problems with the heart: the pulse may be disturbed, irregularities in the rhythm are observed, the heart hurts. Also, the patient may experience shortness of breath, there is general weakness, increased sweating. These symptoms are caused by the inflammatory processes that are observed in the heart - rheumatic carditis. The consequence of the disease is heart disease.
In the case when rheumatism affects the nervous system, the patient may experience involuntary jerking of the limbs, as well as muscles of the face and neck. This symptomatology was called small chorea. There are signs on average in 15% of patients. Basically, these girls are from 6 to 15 years old.
Rheumatism, diagnosed only in clinical settings, is subsequently subject to a thorough correction by a rheumatologist.
The rheumatologist performs a complex of necessary measures with the help of which the diagnostics of rheumatism is carried out. Most often, he undergoes a comprehensive comprehensive examination of the patient.
The first appointment is a general analysis of the blood composition for inflammation. The second is an immunological study aimed at revealing substances characteristic of rheumatism.
Additional technologies - ECG, X-ray. If necessary, to identify rheumatism, arthroscopy, articular biopsy, puncture for the subsequent study of the composition of fluid in the joints is prescribed.
The first stage is indicated by antibiotic therapy. Anti-inflammatory drugs are also prescribed. If the case is severe, the rheumatologist prescribes corticosteroids.
Prevention of rheumatism in children includes:
- gymnastics and physiotherapy;
- lifestyle correction( in particular, day regimen and nutrition);
Classification of drugs that are prescribed by a rheumatologist when a disease is detected, is as follows:
- remedies for rheumatism antibacterial properties;
- anti-inflammatory drugs.
The basis for the optimal treatment of rheumatism is such a consistent mechanism: the clinical stage - procedures at home and in the office of a doctor - rheumatologist - spa therapy.
First, special anti-inflammatory therapy is carried out, rehabilitation is carried out, then the patient is sent to a specialized medical sanatorium intended especially for patients with rheumatism. At the third stage of therapy - medical examination. The procedure sets itself such functional tasks:
- activities aimed at the final fight against rheumatism;
- the implementation of symptomatic treatment for circulatory dysfunction in those patients who suffer from the presence of heart defects, their possible correction;
- rehabilitation period;
- preventive measures.
Prevention of rheumatism and its treatment at home - the task is quite feasible. There are several effective recipes designed to combat the disease.
- A couple of peeled large bulbs are cooked for 15 minutes in a liter of water. The drug is taken in the morning after awakening on an empty stomach, before going to sleep. Dosage is a glass. Good prevention of rheumatism.
- To the aching joints of the feet, a fresh grated onion is applied for no more than half an hour. Periodicity - several times a day.
- Rheumatism in children is treatable with raw potatoes. To do this, you need to double fold any fabric, in the middle of which is placed a potato gruel. The compress is placed in the affected area of the joints of the legs. From above it is necessary to cover the area with something warm. The procedure is repeated every two days.
- Children's rheumatism responds well to a combination of drinking potato juice and an external compress from this root. The procedure should be carried out within a month.
- Broth, cooked potato peels, is suitable for making compresses that are applied to joints affected by rheumatism.
Herbal preparations intended for the treatment of rheumatism of leg joints:
- At 10 grams of St. John's Wort, one glass of warm water is needed. This mixture should be boiled for half an hour on a small fire. A remedy for rheumatism is taken during the day before meals( at a time - a third of the container).
- Leaves of cowberry in a jar, top up with water, insist. The drug is taken twice a day for two teaspoons.
- For two small spoonfuls of blueberry berries you should take a glass of boiling water. Infused broth for half an hour. Take the remedy several times a day on a large spoon.
Timely diagnosis of rheumatism of leg joints, as well as its qualitative prevention and treatment, allow to minimize the negative consequences that the disease results.
rheumatism - symptoms, signs and manifestations in children and adults
- Signs of the development of the disease
With the development of such a systemic inflammatory disease as rheumatism - symptoms usually do not appear immediately. Progressing, the disease affects the connective tissue and is often localized in the cardiovascular system. Usually disease affects children under 15 years old .The cause of serious complications associated with infectious diseases can be such ailments as angina, nasopharyngitis, acute sinusitis and otitis.IMPORTANT TO KNOW!A new means of restoring joints in 99% of subjects. The pain goes away 100%!Read more here - & gt;
The criteria used in the diagnosis of rheumatism, developed in 1988 by WHO, are recognized as small and large manifestations. It is also important to confirm the transferred streptococcal infection. The big manifestations of the disease include carditis, polyarthritis, chorea, tight subcutaneous nodules and annular erythema. Small criteria for detecting ailment are:
- laboratory indicators( leukocytosis, positive C-reactive protein, elevated level of ESR);
- clinical data( arthralgia, fever);
- instrumental information( eg, ECG results).
According to the diagnostic rule: the presence of 2 large or 1 large and 2 small indicators in the presence of evidence of a transferred streptococcal infection is a confirmation of rheumatism. In addition, the radiograph is determined by an increase in the heart and a decrease in the contractility of the myocardium, a change in the shade of the heart. The ultrasound of the body reveals the signs of acquired defects.
Causes of rheumatism
There are two factors that can lead to the formation of rheumatism in a person: a hereditary counterparty and streptococcal infections. Of course, this microbe is in the body of all people, only its number is limited. Subcooling or significant weakening of immunity leads to a many-thousand increase in the number of microorganisms.
The first appears tonsillitis or pharyngitis. Subsequently, the ailment can develop into rheumatism. Often this happens in children. Rheumatism of the joints in them is formed due to an increased reaction of immunity. Individual types of streptococcus are similar in structure to "native" proteins. The similarity becomes fatal - antibodies begin to counteract both microbes, and own structures.
According to research data, rheumatism has its own age range. Most often, it manifests itself in childhood and accompanies the patient throughout his life.
What is the danger of rheumatism
Medical observations have shown that rheumatism usually covers the most active and active cartilage. Moreover, if diseased tissues were susceptible to constant hypothermia or were injured, the risk of getting inflammation of these joints is increased. It is worth noting that the ailment does not lead to any disturbances of a pathological nature in the tissues of the joint.
The disease is usually affected by the outer shell, and with proper treatment the process is completely reversible. The condition of various joints before and after the period of exacerbation of the disease is not particularly different. The disease leads exclusively to an increase in the envelope and inflammatory process in neighboring tissue fibers. Despite this, rheumatism is fraught with many other dangers.
Internal organs are affected by rheumatism, especially the heart is often affected. Progressing in the joints and heart, the ailment acquires a doubled force of exacerbation. The heart valves, as well as the blood circulation as a whole, are at risk. From the harmful effects of rheumatism, the peripheral nervous system and even the lungs are not protected.
Symptoms of rheumatism in children
Such a dangerous ailment as rheumatism - symptoms in children can manifest in a few years. It affects primarily the blood vessels and the muscle of the heart, while at the young age the damage to the cartilage may be completely absent or manifest much later. In fairly severe cases, as a result of acute damage to the cardiovascular system, there is a risk of developing chronic heart disease, and the good that cases such are rare.
Phases of the course of the disease
Rheumatism passes in the two leading phases - inactive and active. By the first form is meant such a state of the affected child, when in laboratory tests to identify the signs of inflammation is not possible. Children remain active. There is a violation of hemodynamics only with significant physical exertion.
With the active phase of childhood rheumatism, symptoms can manifest with one of the three degrees of progression of the disease:
- I degree - minimal inflammation;
- III degree is the maximum progression.
It is important to know that the younger the child, the progression of the disease is more complicated than .In addition, in children, rheumatism usually leads to more serious consequences than for strong adolescents. In this regard, it is recommended to identify the disease as early as possible through a comprehensive survey. Leading signs of rheumatism in children can be represented in the forms:
- articular - often finds itself in a few weeks after an acute infectious disease. This form of rheumatism is accompanied by severe pain in the connective tissues and a high fever, but in rare cases, the child's complaints are only for a weak and quickly subsiding pain;
- is a nervous form or chorea. Symptom is manifested in the form of tearfulness and irritability of the baby, a sharp deterioration in the handwriting, visible nerve ticks of the eyes and hands. If such symptoms are found, it is necessary to urgently consult a doctor, because of the possibility of developing paralysis;
- cardiac form - has such signs of rheumatism, in which the heart is affected without joint disease. The child has complaints only about fatigue and weakness after a long walk. The degree of defeat of the main organ can be different - from mild to severe.
Primary symptoms of rheumatism in adults
Symptoms of rheumatic fever - rheumatic polyarthritis often appear only a couple of weeks after pharyngitis or sore throat provoked by streptococcal infection. The soreness of the joints can be so strong that not only the movements become absolutely impossible, but also a slight touch to the affected area is discomfort. Body temperature reaches 40 °.
But there are cases when the symptoms of rheumatism in adults are practically unnoticeable. Slight weakness and temperature will not attract attention to yourself. In most cases, patients go to the clinic when serious problems with affected joints begin: they swell, blush, become hot to the touch.
Connective fibers acquire high soreness when pressed or attempted to make minimal movement. Unpleasant sensations in the rheumatism of cartilage can appear quickly and unexpectedly, but also just disappear. Cartilage is not deformed, i.e.the disease has a benign course. Rheumatic polyarthritis is characterized by the lesion of mainly such joints:
- of the knee;
Rheumatic disease refers to the class of chronic ailments, and in its course a wavy character predominates, which causes exacerbations several times a year. Disease itself can not disappear. It must necessarily be treated. Repeated attacks of tenderness of joints may occur after months, but in some cases - and in years.
Mechanism of the appearance of joint rheumatism
In very rare cases with progressive joint rheumatism, pathology captures only one joint. Usually, after a while after the onset of the disease, sometimes after a few hours, the painfulness of the affected cartilage somewhat subside. Becomes smaller swelling. However, sharp pains, swelling and redness in the area of the other joint are brewing. The ailment seems to migrate from one organ to another.
In some patients, especially with immediate-onset therapy, only 2 to 3 cartilages are involved in the pathological process. In the opposite situation every day, the disease will affect more and more new tissues. First rheumatism of the hands will develop - the symptoms will be very acute. Then the joints of the limbs, back and even the lower jaw will be affected. In the body there will be considerable pain.
Numerous physician's observations indicate that the most common affliction affects those joint tissues that have been more "stressed" in one patient or another. Perhaps in connection with his profession or way of life. Often, with rheumatism, those damping elements that previously suffered bruises, powerful long-term pressure, frequent hypothermia and other adverse effects suffer.
Not all cases of rheumatic fever develop a violent temperament. When there are repeated seizures of this inflammatory disease, especially in middle-aged people, unpleasant sensations are not unbearable. It happens that the joints remain mobile, and the increase in the overall temperature is rather insignificant and keeps within the range of up to 37.2-37.5 °.
Sometimes the sick even go to work. They do not go to the doctor and make attempts to cure themselves "home" by themselves. However, it is with such a sluggish character of articular attack that repeated exacerbations are frequent. Painfulness increases and the ailment can confidently keep its positions for long 3-4 months.
With competent therapy, soreness and swelling in the joints fully pass in most patients in a couple of weeks. In some cases, the process can be stopped earlier: after a couple of days of active therapy.
Signs of the development of the disease
Due to the fact that the first signs of rheumatism are associated with intoxication after an illness caused by streptococci, the symptomatology subsides quickly. Such unpleasant moments as general weakness, high fever, prolonged permanent character of the headache are not immediately apparent. Usually there is a certain interval of several weeks between streptococcal ailment and the development of rheumatism.
When the limbs are affected, the symptoms of the disease are quite similar to the manifestation of arthritis - the same aching pain, which can sharply worsen. How is rheumatism manifested in a neglected stage or after a long "hibernation" is not difficult to guess. The disease will affect any joints. When the disease of small cartilage symptoms will appear immediately, with the defeat of large organs - signs will be found after a while.
Visible signs of rheumatism:
- redness of the skin over the affected joints;
- swelling and tenderness;
- characteristic shine of the skin over the diseased area.
Reaction of the heart to rheumatism is a rapid heartbeat, dull pain and possible shortness of breath. As a rule, these signs are parallel to the main symptoms - lethargy, temperature and intoxication. The defeat of the hip or shoulder joint with rheumatism is a rarity. And the symptoms are less pronounced. Only the stage of exacerbation will allow to determine that this is the present ailment.
Rheumatoid nodules also indicate a severe form of the disease. They can form with the absence of therapy or with the rapid progression of any form of disease. These nodules are small subcutaneous seals that do not cause additional soreness. Often they are formed on the cartilage of the fingers.
Occasionally, in the period of exacerbations on the skin there is a rash - an annular rash. It has the appearance of pale pinkish points. When pressed, they disappear. The phenomenon is quite rare and occurs when the aggravation subsides.
It is in the limb region that rheumatism rages most, affecting often symmetrical joints. Because of this, the mobility of the cartilage disappears for days and even weeks."Harmful" nodules dissolve themselves, but not as quickly as they form - complete disappearance takes up to a couple of months. No matter what rheumatism the signs of - are, the main thing is not to engage in self-treatment and go to the polyclinic .Then the therapy will be quick and effective.