Complications of rheumatism

Rheumatism( rheumatic fever)

Rheumatism( rheumatic fever)

Rheumatism is an inflammatory infectious and allergic systemic lesion of connective tissue of various localization, mainly of the heart and blood vessels. A typical rheumatic fever is characterized by an increase in body temperature, multiple symmetrical arthralgia of a volatile nature, polyarthritis. In the future, ring-shaped erythema, rheumatic nodules, rheumatic chorea, rheumatic carditis with damage to the heart valves can be attached. Of the laboratory criteria for rheumatism, the most important are positive CRP, an increase in the titer of streptococcal antibodies. In the treatment of rheumatism, NSAIDs, corticosteroid hormones, immunosuppressants are used.

Rheumatism( rheumatic fever)

Rheumatism( synonyms: rheumatic fever, Sokolsky-Buyo disease) occurs chronically, with a tendency to relapse, exacerbations occur in the spring and autumn. The share of rheumatic heart and vascular lesions account for up to 80% of acquired heart defects. In the rheumatic process, joints, serous membranes, skin, and the central nervous system are often involved. The incidence of rheumatism rises from 0.3% to 3%.Rheumatism usually develops in childhood and adolescence( 7-15 years);children of preschool age and adults get sick much less often;3 times more often rheumatism affects the female.

Causes and mechanism of development of rheumatism

Rheumatic attacks are usually preceded by streptococcal infection caused by group A beta-hemolytic streptococcus: scarlet fever, tonsillitis, maternal fever, acute otitis media, pharyngitis, erysipelas. In 97% of patients who underwent streptococcal infection, a stable immune response is formed. The rest of the people do not develop stable immunity, and with repeated infection with β-hemolytic streptococcus a complex autoimmune inflammatory reaction develops.

The development of rheumatism is promoted by reduced immunity, young age, large groups( schools, boarding schools, hostels), unsatisfactory social conditions( food, shelter), hypothermia, family history.

In response to the introduction of β-hemolytic streptococcus in the body, anti-streptococcal antibodies( anti-streptolysin-O, antistreptogyaluronidase, antistreptokinase, antidexoxyribonuclease B) are produced, which together with streptococcal antigens and components of the complement system form immune complexes. Circulating in the blood, they are carried throughout the body and settle in tissues and organs, mainly localized in the cardiovascular system. In the localization of immune complexes, the process of aseptic autoimmune inflammation of connective tissue develops. Streptococcus antigens have pronounced cardiotoxic properties, which leads to the formation of autoantibodies to the myocardium, which further aggravate inflammation. With repeated infection, cooling, stressful effects, the pathological reaction is fixed, contributing to the recurring progressive course of rheumatism.

The processes of connective tissue disorganization in rheumatism go through several stages: mucoid swelling, fibrinoid changes, granulomatosis and sclerosis.

In the early, reversible stage of mucoid swelling, swelling, swelling and cleavage of collagen fibers develops. If at this stage the damage is not eliminated, irreversible fibrinoid changes occur, characterized by fibrinoid necrosis of collagen fibers and cellular elements. In the granulomatous stage of the rheumatic process around the necrosis zones, specific rheumatic granulomas are formed. The final stage of sclerosis is the outcome of granulomatous inflammation.

The duration of each stage of the rheumatic process is 1 to 2 months, and the entire cycle - about six months. Relapses of rheumatism promote the occurrence of repeated tissue lesions in the area of ​​already existing scars. The defeat of the tissue of the heart valves with the outcome of sclerosis leads to deformation of the valves, their fusion with each other and is the most common cause of acquired heart defects, and repeated rheumatic attacks only exacerbate destructive changes.

Classification of rheumatism

The clinical classification of rheumatism is made taking into account the following characteristics:

  • Phases of the disease( active, inactive)

In the active phase, three degrees are distinguished: I - minimal activity, II-activity moderate, III - activity high. In the absence of clinical and laboratory signs of the activity of rheumatism, they speak of its inactive phase.

  • Variant of the course( acute, subacute, lingering, latent, recurrent rheumatic fever)

In acute course rheumatism attacks suddenly, proceeds with a sharp severity of symptoms, is characterized by polysyndromy of the lesion and a high degree of activity of the process, rapid and effective treatment.

In subacute rheumatism the duration of the attack is 3-6 months, the symptomatology is less pronounced, the activity of the process is moderate, the effectiveness of the treatment is less pronounced.

The protracted variant proceeds with a long, more than half a year's rheumatic attack, with sluggish dynamics, monosyndromic manifestation and low activity of the process.

The latent flow is characterized by the lack of clinical and laboratory and instrumental data, rheumatism is diagnosed retrospectively, according to the already formed heart disease.

Continuously recurrent variant of development of rheumatism is characterized by a wave-like, with bright exacerbations and incomplete remission of course, polysinomicity of manifestations and rapidly progressive lesion of internal organs.

  • Clinical and anatomical characteristics of lesions:
  1. with involvement of the heart( rheumatic carditis, myocardiosclerosis), with or without heart failure;
  2. with involvement of other systems( rheumatic involvement of joints, lungs, kidneys, skin and subcutaneous tissue, neurorrheumatism)
  • Clinical manifestations( carditis, polyarthritis, annular erythema, chorea, subcutaneous nodules)
  • Circulatory states( see: degrees of chronic heart failure).

Symptoms of rheumatism

Symptoms of rheumatism are extremely polymorphic and depend on the degree of acuity and activity of the process, as well as the involvement of various organs in the process.

A typical clinic of rheumatism has a direct connection with a streptococcal infection( tonsillitis, scarlet fever, pharyngitis) and develops 1-2 weeks after it. The disease begins with acute subfebrile temperature( 38-39 ° C), weakness, fatigue, headaches, sweating. One of the early manifestations of rheumatism is arthralgia - pain in the middle or large joints( ankle, knee, elbow, shoulder, wrist).With rheumatism arthralgia is multiple, symmetrical and volatile( pain disappears in some and appears in other joints) character. There is swelling, puffiness, local redness and fever, a sharp restriction of movements of the affected joints. The course of rheumatic polyarthritis is usually benign: after a few days the acuteness of the phenomena subsides, the joints do not deform, although moderate soreness can persist for a long time.

After 1-3 weeks, rheumatic carditis joins: pain in the heart, palpitations, interruptions, shortness of breath;asthenic syndrome( malaise, lethargy, fatigue).The defeat of the heart for rheumatism is noted in 70-85% of patients.

In rheumatic heart disease, all or individual membranes of the heart become inflamed. More often there is a simultaneous lesion of the endocardium and myocardium( endomyocarditis), sometimes with pericardial involvement( pancarditis), possibly the development of isolated myocardial damage( myocarditis).In all cases with rheumatism, the myocardium is involved in the pathological process.

In case of diffuse myocarditis, shortness of breath, palpitations, irregularities and pains in the heart, cough during exercise, in severe cases - circulatory insufficiency, cardiac asthma or pulmonary edema. Pulse is small, tachyarrhythmic. A favorable outcome of diffuse myocarditis is myocarditis cardiosclerosis.

With endocarditis and endomyocarditis in the rheumatic process, the mitral( left atrial-ventricular) valve, and rarely the aortic and tricuspid( right atrial-ventricular) valves are more often involved. Clinic of rheumatic pericarditis is similar to pericarditis of another etiology.

In rheumatism, the central nervous system can be affected, the so-called rheumatic or minor chorea serves as a specific sign: hyperkinesis appears - involuntary jerking of muscle groups, emotional and muscle weakness.

Less common skin manifestations of rheumatism: annular erythema( in 7-10% of patients) and rheumatic nodules. Ring-shaped erythema( annular rash) is a ring-shaped, pale pink rash on the trunk and legs;rheumatic subcutaneous nodules - dense, rounded, painless, inactive, single or multiple nodules with localization in the middle and large joints.

The defeat of the kidneys, abdominal cavity, lungs and other organs occurs in severe rheumatism, very rarely at the present time. Rheumatic lung injury occurs in the form of rheumatic pneumonia or pleurisy( dry or exudative).With rheumatic damage of the kidneys in urine, erythrocytes, protein are determined, a jade clinic arises. The defeat of the abdominal cavity in rheumatism is characterized by the development of abdominal syndrome: abdominal pain, vomiting, abdominal tension.

Repeated rheumatic attacks develop under the influence of hypothermia, infections, physical overstrain and occur with a predominance of symptoms of heart damage.

Complications of rheumatism

The development of complications of rheumatism is predetermined by the severity, protracted and continuously recurring nature of the course. In the active phase of rheumatism, circulatory insufficiency and atrial fibrillation may develop.

The outcome of rheumatic myocarditis can be myocardiosclerosis, endocarditis - heart defects( mitral insufficiency, mitral stenosis and aortic insufficiency).When endocarditis is also possible thromboembolic complications( infarction of the kidneys, spleen, retina, cerebral ischemia, etc.).With rheumatic lesions, adhesions of the pleural, pericardial cavities can develop. Mortally dangerous complications of rheumatism are the thromboembolism of the main vessels and decompensated heart defects.

Diagnosis of rheumatism

Objective diagnostic criteria for rheumatism are developed by the WHO( 1988), large and small manifestations, as well as confirmation of a previous streptococcal infection. Great manifestations( criteria) of rheumatism include polyarthritis, carditis, chorea, subcutaneous nodules and annular erythema.

Small criteria for rheumatism are divided into: clinical( fever, arthralgia), laboratory( increase in ESR, leukocytosis, positive C-reactive protein) and instrumental( on ECG - lengthening P-Q interval).

Evidence supporting the previous streptococcal infection is an increase in the levels of streptococcal antibodies( anti-streptolysin, antistreptokinase, anti-hyaluronuridase), bacussis from the throat of β-hemolytic streptococcus group A, recent scarlet fever.

The diagnostic rule states that the presence of 2 large or 1 large and 2 small criteria and evidence of a transferred streptococcal infection confirm rheumatism.

Additionally, the radiograph of the lungs determines the increase in the heart and a decrease in the contractility of the myocardium, a change in the cardiac shadow. By ultrasound of the heart( Echocardiography), signs of acquired defects are revealed.

Treatment of rheumatism

The active phase of rheumatism requires hospitalization of the patient and compliance with bed rest. Treatment is carried out by a rheumatologist and cardiologist. Hypersensitizing and anti-inflammatory drugs, corticosteroid hormones( prednisolone, triamsinolone), nonsteroidal anti-inflammatory drugs( voltaren, indomethacin, butadione, brufen), immunosuppressants( plaquenyl, delagil, imarant, 6-mercaptopurine, chlorobutin) are used.

Sanitation of potential foci of infection( tonsillitis, caries, sinusitis) includes their instrumental and antibacterial treatment.

The use of penicillin antibiotics in the treatment of rheumatism is of an auxiliary nature and is indicated in the presence of an infectious focus or obvious signs of streptococcal infection.

In the remission phase, resort treatment is provided in the sanatoriums of Kislovodsk or the Southern coast of Crimea. In the future, to prevent recurrence of rheumatism in the autumn-spring period, a monthly preventive course of NSAIDs is carried out.

Forecast for rheumatism

Timely treatment of rheumatism virtually eliminates the immediate threat to life. The severity of the prognosis for rheumatism is determined by the defeat of the heart( the presence and severity of the defect, the degree of myocardiosclerosis).The most unfavorable from a prognostic point of view is the continuously progressing course of rheumatic heart disease.

The risk of formation of heart defects increases with the early occurrence of rheumatism in children, late-onset treatment. In primary rheumatic attacks in patients over 25 years of age, the course is more favorable, valve changes usually do not develop.

Prevention of rheumatism

Measures of primary prevention of rheumatism include the detection and rehabilitation of streptococcal infection, hardening, improvement of social, household, hygienic living and working conditions. Prevention of recurrence of rheumatism( secondary prevention) is carried out in conditions of dispensary control and includes prophylactic intake of anti-inflammatory and antimicrobial drugs in the autumn-spring period.

krasotaimedicina.ru

Rheumatism( rheumatic fever)

Rheumatism( rheumatic fever)

Rheumatism is an inflammatory infectious and allergic systemic lesion of connective tissue of various localizations, mainly of the heart and blood vessels. A typical rheumatic fever is characterized by an increase in body temperature, multiple symmetrical arthralgia of a volatile nature, polyarthritis. In the future, ring-shaped erythema, rheumatic nodules, rheumatic chorea, rheumatic carditis with damage to the heart valves can be attached. Of the laboratory criteria for rheumatism, the most important are positive CRP, an increase in the titer of streptococcal antibodies. In the treatment of rheumatism, NSAIDs, corticosteroid hormones, immunosuppressants are used.

Rheumatism( rheumatic fever)

Rheumatism( synonyms: rheumatic fever, Sokolsky-Buyo disease) is chronic, with a tendency to relapse, exacerbations occur in the spring and autumn. The share of rheumatic heart and vascular lesions account for up to 80% of acquired heart defects. In the rheumatic process, joints, serous membranes, skin, and the central nervous system are often involved. The incidence of rheumatism rises from 0.3% to 3%.Rheumatism usually develops in childhood and adolescence( 7-15 years);children of preschool age and adults get sick much less often;3 times more often rheumatism affects the female.

Causes and mechanism of development of rheumatism

Rheumatic attacks are usually preceded by streptococcal infection caused by group A beta-hemolytic streptococcus: scarlet fever, tonsillitis, maternal fever, acute otitis media, pharyngitis, erysipelas. In 97% of patients who underwent streptococcal infection, a stable immune response is formed. The rest of the people do not develop stable immunity, and with repeated infection with β-hemolytic streptococcus a complex autoimmune inflammatory reaction develops.

The development of rheumatism is promoted by reduced immunity, young age, large collectives( schools, boarding schools, hostels), unsatisfactory social conditions( food, shelter), hypothermia, burdened family anamnesis.

In response to the introduction of β-hemolytic streptococcus in the body, anti-streptococcal antibodies( anti-streptolysin-O, antistreptogyaluronidase, antistreptokinase, antidexoxyribonuclease B) are produced, which together with streptococcal antigens and components of the complement system form immune complexes. Circulating in the blood, they are carried throughout the body and settle in tissues and organs, mainly localized in the cardiovascular system. In the localization of immune complexes, the process of aseptic autoimmune inflammation of connective tissue develops. Streptococcus antigens have pronounced cardiotoxic properties, which leads to the formation of autoantibodies to the myocardium, which further aggravate inflammation. With repeated infection, cooling, stressful effects, the pathological reaction is fixed, contributing to the recurring progressive course of rheumatism.

The processes of connective tissue disorganization in rheumatism go through several stages: mucoid swelling, fibrinoid changes, granulomatosis and sclerosis.

In the early, reversible stage of mucoid swelling, swelling, swelling and cleavage of collagen fibers develops. If at this stage the damage is not eliminated, irreversible fibrinoid changes occur, characterized by fibrinoid necrosis of collagen fibers and cellular elements. In the granulomatous stage of the rheumatic process around the necrosis zones, specific rheumatic granulomas are formed. The final stage of sclerosis is the outcome of granulomatous inflammation.

The duration of each stage of the rheumatic process is 1 to 2 months, and the entire cycle - about six months. Relapses of rheumatism promote the occurrence of repeated tissue lesions in the area of ​​already existing scars. The defeat of the tissue of the heart valves with the outcome of sclerosis leads to deformation of the valves, their fusion with each other and is the most common cause of acquired heart defects, and repeated rheumatic attacks only exacerbate destructive changes.

Classification of rheumatism

The clinical classification of rheumatism is made taking into account the following characteristics:

  • Phases of the disease( active, inactive)

In the active phase three degrees are distinguished: I - minimal activity, II activity moderate, III - activity high. In the absence of clinical and laboratory signs of the activity of rheumatism, they speak of its inactive phase.

  • Variant of the course( acute, subacute, prolonged, latent, recurrent rheumatic fever)

In acute course rheumatism attacks suddenly, proceeds with a sharp severity of symptoms, is characterized by the polysyndrome of the lesion and a high degree of activity of the process, rapid and effective treatment.

In subacute rheumatism the duration of the attack is 3-6 months, the symptomatology is less pronounced, the activity of the process is moderate, the effectiveness of treatment is less pronounced.

The protracted variant proceeds with a prolonged, more than half a year's rheumatic attack, with sluggish dynamics, monosyndromic manifestation and low activity of the process.

Latent flow is characterized by the lack of clinical and laboratory and instrumental data, rheumatism is diagnosed retrospectively, according to the already formed heart disease.

Continuously relapsing variant of development of rheumatism is characterized by a wave-like, with bright exacerbations and incomplete remission of course, polysinomicity of manifestations and rapidly progressive lesion of internal organs.

  • Clinico-anatomical characteristics of lesions:
  1. with involvement of the heart( rheumatic carditis, myocardiosclerosis), with or without heart failure;
  2. with involvement of other systems( rheumatic lesions of the joints, lungs, kidneys, skin and subcutaneous tissue, neurorheumatism)
  • Clinical manifestations( carditis, polyarthritis, annular erythema, chorea, subcutaneous nodules)
  • Circulatory states( see: degrees of chronic heart failure).

Symptoms of rheumatism

Symptoms of rheumatism are extremely polymorphic and depend on the degree of acuity and activity of the process, as well as the involvement of various organs in the process.

A typical rheumatism clinic has a direct connection with a streptococcal infection( tonsillitis, scarlet fever, pharyngitis) and develops 1-2 weeks after it. The disease begins with acute subfebrile temperature( 38-39 ° C), weakness, fatigue, headaches, sweating. One of the early manifestations of rheumatism is arthralgia - pain in the middle or large joints( ankle, knee, elbow, shoulder, wrist).With rheumatism arthralgia is multiple, symmetrical and volatile( pain disappears in some and appears in other joints) character. There is swelling, puffiness, local redness and fever, a sharp restriction of movements of the affected joints. The course of rheumatic polyarthritis is usually benign: after a few days the acuteness of the phenomena subsides, the joints do not deform, although moderate soreness can persist for a long time.

After 1-3 weeks, rheumatic carditis joins: pain in the heart, palpitations, interruptions, shortness of breath;asthenic syndrome( malaise, lethargy, fatigue).The defeat of the heart for rheumatism is noted in 70-85% of patients.

In rheumatic heart disease, all or individual membranes of the heart become inflamed. More often there is a simultaneous lesion of the endocardium and myocardium( endomyocarditis), sometimes with pericardial involvement( pancarditis), possibly the development of isolated myocardial damage( myocarditis).In all cases with rheumatism, the myocardium is involved in the pathological process.

With diffuse myocarditis, shortness of breath, palpitations, irregularities and pains in the heart, cough during exercise, in severe cases - circulatory insufficiency, cardiac asthma or pulmonary edema. Pulse is small, tachyarrhythmic. A favorable outcome of diffuse myocarditis is myocarditis cardiosclerosis.

With endocarditis and endomyocarditis in the rheumatic process, the mitral( left atrial-ventricular) valve is more often involved, less often the aortic and tricuspid( right atrial-ventricular) valves. Clinic of rheumatic pericarditis is similar to pericarditis of another etiology.

In rheumatism, the central nervous system can be affected, the so-called rheumatic or minor chorea serves as a specific sign: hyperkinesis appears - involuntary jerking of muscle groups, emotional and muscle weakness.

Less common skin manifestations of rheumatism: annular erythema( in 7-10% of patients) and rheumatic nodules. Ring-shaped erythema( annular rash) is a ring-shaped, pale pink rash on the trunk and legs;rheumatic subcutaneous nodules - dense, rounded, painless, inactive, single or multiple nodules with localization in the middle and large joints.

The defeat of the kidneys, abdominal cavity, lungs and other organs occurs in severe rheumatism, very rarely at the present time. Rheumatic lung injury occurs in the form of rheumatic pneumonia or pleurisy( dry or exudative).With rheumatic damage of the kidneys in urine, erythrocytes, protein are determined, a jade clinic arises. The defeat of the abdominal cavity in rheumatism is characterized by the development of abdominal syndrome: abdominal pain, vomiting, abdominal tension.

Repeated rheumatic attacks develop under the influence of hypothermia, infections, physical overstrain and occur with a predominance of heart attack symptoms.

Complications of rheumatism

The development of complications of rheumatism is predetermined by the severity, protracted and continuously recurrent nature of the course. In the active phase of rheumatism, circulatory insufficiency and atrial fibrillation may develop.

The outcome of rheumatic myocarditis can be myocardiosclerosis, endocarditis - heart defects( mitral insufficiency, mitral stenosis and aortic insufficiency).When endocarditis is also possible thromboembolic complications( infarction of the kidneys, spleen, retina, cerebral ischemia, etc.).With rheumatic lesions, adhesions of the pleural, pericardial cavities can develop. Mortally dangerous complications of rheumatism are the thromboembolism of the main vessels and decompensated heart defects.

Diagnosis of rheumatism

Objective diagnostic criteria for rheumatism are the large and small manifestations developed by the WHO( 1988), as well as confirmation of a previous streptococcal infection. Great manifestations( criteria) of rheumatism include polyarthritis, carditis, chorea, subcutaneous nodules and annular erythema.

Small criteria for rheumatism are divided into: clinical( fever, arthralgia), laboratory( increase in ESR, leukocytosis, positive C-reactive protein) and instrumental( on ECG - lengthening P-Q interval).

Evidence supporting the previous streptococcal infection is an increase in the titers of streptococcal antibodies( antistreptolysin, antistreptokinase, anti-hyaluronidase), bacussis from the throat of β-hemolytic streptococcus group A, recent scarlet fever.

The diagnostic rule states that the presence of 2 large or 1 large and 2 small criteria and evidence of a transferred streptococcal infection confirm rheumatism.

In addition, the chest radiograph shows an increase in the heart and a decrease in the contractility of the myocardium, a change in the cardiac shadow. By ultrasound of the heart( Echocardiography), signs of acquired defects are revealed.

Treatment of rheumatism

The active phase of rheumatism requires hospitalization of the patient and compliance with bed rest. Treatment is carried out by a rheumatologist and cardiologist. Hypersensitizing and anti-inflammatory drugs, corticosteroid hormones( prednisolone, triamsinolone), nonsteroidal anti-inflammatory drugs( voltaren, indomethacin, butadione, brufen), immunosuppressants( plaquenyl, delagil, imarant, 6-mercaptopurine, chlorobutin) are used.

Sanitation of potential foci of infection( tonsillitis, caries, sinusitis) includes their instrumental and antibacterial treatment.

The use of penicillin antibiotics in the treatment of rheumatism is of an auxiliary nature and is indicated in the presence of an infectious focus or obvious signs of streptococcal infection.

In the remission phase, resort treatment is provided in the sanatoriums of Kislovodsk or the Southern coast of the Crimea. In the future, to prevent recurrence of rheumatism in the autumn-spring period, a monthly preventive course of NSAIDs is carried out.

Forecast for rheumatism

Timely treatment of rheumatism virtually eliminates the immediate threat to life. The severity of the prognosis for rheumatism is determined by the defeat of the heart( the presence and severity of the defect, the degree of myocardiosclerosis).The most unfavorable from a prognostic point of view is the continuously progressing course of rheumatic heart disease.

The risk of formation of heart defects increases with the early occurrence of rheumatism in children, late-onset treatment. In primary rheumatic attacks in persons over 25 years of age, the course is more favorable, valve changes usually do not develop.

Prevention of rheumatism

Measures of primary prevention of rheumatism include the detection and rehabilitation of streptococcal infection, hardening, improvement of social, household, hygienic living and working conditions. Prevention of recurrence of rheumatism( secondary prevention) is carried out in conditions of dispensary control and includes prophylactic intake of anti-inflammatory and antimicrobial agents in the autumn-spring period.

krasotaimedicina.ru

Symptoms and Causes of

What is rheumatism?

Rheumatism is a systemic inflammatory disease, the pathological process of which is localized mainly in the heart membrane. At risk are people who are predisposed to this disease, mainly at the age of 7-15 years. Rheumatism affects people of young age.

Rheumatic heart disease is one of the main causes of death( in the US, for this reason, approximately 50,000 people die each year).Often this disease begins in the cold season, mainly in the northern latitudes. Rheumatism does not apply to epidemic diseases, although the previous streptococcal infection can take the form of an epidemic. For this reason, rheumatism can begin immediately in a group of people - for example, in schools, orphanages, hospitals, military camps, sometimes in poor families, in close living conditions.

Bacteriological and serological studies have shown that rheumatic fever is a particular allergic reaction to infection with one of the beta-hemolytic streptococci of group A.

Over a month, 2.5% of streptococcal infections begin to ache with acute rheumatism. Often, such diseases as angina, scarlet fever, maternal fever, acute inflammation of the middle ear, erysipelas precede the development of rheumatism. The body does not develop immunity to infection, a re-attack of rheumatism begins to re-infection.


Etiology of rheumatism

rheumatism

Rheumatism is a complex pathological process of disruption of connective tissue synthesis, affecting mainly the locomotor system and heart.

Despite the fact that in modern research and practice rheumatism is determined in several ways, the essence of the pathological process is the same.

The basis for the development of rheumatic pathology is the disruption of the work of cells of connective tissue and the destruction of the intercellular substance. The main change consists in the destruction of collagen fibers, which form the tissues of the joints and heart. For this reason, the heart is suffering most( primarily valves), vessels and the locomotor apparatus( joints and cartilages).

The etiology of rheumatism today is represented by three theories:

  • Complex theory. It is based on the multiplicity of the reasons for the formation of rheumatism, including allergic reaction and bacterial damage( organisms of the genus Streptococcus).

  • Infectious theory. Based on the fact that the main reason for the development of rheumatism is the bacterium streptococcus.

  • Bacterial Immunologic Theory. Its essence lies in the fact that the microorganism is a trigger of the disease, which leads to an immune reaction and as a result - the destruction of connective tissue substances.

The Integrated Theory of

According to a complex theory, rheumatism is a polyethological process that includes several causes. Unlike the bacterial-immunological theory, here we are talking about a microorganism, as an independent reason, rather than a trigger.

This concept is based on the idea of ​​the development of the disease as a result of the penetration of streptococcal infection into the tissues of the body and their dislocation in the heart and joints( they are carried with the blood flow).

However, the necessary condition is repeated contact with the pathogen, which leads to an increase in the sensitivity of the organism. As a result, the body becomes less resistant to the effects of a particular strain of streptococcus, and the immune response is not able to completely suppress manifestations of infection.

The concentration of antibodies, however, is high enough to act destructively on the cellular structures and intercellular substance of the organism itself. The same effect is possessed by substances produced by streptococcus.

Both bacteria and antibodies affect the body equally, provoking rheumatism. In support of the theory, often in the study of patients handed down by rheumatism specimens( analyzes), streptococci are detected.

The infectious theory of

comes from the only cause of the disease - bacterial damage. In the rheumatic fluid taken from patients with pleural cavity or pericardium, specific pathogenic particles are detected, which serves as a confirmation of the theory.

Immune theory

Gives immunity the dominant role in the mechanism of the development of the disease. The reason is that in the blood of patients a high concentration of antibodies to streptococcus is detected, but the tests for streptococcus itself also remain positive. Consequently, the immune response acts in this case as a destructive factor.

Within the framework of the theory, the microorganism does not have a significant effect on the body and is a trigger.

Thus, all the theories point to the complex nature of the disease, which is based on infectious disease and immune response.


Causes of rheumatism

Causes of rheumatism

The main causes of rheumatism are three:

  • Postponed streptococcal disease( sore throat, etc.)

  • Immune( allergic) reaction

  • Genetics.

Postponed diseases

As it was said, only streptococci( group A streptococcus, b-homolytic) affect the formation of the disease and only after repeated interaction, as a result of which the protective capacity of the organism decreases.

Since there are also serological subgroups within the group of microorganisms, it is important to say that the interaction should be carried out with streptococcus of the same subgroup. This explains why rheumatism develops not after any cold-related illness.

The risk of developing rheumatism is higher and with a single contact, if the patient does not receive the necessary treatment. The disease turns into a chronic form, and the patient has a bacterial focus that can provoke rheumatism and other serious complications at any time.

Allergic reaction

Severe allergic reaction can cause both streptococcus itself and the substances released by it( toxic and protein-enzymes).Since the pathogen of blood spreads throughout the body, the immune response can be systemic, but is most strongly manifested by heart and joint damage.

According to studies, bacteria are "responsible" for the development of acute rheumatism with involvement in the process of joints( this is a "classical" form).

However, chronic rheumatism is not associated with streptococcal disease, because no antibodies to streptococcus or streptococcus itself are detected by analysis. There is also no effectiveness of preventive measures against recurrence of rheumatism. These arguments speak in favor of an unexplored other allergic process.

Genetics

The disease is not transmitted genetically, but the "inheritance" is a predisposition to the disease. It is caused, first of all, by the similarity of the immune systems of parents and the child, and since rheumatism is primarily an immune disease, the mechanism of its development and causes are similar to other allergic pathologies( Hashimoto thyroiditis, bronchial asthma, etc.).

About the main cause of rheumatism you will tell Elena Malysheva:

Be sure to watch the video to the end in order to understand the cause of rheumatism!


Symptoms of rheumatism

Symptoms of rheumatism

Rheumatism is not a single disease. Often it "neighbors" with other diseases because the harmful substances released by streptococcus and antibodies of immunity damage many organs and systems, and all these manifestations can be considered as forms of rheumatism.

The first symptoms of rheumatism do not allow diagnosing the disease. Appear in 2-3 weeks later, after a re-transmitted disease of the upper respiratory tract( pharyngitis, laryngitis, sore throat) with streptococcal lesions. The picture looks like a relapse of a cold. Symptoms of acute rheumatism are considered to increase body temperature sometimes up to 40 degrees, increased heart rate, chills, excessive sweating, loss of strength, swollen and painful joints. In the first place, larger and more actively used joints suffer.

The inflammation then spreads to the rest of the joints, often symmetrically. Joints strongly swell, blush, feel hot, feel pain when pressing and moving. Usually the inflammatory process does not lead to stable changes in the joints. Pulse is frequent, arrhythmic, chest pain, dilated heart enlargement, sometimes pericardial friction noise is heard - this indicates heart damage.

  1. General symptoms of rheumatism:

    • Hyperthermia. Body temperature rises to threatening marks( 38.0-40.0 degrees).Symptom is associated with the development of an acute immune response against pathogens.

    • Lethargy. As patients describe, the body becomes "cotton", constantly want to sleep.

    • Headache .It is localized in the forehead area.

    ( This symptom is not specific and is typical for general intoxication of the body)

  2. Specific symptoms of rheumatism:

    • Joint pain. First of all large joints( knee, elbow), pains of a pulling character are affected. Dull and long. For rheumatism is characterized by rapid development of the process, and the same rapid disappearance of inflammation and pain in the joints with the restoration of their functions.

    • Pain behind the breastbone. Pain in the region of the heart is blunt or aching. A symptom does not appear immediately, but after a day or several days.

    • Vascular disorders. Vascular leakage, nasal bleeding, etc.

    • Annular rashes. show no more than 4-10% of all cases. They look like a pink rash, forming a roundness with uneven edges. They do not disturb the patient in any way.

    • Rheumatic nodes. Are formed on the affected joints. They look like subcutaneous formations from 5 mm to 2-3 cm in diameter, dense and immobile, but painless. They are extremely rare and persist for about 2 months after the onset of the disease.

    ( Specific symptomatology appears only after 1-3 days, occasionally there are symptoms of lesions of the abdominal organs( pain in the right upper quadrant, etc.), which indicates a severe course of the disease and requires immediate hospitalization)

Rheumatism in children occurs in moremild or chronic, without any symptoms. There is general malaise, a rapid pulse and pain in the joints, with the movement of soreness is not felt( so-called "pain of growth").If there are no signs of heart damage, the disease rarely ends with death, although with the development of carditis, the average life expectancy of the sick in the future is significantly reduced.


Signs of rheumatism

Other signs of rheumatism include:

  • Secondary. The disease is formed as a result of the development of a chronic focus of unique streptococcus-b-homolytics. Therefore, the manifestations of the disease do not occur immediately, but after a certain period( several weeks).

  • Polyethiologic. It is caused both by antibodies of lymphocytes, and by toxins, and also by enzymatic substances of streptococcus.

  • Propensity for recurrent .After the first course of rheumatism in acute form, the disease, even with successful treatment, changes into a chronic form with frequent relapses.

  • Monopathology of the .For rheumatism, regardless of its etiology, there is a specific single complex of symptoms, indicative of the defeat of the heart, vessels, cartilage and joints. The heart most strongly suffers, the tissues of which are destroyed under the influence of antibodies. The mechanism of defeat is also one.

  • Many associated pathologies. Some doctors call concomitant diseases forms of rheumatism. This is not entirely accurate, in addition, they do not appear in all patients and not always. Among them are chorea( nervous disease), erythema nodal, etc.

  • Self-management of symptoms. Symptoms of acute rheumatism pass independently and as rapidly as they arose( except cases of severe course, when there is acute heart failure).

  • Unpredictability. Symptoms decrease after a certain period, but it is impossible to predict accurately. Even against the background of treatment, relapses occur. The frequency of relapse is also unclear. The disease can "quiet down" for a long time, and then manifest again, and can give information about yourself every month. The duration of relapse does not lend itself to an accurate prognosis.

  • Elan. The first specific symptoms develop rapidly and all at once.

  • The complexity of diagnosis. Rheumatism has similar manifestations with other diseases. Since bright symptoms that indicate a pathology, you can meet very rarely, rheumatism is easily confused with similar diseases. For example, with joint damage, with rheumatoid arthritis, but this is an entirely different disease, not related to rheumatism.


Diagnosis of rheumatism

With one hundred percent accuracy, none of the diagnostic manipulations will not indicate the presence of rheumatism. Only having estimated in the complex the received data, the skilled expert can draw a conclusion about the existence of the disease. The diagnosis of this disease is complex.

Diagnostic measures include a number of laboratory and instrumental studies:

  • ultrasound diagnostics.

  • Cardiography( ECG).

  • Assays.

US

An ultrasound examination( also known as ECHO) of the heart allows you to assess the condition of the heart valves, as well as the ability to reduce. As rheumatism develops, changes in the activity of the heart grow. Thanks to echocardiography it is possible to identify defects at early stages and take the necessary actions in time.

Cardiography( ECG)

The study allows you to clarify the degree of supply of cardiac muscle nutrition. ECG reveals the slightest violations of cardiac activity and displays them graphically using a special sensor. It is most effective to conduct a number of cardiographic studies for several days, because rheumatism is a constant violation and the best changes in the work of the heart are visible in dynamics.

Assays

For the diagnosis of rheumatism, venous blood is collected. The doctor should look after the doctor as follows:

  • Leukocytosis. Increased white blood cell count.

  • Protein disorders of blood composition.

  • Detection of antibodies to streptococci.

  • Detection of antibodies to streptococcal enzyme substances( ASL-O)

  • Detection of a specific C-reactive protein.

  • Reduction of hemoglobin.

  • Increased ESR.

Also, a physician at a primary examination can detect symptoms of polyarthritis( enlargement and swelling of the joints, redness, joints hot to the touch).In a complex, these diagnostic manipulations allow the diagnosis of rheumatism with high accuracy.

For the diagnosis, it is important that one of the following symptom complexes occur:

  • Cardiac dysfunction( carditis) and discharge of antibodies against streptococcus from the blood.

  • Heart failure and the presence of two laboratory indicators indicating rheumatism.

  • Dysfunction of the heart and brightly expressed external manifestations( puffiness of the joints, etc.).

  • Two specific signs in the history( inflammation of the joints, cardiac dysfunction, minor chorea, skin rashes, rheumatic nodes) and one nonspecific( cardiac rhythm disturbances, hyperthermia, changes in laboratory analyzes according to the type mentioned above, etc.).

  • One specific feature and three nonspecific.


Forms of rheumatism and its classification

Forms of rheumatism and its classification

The main classification adopted by rheumatologists includes two types of rheumatism.

Acute rheumatism

Rheumatism in the acute phase is most often manifested in young people up to 20 years of age. The causative agent is streptococcus. Conjugacy of the disease from a previous infection of the upper respiratory tract is a delayed manifestation of symptoms( 14-21 days).

Acute rheumatism develops rapidly. First symptoms of general intoxication appear, as with colds, which does not allow to immediately determine the disease, then after a day or two specific symptoms appear( polyarthritis, carditis, skin rashes and very rarely nodules).The acute phase lasts, on average, up to 3 months. Perhaps a longer period( up to six months).The most dangerous in acute rheumatism is heart damage( carditis), becausein 1/4 of all cases it promotes the formation of heart disease.

Chronic rheumatism

The chronic form is characterized by a frequent recurrent course, even with therapy. Exacerbations occur at any time of the year. Especially often in cold seasons( autumn, winter).The same effect is experienced by patients living in damp or cold apartments. Exacerbations - several times a year. Most patients( about 85%) are under 40 years of age.

Joints and heart are affected. The course of the disease is severe and significantly reduces the standard of living. The patient experiences constant pain in the joints and heart. After the acute phase( relapse) is over, a lingering course can last several months, and even for years.

Classification of rheumatism

Rheumatism is divided into forms by the criterion of the affected system or organ:

  • Cardiac form of rheumatism. Otherwise - rheumatic carditis. In this case, the muscular structure of the heart is affected. May disturb the patient with severe pain, but can barely manifest. But destructive processes will still go. In the first stages, the course is almost invisible and is only detected with the help of an ECG.In the late stages of formation, severe heart damage and acute heart failure occur against a background of decreased nutrition of the muscles of the organ and, as a consequence, a decline in contractility. It is manifested by heart rhythm disturbances( tachycardia) and is detected by means of ultrasound( ECHO).

  • Articular form of rheumatism. May exist as an independent clinical manifestation of rheumatism or in combination with heart damage. In this form of the disease, large joints suffer. At a later stage, small joints are involved in the process. When rheumatism, under the influence of antibodies of lymphocytes and enzymes of streptococcus, the articular bag and cartilage itself is destroyed. Therefore, the diagnosis of problems is not: the joint looks very swollen and red. The patient can not move the affected limbs, as severe pains occur. For the acute phase, the course of the articular form is characterized by an increase in body temperature to 38-39 degrees.

  • The defeat of the nervous system. The neurological form is less common. With this form of the disease, the neuronal cells of the cerebral cortex, responsible for motor activity, are affected. Their involuntary stimulation with active substances leads to the fact that the patient has spontaneous uncontrolled muscular movements. It is manifested by uncontrolled limb movements and grimaces. The form is extremely unpleasant, because it complicates the social life of a person and prevents self-service in everyday life. Symptoms last from 2 to 4 weeks. In a dream manifestations are absent.

  • Pulmonary form. Is manifested in a complex with joint and heart damage, but is very rare( about 1-3% of the total number of clinical cases).It develops in the form of pleurisy or bronchitis.

  • Skin. manifests itself as skin rashes, or rheumatic nodules. It occurs in no more than 5% of cases.

  • Ophthalmic form. Diagnosed only in conjunction with the "classic" symptoms of rheumatism. It consists in retinal damage( retinitis), or other structures of the eye( irit, iridocyclitis, etc.).May cause complete or partial loss of vision.


Complications of rheumatism

Complications of rheumatic fever include:

  • Chronic recurrent course. The disease can go to a chronic form.

  • Development of heart defects. The formation of defects is found in 25% of cases of the acute phase of the pathology. The vice affects the basic muscular structures of the heart and leads to a decrease in the quality of the organ's work.

  • Chronic heart failure. The heart, being stricken with rheumatism, ceases to cope with its functions. There may be diffuse changes, a decrease in cardiac contractility and rhythm disturbances.

  • Thromboembolic and ischemic disorders. As a result, foci of ruptures or blockages( strokes) of blood vessels, including the retina of the eye, renal arteries, etc., may occur.

  • Inflammation of the heart. is infectious in nature and can pose a direct danger to the patient's life.


How to treat rheumatism? Drugs from rheumatism

Bicillin

Bicillin

Rheumatism is a pathology of mixed, immune-bacteriological nature. Therefore, it is complicated in the treatment and is not completely cured. Since the primary source of the disease is the streptococcal bacterium( and the immune response is secondary and responds to the "attack" of the alien organism), the main task of the treatment is to eliminate the bacteria and promptly remove the products of their vital activity and decay.

The main( and basic) drug for fighting the pathogen is bicillin( it is an antibiotic of the penicillin series, it has a longer action than regular penicillin).

The first( active) phase of antibiotic therapy lasts from 10 to 14 days. Studies show that a shorter period is not advisable, since the infection persists, and the larger one is ineffective, as streptococcus begins to produce substances that destroy the antibiotic and is detrimental to the patient.

The second( passive) phase begins next. Three weeks after the end of the reception of bicillin, the patient intramuscularly injected the drug bicillin. Such treatment should last for 5-6 years( 1 injection every 3 weeks) to reduce the likelihood of recurrence and prevent possible complications in the heart.

Why is it important to take antibiotics? Elena Malysheva will tell:

Aspirin

The medical practice has been well proven by the preparation of acetylsalicylic acid. Taking aspirin has many contraindications( the period of fetal and lactation, fragility of the vessels with digestive organs, etc.), but its administration has a significant therapeutic effect in the joint and neurological forms of the disease. Aspirin relieves pain and reduces inflammation in the joints. The first two weeks are taken in the maximum permissible doses.

After the main period of therapy, taken for another 30 days at a dosage of 2 g / day.

Hormonal preparations

In the treatment of severe rheumatism, prednisolone is used in the maximum permissible dosage.

General recommendations

If the disease proceeds easily, a semi-post regimen for up to 10 days is prescribed. If there is a severe course, it is necessary to exclude any motor activity, because it aggravates the course of the process. Bed rest is prescribed for up to a month.

To evaluate the effectiveness of treatment resort to laboratory analysis. As soon as the indices approach the normal values, bed rest can be disregarded. If the disease is difficult, with severe cardiac arrhythmias, joint pain, hospital treatment is needed, which lasts up to two months.


Disability in rheumatism

Disability in rheumatism

A single list of diseases, in which the patient will be guaranteed a degree of disability is not.

The medical commissions establish a disability group based on three main criteria:

  • ability to self-service;

  • general health and quality of life;

  • work capacity and employment opportunities.

Depending on the severity of the course of the disease, the ability to self-service, as well as independent movement, can drop dramatically. Many labor factors can exacerbate patients, for example, work associated with physical exertion or high activity. The quality of life is determined by the frequency of relapses and the severity of their course.

Based on these criteria, medical commissions appoint patients to either a third or a second disability group. There are rare cases of appointment of the first group.

III group is appointed if the pronounced functional impairments are absent, the patient is able to service himself, and manifestations of relapses occur no more than 3 times a year. Limitations of work capacity in this case are minimal and concern only physical loads and immobilization during periods of exacerbations.

Group II may be prescribed if the patient has clear manifestations of rheumatism. Exacerbations are frequent( more than 3 times a year), the ability to self-service is reduced during periods of exacerbations. Employment is permissible at places where regular physical activity is not required and there is no dampness and cold.

I group is assigned in case of severe functional impairment. Exacerbations are frequent and long-lasting. Even during periods of remission, symptoms persist and manifest in the form of pain in the joints and heart. The ability to work is severely impaired, periods of inability to work are from 3 months to 6 months.


Prevention of rheumatism

Prevention of an initial streptococcal infection is the only possible measure of prevention of rheumatic fever. If you start treatment with penicillin in time, the probability of developing the disease is minimized.

Preventative measures reduce the likelihood of the disease:

  • Increased immunity. The main cause of rheumatic fever is the penetration of streptococcal infection with blood flow to organs and systems. Most often, the cause of unimpeded infection is reduced immunity, which is not able to suppress the pathogen in time.

  • For the purposes of strengthening the immune system requires a proper vitaminized diet and proper rest.

  • Avoid contact with streptococcus. The rules of personal hygiene should be observed and, if possible, try to infect diseases less often. Also it is necessary to exclude contact with people who have been infected with streptococcal infection.

  • At the first manifestations of catarrhal disease it is important to start treatment in time. The formation of rheumatism is facilitated not only by repeated contact with the bacterium pathogen, but also for a long period without treatment. At the first symptoms of a cold you need to urgently go to the doctor. Especially this recommendation concerns persons with confirmed streptococcal lesions or who have already had the disease before.

  • If there was a contact with an infected streptococcus, a set of preventive therapeutic measures is carried out. Among them - reception of bicillin in an adequate dosage( 1.5 million units once, intramuscularly).

Thus, rheumatic fever is complex, both in terms of etiology, and in terms of symptoms. The disease is not well understood, so there are difficulties with diagnosing and setting the right diagnosis, and it is not completely cured.

However, modern methods of treatment can eliminate negative manifestations of pathology, minimize the danger to life and harmful effects, as well as ensure a high quality of life for patients with rheumatism.

Author of the article: Muravitsky Igor Valerevich, rheumatologist, especially for the site ayzdorov.ru

ayzdorov.ru

Risk factors for rheumatism

  • Female sex;
  • Blood relationship with people on the first line, who have rheumatism or any systemic connective tissue diseases;
  • Age from seven to fifteen years;
  • Frequent infectious diseases of the nasopharynx( sore throats, pharyngitis);
  • Overcooling, physical exhaustion, for example, severe emotional stress, eating disorders.

Symptoms of

Heart attack in rheumatism

Symptoms of the disease usually appear after the transferred angina. After a while, patients feel worse. This is the so-called rheumatoid attack after angina. The main features are as follows:

  • Joint pain, general weakness;
  • A sudden temperature jump is possible. Although sometimes the disease develops secretly( subfebrile temperature, moderate weakness).
  • Disturb severe pain in the joints, there is a swelling. Most joints are large and medium. The skin over the joint becomes hot to the touch, acquires a strained look. The defeat of the joints is symmetrical. Inflammatory process for a few hours can immobilize the patient, deprive him of sleep, disrupt his general condition. After two or three weeks, the symptoms of the disease subside;
  • There is a combination of arthritis and rheumatic heart disease( endocarditis, myocarditis, endomyocarditis).With damage to the heart muscle, patients can complain of heart pain, dyspnea, malaise. Such symptoms indicate the occurrence of rheumatic heart disease. It is necessary to know that rheumatism leads to severe heart defects. These vices cause heart failure;
  • Appearance on the skin of a reddish rash, which is called annular erythema. Elements of the rash merge into rings, figures. The rash disappears in a few weeks;
  • There may be subcutaneous nodules. Usually, they are discovered by a doctor when the patient is examined. They are of dense consistency and painful on palpation. After a certain time( up to several weeks), the subcutaneous nodules pass by themselves.

Complications of rheumatism

Joint damage in rheumatism

Rheumatism belongs to a group of chronic diseases and can be exacerbated periodically. The joints can "feel" the weather, can ache a bit after physical overwork.

The most dangerous complications of rheumatism after a recent angina are lesions of the kidneys and heart defects. If as a result of the disease inflammation develops in the valve with the formation of edema, then the blood flow is disturbed. The result is heart disease. Patients with symptoms of acute heart failure( weakness, dyspnea, pain in the heart) are observed.

With the defeat of the central nervous system, the development of rheumatic chorea is possible. This disease, which affects the nerve trunks. Accompanying chorea with a periodic loss of consciousness. Observations of visual impairment and limited mobility of the joints. Characterized by chorea and emotional instability, spontaneous jerking of the facial muscles and extremities.

The timing of the development of symptoms of complications depends on the pathogen and on the immunity of the patient. If immunity is strong, complications may not appear.

Diagnosis

There are a number of clinical signs that help to recognize this disease. To conduct diagnostics of rheumatism, laboratory tests also help. In the general analysis of blood neutrophilic leukocytosis is observed. Sometimes eosinophilia may appear. With the active process, the ESR is accelerated( fifty to sixty mm hour).The amount of hemoglobin decreases. There are changes in protein fractions( C-reactive protein appears, the content of serumucoid and fibrinogen increases).

The ECG shows a decrease in voltage, extrasystole, conduction disturbance. Radiography of the chest will help determine the size of the heart, which can be increased with rheumatism.

Treatment of rheumatism and rheumatoid arthritis

Hip arthritis in the rheumatoid process

Obligatory bed rest or hospitalization, comfortable position of the affected joints, careful care for the patient( fighting sweating with rheumatism).The patient should wear comfortable, light underwear, which must be changed more often. It is necessary to avoid hypothermia, to eliminate drafts.

A daily diet should have enough protein. You should include a variety of fruits and vegetables. It is necessary to ensure the intake of a sufficient amount of vitamin C and potassium.

The attending physician will prescribe the necessary medical treatment for rheumatism. If there are foci of infection( sinusitis, angina ), antibiotic therapy is applied throughout the course of treatment. Penicillin or bicillin is administered intramuscularly. For two to four months, anti-inflammatory drugs( sodium salicylate, acetylsalicylic acid) are used. With intolerance to salicylates( vomiting, dizziness, nausea), amidopyrine is possible. Taking these drugs will help relieve joint pain and relieve swelling.

First aid for joint pains are non-steroidal anti-inflammatory drugs( diclofenac, indomethacin, piroxicam).These drugs can alleviate the condition of the patient, but only with their help to cure rheumatoid arthritis can not. Their long-term use can cause side effects, which can provoke the development of gastritis or stomach ulcers.

Good applications with dimexid on the most painful joints. After six to seven days, there are improvements in 80% of patients. Intra-articular administration of corticosteroids( hydrocortisone, flosteron) is widely used. The pain is removed quickly. But do not get carried away by injecting hormones, because they can adversely affect the body.

As for exercise therapy, it is impossible during the active phase of the disease to buy the simulator http: //price.ua/ catalog4826.html and independently engage in it. Therapeutic physical training is allowed only under the supervision of a sports doctor and then, not in all cases.

Physiotherapy treatment is successfully used. It should be remembered that only complex treatment, taking into account the peculiarities of the health status of each patient, will give the most favorable result. The final choice of the curative program should be made by the attending physician, who will take into account the indications and contraindications in the appointment of therapy.

Prevention

Monitor the immune system and in time treat diseases of the upper respiratory tract. Timely treat chronic diseases of the throat, chronic tonsillitis and sinuses of the nose. Avoid hypothermia. More often, sore throat and rheumatism suffer from weakened people, unoccupied. Therefore, your body must adapt to the change of heat and cold without harm to health. To do this, perform hardening procedures. Strengthen your body.

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Angina and rheumatism - Complications after sore throat

Author: Candidate of Medical Sciences G.E. Perchikova

Many people may have a puzzled question: what do two seemingly different diseases like anginaand rheumatism?

Almost everyone has ever had a sore throat, or at least watched it with their loved ones, but rarely does anyone know how insidious this disease is at times and what serious consequences may occur in people who have had a sore throat. But its complications are extremely diverse: an infection nesting in the tonsils can lead to kidney and other organs. But one of the most frequent and most serious complications is rheumatism.

To imagine how a connection is made between two seemingly completely different diseases, such as angina and rheumatism, you should learn more about what constitutes the first of them, angina.

What is angina

In the mouth on either side of the soft palate are palatine tonsils. They got their name from the form, since they remind almonds. The tonsils are covered with a pink mucosa, their surface is uneven, with a multitude of small holes leading into the cracks, or interlobar spaces of the gland, called lacunas. It is here, in these holes, and various microbes enter the oral cavity, most of them streptococci and staphylococci.

For the development of angina, that is, the emergence of an acute inflammatory process in the tonsils, not enough presence and penetration of microbes into them. Streptococci always inhabit the body, in particular the mouth, throat, nasopharynx. And in healthy people on the mucous membrane of the tonsils, streptococcus and other pathogens can be detected.

But in the human body there are a number of protective devices regulated by a normally functioning central and autonomic nervous system, organs of internal secretion, which prevent the development of the disease. Only under the influence of unfavorable circumstances, for example, as a result of severe overwork, emotional upheavals, weakening of the body due to previous illnesses, and finally, after the hypothermia of the throat, legs, hands or the whole body, the resistance of the organism is sharply reduced, its "protective forces" are weakened. Can begin a sore throat.

The malaise, as a rule, arises sharply, suddenly: there are pains at swallowing, felt more with one or at once from both parties.

The tonsils, the soft palate and the posterior wall of the pharynx are swollen and red. The doctor diagnoses: biliary angina .

If on the enlarged red tonsils are visible, in addition, whitish-yellow abscesses of no more than millet grain, covering like holes on the mucosa, then the angina is called the follicular .

There is another kind of inflammation of the tonsils - the so-called lacunar angina .With her tonsils covered with large, purulent deposits, associated with the necrotic surface of the mucous membrane. Significantly less common are phlegmonous , pleated and ulcerative inflammation.

So, we described the local manifestation of the disease - the defeat of the tonsils. But angina is a disease of the whole body: a person experiences frustration, weakness, an ache in the whole body. Usually the body temperature immediately increases, which can reach up to 40 degrees. The rise in temperature can be preceded by a strong chill. The lymph nodes under the lower jaw and on the neck are enlarged and painful. By itself, angina, that is, inflammatory phenomena in the throat and malaise, is short-lived. If the disease proceeds easily, it detaches from work for 5-8 days.

But it's bad when the tonsillitis begins to recur frequently and leaves behind a chronic inflammation of the palatine tonsils, the so-called chronic tonsillitis .Such patients often have pain when swallowing, the temperature rises slightly - to 37.1 - 37.5 degrees, the malaise becomes permanent, the ability to work decreases, bad breath appears.

Each of the forms of angina listed by us can end safely and each of them - acute and chronic - can cause serious complications.

Among these complications, special attention should be paid to rheumatism.

Angina - after which, 12-14 days after the disappearance of all signs of the disease rheumatism develops , it differs little from the usual, non-rheumatic angina.

What is rheumatism

Rheumatism - the disease is very serious and often leads people to disability, shortens life. Therefore, it is necessary to fight it in time and seriously.

What is dangerous for this disease?

Rheumatism not only affects the joints, as scientists thought before the publication in the first half of the XIX century of the outstanding works of the French doctor I. Buyo and the Russian physician G. Sokolsky. It turned out that rheumatism is a disease of the entire body, which affects primarily such an important organ as the heart, and then other internal organs and joints.

There are many different theories about the origin of rheumatism. The greatest number of supporters has an infectious-allergic theory. How does this theory explain the occurrence of rheumatism? To a person fell ill with rheumatism, her supporters say, a combination of two causes is necessary: ​​penetration of microbes into the body, that is, infection, and a special state of increased reactivity of the organism, its allergic reaction. It is suggested that rheumatism is provoked by streptococcus. The microbe itself does not cause rheumatism, but it prepares the soil: after penetrating into the human body, streptococcus creates an increased sensitivity to the repeated penetration of microbes or their poisons.

Thus, after the tonsillitis or exacerbation of chronic tonsillitis, microbial toxins enter the blood and lymphatic vessels - toxins, the products of the decay of cells from the affected tonsils, the products of the decay of dead microbes.

These substances act on all organs and tissues of the body, including the cardiovascular and nervous system. Human defense forces are so restructured that extraordinary reactions occur in the body - the state of allergy: the patient becomes very sensitive to streptococcus, and repeated ingestion of it leads to rheumatism.

But often this condition is not enough to start the disease. The last push can serve as a great fatigue, nervous shock, and more often cooling, cold.

In recent years, a new theory of rheumatism - the theory of "autoaggression".And in it great importance is given to the infectious focus, from which the blood receives streptococci, the products of their decay and vital activity. Influencing the tissues of various organs, they change them so much that they transform into something alien to the body - autoantigens. The organism responds to the appearance of autoantigens by the formation of antibodies. As a result of the binding of autoantigens with antibodies, cells of various organs and tissues are damaged - their inflammation occurs. With the attenuation of the main infectious focus, the formation of autoantigens and antibodies is declining.

What happens with rheumatism?

In connective tissue, which is widespread throughout the body, changes in structure, qualitative and quantitative reactions occur, then a special kind of cell accumulation, the so-called rheumatic nodules, or granulomas. These nodules can be found in the tonsils, in the muscle and valves of the heart, lungs, kidneys and other organs. The cardiovascular system is the arena on which the most severe reactions are played out.

In rheumatism, an inflammatory process can develop in all three layers of the heart: the outer membrane - the pericardium, the middle muscular - the myocardium, the inner - the endocardium. Such a disease is called rheumatic carditis.

As a result, heart valves change, deform, valvular heart defects are formed, resulting in impaired blood circulation.

Sometimes rheumatic carditis is combined, for example, with inflammation of the joints, but it can also proceed independently.

The patient complains of malaise, weakness, fever, shortness of breath, unpleasant sensations in the heart, palpitations with any change in body position and even at rest. But often there is a latent form of endocarditis: the patient does not complain about anything and leads a habitual way of life, and rheumatism is recognized only when a completely formed heart defect is found.

If, in addition to the heart, joints are involved in the process, the disease develops often as acute infectious, with high fever, chills, severe headache, general malaise. In joints appear inflammatory phenomena of a volatile nature: they pass from one joint to another. Joints swell, skin over them blushes, hot to the touch, movements are sharply painful. This state lasts several weeks, then the temperature gradually decreases, the swelling and pain disappear, the movements are completely restored. Rheumatism, as a rule, does not change the shape of the joints, in the worst case, in some patients there are small pains that intensify in bad weather.

Rheumatic skin lesions in the form of various rashes and nodules, rheumatic pneumonia, pleura, and kidneys do not leave serious consequences.

But back to valvular heart disease. A characteristic feature of rheumatism is its tendency to repeat, to new attacks( relapses).Each such recurrence of the disease worsens the heart condition, favors the formation of new valvular defects and the development of sclerotic changes in the heart muscle. In the end, this leads to a violation of blood circulation, to persistent decompensation with shortness of breath, edema, unpleasant sensations in the heart.

New attacks of rheumatic fever occur, usually after repeated angina or exacerbation of chronic tonsillitis .Therefore, the prevention of rheumatism primarily involves fighting with tonsillitis and chronic tonsillitis.

If rheumatism can occur after repeated and even after the first ever sore throat, then we must protect ourselves from this disease in every possible way. Angina is an acute disease .It is especially important to protect children from it, as they are more susceptible than adults, and people suffering from chronic tonsillitis.

A patient with a sore throat should be isolated from others if possible;The room in which it is located, regularly ventilate, wipe the dust with a damp cloth. Dishes from which he eats, do not give to others and wash necessarily with hot water.

Despite the subjectively good condition, a patient with angina should follow all the doctor's instructions and, if necessary, lie in bed.

You can go to work only after the normal temperature is established, the inflammation of the tonsils will disappear and a normal blood test will be obtained. The latter is especially important, since prolonged angina, accompanied by an acceleration of the reaction of erythrocyte sedimentation in the blood - ROE, indicates that the process of angina has been delayed and, if the regime is violated, may result in rheumatic fever.

What can I do to avoid sore throat?

First of all, it is timely to treat or remove the sick teeth, because they accumulate different microbes that lead to the disease.

Great value for warning angina has free-breathing nose. Air, passing through the nose, is released from dust and partly from microbes, and also becomes warmer. If the patient breathes his mouth, he can rather cool the tonsils, more swallows the microbes. The cause of obstruction of nasal breathing can be diseases of the adnexal cavities of the nose( sinusitis, frontalitis), adenoids. They need to be treated in a timely manner by specialists in diseases of the ear, throat, nose.

To repeated angina often leads to chronic inflammation of the tonsils;it must be actively treated. To this end, doctors conduct repeated courses of treatment for patients. In some cases, the tonsils are exposed to X-rays or ultraviolet rays. But if all this does not lead to the desired results, then they resort to the prompt removal of tonsils - tonsillectomy.

Surgery for tonsillectomy

This simple operation is performed in special otolaryngological hospitals, not earlier than a month after the angina.

After the operation, angina ceases, an unpleasant sensation in the throat disappears. True, the removal of tonsils does not exclude the possibility of recurrence of attacks of rheumatic fever, but this possibility becomes much less. Individual stability of the organism develops throughout the life under the influence of environmental conditions. And we can influence the conditions of life.

It should be stressed that people with sore throats and rheumatism often suffer from pampered, untrained, poorly hardened;Those who very easily catch cold with rapid changes in their surrounding temperature. Therefore, it is necessary to systematically temper the body, to teach it to adapt to the change of cold and heat without harm to health, carry a strong wind, cold water. This is facilitated by special hardening procedures. But you can start them when the person feels well, and not during illness and not right after it. It is best to consult your doctor beforehand.

Given that rheumatism often begins at preschool and school age, it is necessary to pay special attention to the correct physical education of children. Tempering a child can begin with an infant: to accustom it to air baths, then to various water procedures. Both children and adults, of course, are useful in physical culture and sports.

Water procedures should be performed daily. Only systematic hardening can lead to correct and rapid reactions of blood vessels, as a result of which the body's ability to adapt to changes in the environment develops.

Swimming, exercise, walking, not only strengthen the nervous system, but also increase the body's defenses.

And how much the correct mode of work and life means: active rest on non-working days, maximum stay on fresh air, regular, regular, vitamin-rich food, separate food, a moderate diet for rheumatic people prone to rheumatism! All these measures, such simple and accessible, as well as constant observation of the doctor, not only at the time of exacerbation, but also during the latent period of the disease, are very effective in preventing the occurrence and recurrence of angina and rheumatism .

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