Signs of rheumatism in children

Rheumatism in children

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, carrying out a chest X-ray 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 carditis is carried out 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 a cerebral syndrome in a child requires the involvement of a neurologist and the exclusion of neurosis, Tourette's syndrome, brain tumors, etc.

The 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 the quinoline series( plakvenil, delagil) are included in the 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 observation of the child by specialists( a pediatric 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 rheumatic fever 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.ru

Rheumatism in children

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, synovial joints of the joints, 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 to attribute rheumatism in children to an infectious-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 the connective tissue.

An important role in the development of rheumatism in children is given 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), causing pyrogenic, cytotoxic and immune reactions that cause damage to the heart muscle with the development of endomyocarditis, contractility and myocardial conduction.

In addition, 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, 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, and in this connection, 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 clearly expressed;
  • 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. A sharply positive CRP, a high serum globulin level, a significant increase in anti-streptococcal antibody titres, etc.

The inactive phase of rheumatic fever in children is noted during the interictal period and is characterized by the 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 heart disease) 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 10-12 months later 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 aorta, mitral valve prolapse, mitral-aortic defect.

In 40-60% of children with rheumatism, polyarthritis develops, both in isolation and in combination with rheumatic heart disease. 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 rheumatic fever in children

Rheumatism in a child may be suspected by a pediatrician or a pediatric 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 rheumatic fever 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 carditis is carried out 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 a 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 in 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.

At 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 are carried out. 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 rheumatic fever 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.ru

Rheumatism in children - Childhood illnesses - Great medical encyclopedia

What is rheumatism in children?

Rheumatism in children is a disease accompanied by fever and inflammation of the joints( polyarthritis).Less common are other forms of rheumatism: central nervous system damage( small chorea), inflammation of the heart( carditis) - inflammation of the outer shell is called pericarditis, myocarditis of the heart muscle, endocarditis of the inner shell. Sometimes under the skin in the connective tissue are formed nodules( erythema nodosum) and( or) pale pink eruptions( annular erythema).In children under the age of 1 year, rheumatic fever is rare, it is more common in school-age children.

Symptoms of rheumatism in children

  • General symptoms: High temperature, general weakness, subcutaneous nodules, short-term rashes on the skin.
  • Polyarthritis: joint pain, swelling.
  • Chorea: sudden involuntary movements, contraction of facial muscles( grimaces).
  • Carditis: chest pain, palpitations.

Causes of rheumatism in children

The development of the disease is associated with streptococcal infection. Usually rheumatism in children is preceded by angina, acute respiratory diseases. In the event that a person has defects in the immune system, rheumatism can become a consequence of these diseases.

Treatment of rheumatism in children

Usually rheumatic disease is treatable. Antibiotics are prescribed to kill streptococcal infection. Further treatment depends on the nature of the disease. Usually prescribed antipyretic and anti-inflammatory drugs, as well as painkillers. With inflammation of the heart( cardiovascular), salicylic preparations are used, with a serious course of the disease - glucocorticoid drugs( for example, prednisolone).Small chorea is accompanied by chaotic uncoordinated limb movements, so sedative medications and bed rest are prescribed. With a small chorea characterized by a sharp change of mood, impulsivity, violation of concentration, fast fatigue.

Inflamed joints are very sensitive to cold, so the baby should be warmly dressed. And even after recovery, it is necessary that the joints are not subjected to hypothermia.

Usually the first signs of rheumatic fever in children appear two to three weeks after an infectious disease. When there is high fever, weakness, joint pain, you should consult a doctor.

The doctor will establish an accurate diagnosis and prescribe to comply with bed rest. Assign medications that will remove signs of inflammation.

The course of the disease

The course of the disease depends on the form of rheumatism.

Migrating polyarthritis

After 1-3 weeks after the infection, the child suddenly has a fever, joint pains appear. At what painful sensations can sharply appear and as sharply to disappear or move. Joints blush, swell, painful on palpation and movements. Usually the ankle, elbow and knee joints are affected. Migrating polyarthritis - the disease is curable, usually lasts for two weeks.

Small chorea

Small chorea( dances of St. Witt) begins imperceptibly. The first signs of chorea can appear six months after the infectious disease, so the causes of the disease are difficult to establish. The disease is characterized by the sudden appearance of violent chaotic movements of the limbs and other muscles of the body. The acute phase lasts from several weeks to several months and, as a rule, culminates in complete recovery.

Carditis

With inflammatory heart damage, for example, with endocarditis, there is a risk of damage to the heart valves. Often with carditis there is no heart pain, but a doctor can establish a diagnosis when listening to heart sounds.

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doktorland.ru

Rheumatism in children - symptoms, treatment, prevention

Many parents are familiar with the situation when a child complains that his legs hurt, and at the same time looks tired and broken. Usually, adults write off this condition for excessive activity of the baby during the day. However, if this situation is repeated quite often, one should take a closer look at the child's health: the described manifestations may indicate the development of such a serious disease as rheumatism.

Rheumatism in children occurs frequently. And infants do not get sick for a year, but babies from 1 to 5 years old are already susceptible to this pathology. The peak incidence of childhood rheumatism falls on the age of 10-15 years. It should be understood that rheumatism is a serious illness, which in the absence of timely and competent treatment can lead to serious complications( heart failure, heart defects, etc.).Consider the causes, signs, as well as methods of treating rheumatism in children.

Causes of rheumatism

Rheumatism is an infectious-allergic disease in which a systemic lesion of connective tissue occurs. The versatility of the symptoms of this disease is due to the fact that the pathological process develops directly in the connective tissue, and it is present throughout the human body.

Rheumatism in children in most cases occurs after a streptococcal infectious disease that has not been treated with antibacterial drugs. The causative agent - hemolytic streptococcus - is the cause of acute respiratory disease, tonsillitis and scarlet fever. However, for the development of rheumatism, the mere presence of a causative agent in the child's body is not enough. The disease occurs only in those who have recovered from infants who have failed in the functioning of the immune system. As a result of this disorder, antibodies are developed that attack their own cells of connective tissue, which leads to its damage.

The following diseases and conditions are called the factors that provoke the development of rheumatism in children:

  • Chronic foci of infection in the body, in particular sinusitis, tonsillitis, otitis, caries;
  • Subcooling;
  • Unbalanced diet, in which the child does not receive the required amount of proteins and vitamins;
  • Hereditary predisposition;
  • Congenital infection with streptococcus.

Symptoms of rheumatism in children

The manifestations of rheumatism in children depend on its phase and form. The inactive phase of the disease is characterized by the absence of signs. The baby feels normal, only after a physically active or emotionally charged day, he can complain of fatigue, pain in the legs or arms.

Symptoms of the disease in the active phase differ depending on its shape: articular, cardiac or nervous.

With articular form, a frequent symptom of rheumatic fever in children is severe pain in swollen joints as the body temperature rises. As a result, there are difficulties in moving. Primarily, large joints are affected, in particular the ankle, knee, elbow, wrist, shoulder. Sometimes this form of rheumatism is not so acute: the temperature and swelling are absent, and the child complains of pain in one or in the other joint.

Cardiac form of the disease can begin acutely( high body temperature, deterioration of well-being) or develop gradually. The kid quickly becomes tired, he has weakness, and with the slightest physical exertion, the pulse and heart rate increase. In the case of severe heart damage, a child may experience pericarditis( inflammation of the pericardium of the heart).

In the nervous form of rheumatism, children experience involuntary twitching of the muscles of the legs, hands, eyes and face, which resemble grimacing. Such movements increase when the child is in an excited state. Sick children become irritable and whiny;schoolchildren usually suffer from poor handwriting.

Rheumatic pneumonia, nephritis, hepatitis, skin lesions( rheumatic nodules) etc. are more rare symptoms of rheumatism in children, etc.

Treatment of rheumatism

Treatment of rheumatism in children should be carried out in three stages: inpatient, sanitary and dispensary.

Inpatient treatment usually lasts 1.5 months and the first 1-2 weeks requires strict bed rest. Complex therapy consists of medical treatment, physiotherapy and physiotherapy. As drugs, antibiotics, NSAIDs, antihistamines and immunosuppressive agents are usually prescribed. If necessary, the doctor can appoint a small patient heart and diuretics, as well as other medications.

Sanitary treatment of rheumatism in children fixes the results of the above therapy. At this stage, special attention is paid to physiotherapy, curative gymnastics, vitamin therapy and nutrition.

The purpose of dispensary observation of children is the timely detection of activation of rheumatism and its prevention.

Prevention of rheumatism in children

Specialists distinguish primary and secondary prevention of rheumatic fever in children. The primary is to prevent a child from developing this disease. The main thing is to timely treat infectious diseases of streptococcal origin not only in the baby, but also among all family members. It is important not to allow the development of chronic foci of infection in the body, especially in the nasopharynx and oral cavity. Actual is also the tempering of a child from an early age, the correct regime of the day and a balanced diet.

Secondary prevention of rheumatic fever in children is necessary in order to avoid the transition of the disease to the active phase. It is extremely necessary if the child has had a cardiac form of the disease. In this case, after the termination of therapy for three years, the baby is prescribed a drug Bitsillin-5 and vitamin complexes.

Rheumatism in children refers to severe diseases, which are dangerous by various complications. However, parents should not panic if their child is found out this disease. Timely diagnosis and the correct implementation of all the recommendations of the doctor will be the key to the rapid recovery of the child.

Text: Galina Goncharuk

lady7.net

Rheumatism in children symptoms and treatment |How to treat rheumatism

Rheumatism( rheumatismus) or Sokolsky-Buoyu's disease of children is a systemic inflammatory disease of the connective tissue with a predominant cardiovascular lesion etiologically associated with the P-hemolytic group A 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:

Each 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-type preparations( delagil, plakvinil) at 5-10 mg / kg per day is shown.

An extract from the hospital is made after 11/2 ~ 2 months, provided that the well-being is improved, the positive dynamics of the pathological process is clearly visible and its activity is reduced.

Aftercare and rehabilitation of patients( stage 2) are performed at the 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 performed by a district( city) rheumatologist who regularly examines every child suffering from rheumatism in order to identify signs of disease activation and performs a 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 work, 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).
2.

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 marked, 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 reduction of the quadriceps muscle when causing the knee reflex).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 nervous system 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 rheumatic fever in children

Most often( 80%) rheumatism 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 trait 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 degree of activity of rheumatism

Clinical and anatomical characteristics of lesions

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Rheumatism in children - how to treat rheumatism in children |Therweitis. Ru

admin About the disease Rheumatism in children is a systemic inflammatory disease of connective tissue due to the accumulation of uric acid salts in the blood. The disease most often occurs in children aged 7 to 15 years. Very rarely, children under the age of 3 and children over 40-45 years old become ill. It was established that the onset of the disease or its recurrence is preceded by angina, pharyngitis, rhinitis or scarlet fever, streptococci. The cause may be hereditary predisposition, although the disease itself is not inherited. 23-08-2013 Print version

General information

Rheumatism in children is a systemic inflammatory disease of connective tissue due to the accumulation of uric acid salts in the blood. The disease most often occurs in children aged 7 to 15 years. Very rarely, children under the age of 3 fall ill and people older than 40 -45 years. It was established that the onset of the disease or its recurrence is preceded by angina, pharyngitis, rhinitis or scarlet fever, streptococci. The cause may be hereditary predisposition, although the disease itself is not inherited. In children, rheumatism has a significant tendency to acute, severe, flow. As a rule, the cardiovascular system is affected, and with each attack its damage is intensified. Treatment of rheumatism in children is carried out in a hospital, its duration is 45-60 days. The patient is provided with a treatment regimen depending on the activity of the pathological process and the intensity of heart changes. Food should be age appropriate.

Signs of rheumatism in children

All children who have suffered rheumatism, with the occurrence of acute respiratory viral infection, angina, sinusitis within 10 days, prescribe antibiotics and anti-inflammatory drugs. Rheumatism in children also affects the joints. The disease begins and age 2-4 years, sometimes in the first year of life. There are feverish condition, intoxication, swelling and tenderness of the joints, at first large( knee, elbow, ankle, hip).Then the neck part of the spine, wrist, jaw, and finger joints suffer. The defeat is symmetrical. The shape of the joints changes. They sometimes show a small amount of liquid. Children complain of soreness in the joints during movement, especially when extending. With repeated attacks, these complaints are more pronounced.

After the development of joint damage, it is possible to note atrophy and hypotension of muscles. Simultaneously there are multiple muscle contractures. In advanced cases of rheumatism in children, bone tissue also changes. On the roentgenogram - signs of increased bone formation from the periosteum and at the same time its resorption. The periosteum that grows in the joint region, the granulation tissue leads to a change in the cartilage, which is the cause of deformation of the joints and the surfaces of the bones. At the place of granulation, fibro-scar tissue forms, which leads to subluxation and dislocation.

Following the defeat of the joints in children, an increase in lymph nodes develops, which reach a maximum value within a few days. With the reverse development of the process in the joints, they decrease. Nodes are slightly painful, dense, not soldered to the skin, do not get stuck. The temperature curve is typically wavy in typical cases. The liver is enlarged by 2-3 cm, sometimes the spleen is enlarged. In the study of heart function, the tendency to tachycardia, myocardial dystrophy, is determined. In the blood - anemia, increased ESR, first leukocytosis, then leukopenia.

Treatment of rheumatism in children

Treatment is carried out in a hospital with strict adherence to strict bed rest in the acute period, with the necessary care for the child. In the acute stage, antibiotic use is possible individually according to the indications. Non-steroidal anti-inflammatory drugs( acetylsalicylic acid, butadione, amidopyrine), antihistamines are used. Glucocorticoids are used in short courses for 1-2 weeks, prednisolone is more often used.

In children of school age, in the course of a severe course of the disease, indomethacin, brufen, immunosuppressants, deligil, and chloroquine are also used in a combination of therapy or if glucosorticoid cancellation is necessary. In a complex of therapy use nonspecific stimulating agents - vitamins, physiotherapy, aloe, transfusions of blood plasma. From the beginning of recovery, therapeutic massage and gymnastics are used.

In the period of remission, sanatorium treatment is provided. Surgical correction is possible( consultation of orthopedic surgeon).The prognosis with active complex treatment is relatively favorable, but in the case of disease progression - serious. Polyarthritis is often combined with rheumatic heart disease. In the treatment of rheumatoid polyarthritis, children also benefit from traditional medicine.

Medical treatment of rheumatism in children: one of antirheumatic drugs - amidopyrine or analgin according to 0.15-0.2 g per year of life( no more than 2-2.5 grams / day);Acetylsalicylic acid - 0.2-0.25 grams / day per year of life. In recent years, more and more drugs are used such as methindol( indomethacin) and voltaren at a dose of 1-3 mg /( kg per day) alone or in combination with hormonal drugs. In a hospital, a sick child undergoes a course of treatment on average for 1.5-2 months, and then for 2, 3 months for stage treatment is sent to a sanatorium. After the sanatorium the child comes under the supervision of a pediatrician-cardiologist. The prognosis remains serious with modern methods of treatment, since even after the first attack, heart disease is formed in 10-15% of children.

Methods of treatment of rheumatism in children

Recipe 1 .Lay out on the linen sheet the young leaves of the birch, then lay it on the baby and swaddle, leaving only the heart region untouched. It is best to do this during a daytime sleep for 1.5-2 hours. Term of treatment is up to 2 weeks. One of the best means for treating rheumatism in children.

Recipe 2 .Fresh wormwood wormwood spread out in layers on a dense linen sheet, then roll it with this grass into a roll. Two people stand at the edges of the sheets and squeeze it out, like squeezing normally washed laundry. As a result, the sheet will become green from the wormwood juice. To wrap the child in this sheet for 1.5-2 hours.

Recipe 3 .If the baby complains of pain in the joints, you should make him a mattress from May hay. Sewing an ordinary bag of any suitable material, stuff it with hay and put it in a baby cot. If the child has hay fever, the May hay should be replaced with oat straw in green.

Recipe 4 .Smear all the child's body( except the heart area) with turpentine ointment, wrap a linen sheet, cover with a warm blanket and hold it for 15 minutes. If he is worried, the procedure can be shortened to 5 minutes. Turpentine ointment should be prepared as follows: 5 parts of unsalted porcine interior fat should be thoroughly mixed with 1 part of purified turpentine turpentine. Previously, this ointment should parents experience on themselves.

Recipe 5 .For the treatment of rheumatism in children mix 100 grams of swine-soaked interior fat with the contents of three jars of Vietnamese balm Golden Star, lubricate the baby with this ointment, bypassing the heart area, and wrap the baby with a soft sheet.

Recipe 6 .Bathe the child in an alkaline bath. To prepare it you need to collect clean wood ash, fill with water, boil, defend for the night or day. Pour into a bath, diluted with water. In the bath the patient should sit 10-15 minutes at a water temperature of 30-32 ° C and water should reach him to the stomach area. Alkaline baths should be used only on the advice of a doctor or specialist.

Recipe 7 .Collect the earthworms, wash them and put them in a glass jar, tie them with paper and put them on the sun for a few days. When worms dissolve, this solution spreads painful joints - there are not only pains, but also tumors.

Recipe 8 .To eat during illness it is possible milk in all kinds - fresh and sour, raw vegetables and fresh berries. Tomatoes and cranberries are very useful. It is necessary to warmly dress and drink more liquid to cause the separation of sweat and urine.

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