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Acute rheumatic fever (rheumatism)
The Acute Rheumatic Fever (ARF) is an inflammatory disease of connecting fabrics which affects heart, joints, skin and even a nervous system. It is usually observed at genetically predisposed people, in several weeks after the postponed illness, for example quinsy caused by a special strain of streptococci.
Usually this disease is called rheumatism, however today understand a state at which symptoms of both rheumatic fever, and a chronic rheumatic heart trouble are observed as rheumatism. Earlier was considered that rheumatism affects joints, however modern researches proved that this damage quickly and has no special effects. However the disease causes heart disease, usually breaking operation of its valves. At the same time the initial stage of an illness proceeds asymptomatically more often, and comes to light usually at routine inspection at suspicion on arrhythmias or heart failure.
Acute rheumatic fever a long time was a basic reason of heart diseases, but thanks to antibiotics at a streptococcal infection, the number of patients considerably decreased.
In Russia prevalence of acute rheumatic fever makes 0,05%, and usually it begins at teenage age (till 16 flyings). Women are ill three times more often than men.
Symptoms of acute rheumatic fever
The first symptoms of ORL appear in 2-2,5 weeks after the postponed illness, usually after quinsy or a pyoderma. At the person overall health worsens, body temperature can increase to 38-40 degrees, joints hurt and napukhat, integuments redden. The palpation is painful, as well as the movement by joints. Usually large joints of an organism are surprised (knee and elbow), it is rare — joints of brushes and feet. The inflammation of joints is usually observed at the same time on two extremities.
Pain at the same time migrating that is can move from one joints in others. It displays of arthritis which lasts no more than 10 days. After a while symptoms of arthritis disappear, is more often at children, and at adults arthritis can sometimes develop into the syndrome to Zhakk which is characterized by deformation of bones of hands without disturbance of functions of joints. As a result of repeated attacks, arthritis affects the bigger number of joints, passing into a chronic form.
Along with symptoms of arthritis also the rheumatic carditis (damage of heart) develops. Sometimes symptoms are not observed, but more often there is arrhythmia, short wind, the aching heartaches and hypostases. Even at an easy current of a rheumatic carditis heart valves are mentioned, they shrivel and lose the elasticity. It leads to the fact that they either do not open completely or are leaky closed, and valve defect forms.
Usually the rheumatic carditis is observed at young age from 15 to 25 years, and rheumatic heart disease nearly 25% of the diseased, especially in the absence of adequate treatment as a result have. By the way, about 80% of the acquired heart diseases fall to the share of ORL.
At many the monosimptomny current of ORL, with dominance of symptomatology of arthritis or a rheumatic carditis is observed.
On skin symptoms of acute rheumatic fever are shown in the form of ring-shaped rashes (erythema) and hypodermic rheumatic small knots. These small knots usually have the kernel size, and are located in periartikulyarny fabrics. They are absolutely painless, integuments are not changed. Rheumatic small knots are often formed over bone ledges in joints. They occur only at children. The ring-shaped erythema is a disease which characteristic symptom is emergence on a body of pink spots with a diameter about 5 centimeters. They spontaneously arise and disappear, and are localized on a breast, a back and an internal surface of extremities.
The rheumatic damage to a nervous system caused by ORL most often is observed at children at small age therefore the child is put whimsical, it quickly gets tired, changes handwriting, gait. The hysterical chorea is often observed at girls in 1,5-2 months after a streptococcal infection. The chorea represents involuntary twitchings of extremities and muscles which disappear during a dream.
At the teenagers who had quinsy, often acute rheumatic fever begins gradually, temperature rises to subfebrile, large joint pains and moderate signs of a carditis disturb. Recurrence of ORL is connected with postponed streptococcal infections, and is usually shown as a rheumatic carditis.
The beta and hemolitic streptococcus of group A which strikes the weakened organism is an origin of acute rheumatic fever. How the person had quinsy, the scarlet fever or tonsillitis caused by streptococci it begins ORL. Pay attention that acute rheumatic fever is a disease of the noninfectious nature since streptococci do not affect joints. Just as a result of infection normal work of immune system is broken. Researches prove that some proteins of a streptococcus have a lot of similar to proteins of joints therefore immunity, "answering" a streptococcal call, begins to attack own fabrics, the inflammation develops.
The chance to get acute rheumatic fever at those whose relatives have rheumatism is big. Children from 7 to 16 years are subject to a disease, adults are ill much less often. Besides, the chance of infection with a streptococcus increases in bad living conditions, at a hyponutrient and regular malnutrition.
Diagnosis of acute rheumatic fever
Diagnosis of rheumatic fever is carried out by the rheumatologist, and is based on the analysis of an overall picture of a disease. It is important to determine correctly the fact of a streptococcal infection at least one week prior to damage of joints. Usually it is not difficult to make the diagnosis "acute rheumatic fever" if joint and cordial symptoms are observed.
Are appointed the general clinical and immunoassay of blood. Laboratory analyses also help to establish the diagnosis correctly. At patients on rheumatism development of a neutrophylic leukocytosis and increase in a blood sedimentation rate (higher than 40 mm/h) is observed, and remains for a long time. In urine the microhematuria sometimes is found. In the analysis of serial crops from a pharynx and from almonds find a β-hemolitic streptococcus. The biopsy of a joint and an arthroscopy can be carried out. Ultrasonic research of heart and an electrocardiography are reasonable for detection of heart diseases.
Treatment of acute rheumatic fever
The first symptoms of acute rheumatic fever demand observance of a bed rest, and use of medicines which will help to cope with symptoms and to prevent recurrence of a disease. A diet at acute rheumatic fever — with the low content of salt and high — vitamins and minerals. The diet needs to be enriched with fruit and vegetables, eggs, chicken meat, buckwheat, fish, dried apricots, and also the products rich with vitamin C (a citrus, sweet pepper, a dogrose), B1, B6, P and PP vitamins which promote acceleration of metabolic processes in an organism.
For elimination of a cause of illness — a streptococcus microorganism, antibiotics of a number of penicillin are used (amoxicillin) or macroleads (roksitromitsin, klaritromitsin). After end of a course of treatment antibiotics of long action are accepted.
Besides, antiinflammatory drugs (for example, an ibuprofen and diclofenac) who are appointed the attending physician help to reduce manifestations of an inflammation of joints. At a liquid delay in an organism diuretic drugs (furosemide) can be appointed. Also the drugs stimulating an immune response of an organism such as gamma-globulin and others can sometimes be appointed.
At manifestations of a rheumatic carditis accept drugs for stimulation of cordial activity, for example, digoxin.
The created defects are treated by antiarrhytmic drugs, nitrates and diuretic. Duration and features of treatment depend on expressiveness of defect, existence of heart failure, etc. In a case when diagnosis of acute rheumatic fever shows existence of heavy heart disease, usually there is a need of operation on heart valves, plastics or prosthetics of the valve.
Along with medicamentous drugs treatment of acute rheumatic fever includes also physiotherapeutic procedures, for example, the infrared radiation and warming up by UVCh-lamps. On the affected joints it is useful to impose mud and paraffin applications, to take oxygen and radonic baths. After the end of treatment it is necessary to take a course of medical massage and to regularly do fitness training.
Prevention of acute rheumatic fever
The prevention of development of ORL consists in timely and correct treatment of various streptococcal infections (quinsy, pharyngitis, a skin infection) by prescription of antibiotics. Usually treatment continues not less than one and a half weeks. For treatment of the tonsillitis caused by a streptococcal infection Biseptolum, ofloxacin are used.
Prevention of acute rheumatic fever after the postponed infectious diseases includes a number of medical actions. First of all appoint antibiotics of the prolonged action, a bitsillinoprofilaktik (ekstentsillin and retarpen), for the term of about 5 years. More than 5 years treatment continues for those who transferred a rheumatic carditis.
It is necessary to observe the correct daily routine, to regularly eat, play sports, to refuse smoking and alcohol intake, to temper an organism, to walk in the fresh air. Do not forget that pathogens, and especially streptococci, there is a lot of in environment, they is in dust and dirty things therefore it is necessary to carry out often wet cleaning, to air the room. And also should cured carious teeth, tonsillitis, antritis and sinusitis.