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Acute rheumatic fever (FRA) - an inflammatory disease of the connective tissue that affects the heart, joints, skin and even the nervous system. It usually occurs in genetically predisposed people, a few weeks after diseases, such as sore throat Caused by the special strains of streptococci .
Typically, the disease is called rheumatism But today, under rheumatism understand a condition in which there are symptoms such as rheumatic fever and chronic rheumatic heart disease . Previously it was thought that rheumatism affects the joints However, modern research has proven that this damage short and does not have special effects. However, the disease causes heart disease Generally disrupting its valves. The initial stage of the disease often asymptomatic and usually detected during routine inspection of suspected Arrhythmia or heart failure .
Acute rheumatic fever has long been a major cause of heart defects, but thanks to the use of antibiotics in streptococcal infections, the number of patients has decreased significantly.
In Russia, the incidence of acute rheumatic fever is 0, 05%, and it usually begins in adolescence (16 years). Women suffer three times more often than men.
Symptoms of acute rheumatic fever
The first symptoms appear after 2-2 ARF, 5 weeks after undergoing the disease, usually after sore throat or pyoderma . The man is getting worse overall health, body temperature can rise to 38-40 degrees, joints ache and swell, redden skin. Palpation painful as the movement of the joint. Usually affects the large joints of the body (knee and elbow), rarely - joints of the hands and feet. Joint inflammation is usually observed at the same time on two legs.
Pain while migrating, i.e. it can be moved from one joint to another. It displays Arthritis Which lasts no more than 10 days. After a while the symptoms of arthritis disappear more often in children and adults sometimes can develop into arthritis syndrome Jakko Characterized by bone deformities of hands without dysfunction of joints. As a result of repeated attacks, arthritis affects more of the joints becomes chronic.
Along with the symptoms of arthritis and developing rheumatic heart disease (heart disease). Sometimes the symptoms are not observed, but more often arrhythmia, breathlessness , Aching pain in the heart and edema. Even in mild rheumatic heart disease affected heart valves, they shrivel and lose their elasticity. This leads to the fact that they are either fully open or not properly interlock and formed valvular .
Typically, rheumatic heart disease occurs at a young age from 15 to 25 years, and rheumatic heart disease suffer as a result of almost 25% of cases, especially in the absence of adequate treatment. Incidentally, the proportion of ARF accounts for about 80% of acquired heart disease.
Many observed monosemeiotic for ARF, with a predominance of symptoms Arthritis or rheumatic heart disease .
The skin symptoms of acute rheumatic fever manifested in the form of ring-shaped rash ( erythema ) And subcutaneous rheumatic nodules. These nodules are usually the size of a grain, and is periarticular tissues . They are absolutely painless, the skin does not change. Rheumatic nodules often over bony prominences are formed in the joints. There are only children. Annular erythema - A disease which is a common symptom is the appearance of pink spots on the body of a diameter of about 5 centimeters. They spontaneously appear and disappear, and are located on the chest, back and the inside of the legs.
Rheumatism of the nervous system caused by rheumatic fever, occurs most often in children under the age of small, whereby the child is placed moody, he gets tired quickly, change handwriting, gait. Chorea often observed in girls after 1, 5-2 months after the streptococcal infection. Chorea It is an involuntary jerking of the limbs and muscles that disappear during sleep.
Adolescents who have had a sore throat, acute rheumatic fever often begins gradually, the temperature rises to subfebrile , Concerned about pain in the large joints, and mild symptoms carditis . Recurrences of ARF associated with streptococcal infections, and is usually manifested as rheumatic heart disease.
The cause of acute rheumatic fever is beta-hemolytic streptococcus Group A, which affects weakened body. It was after a person has been ill sore throat . scarlet fever or tonsillitis Caused by streptococcus, it begins ARF. Please note that acute rheumatic fever - a disease of infectious nature, as streptococcus not affect the joints. Just as a result of infection interferes with the normal operation of the immune system. Research has shown that some proteins of Streptococcus have many proteins similar to the joints, causing immunity, "responding" in Streptococcal challenge starts attacking its own tissues, the inflammation.
Great chance to get acute rheumatic fever in those whose relatives are suffering from rheumatism. Disease susceptible children from 7 to 16 years, adults get sick less often. In addition, the chance of infection by streptococcus increases in poor living conditions, insufficient nutrition and regular malnutrition.
Diagnosis of acute rheumatic fever
Diagnosis of rheumatic fever is carried rheumatologist, and is based on an analysis of the overall picture of the disease. It is important to establish the fact of a streptococcal infection at least a week before the joint damage. Usually, the diagnosis " acute rheumatic fever "Not difficult if there are joint and cardiac symptoms.
Appointed general clinical and immunological analysis of blood. Laboratory tests also help to correctly establish the diagnosis. In patients observed in the development of rheumatism leukocytosis and increased erythrocyte sedimentation rate (above 40 mm / h), and persists for a long time. The urine is sometimes observed microhematuria . In analyzing crop production from the throat and tonsils detect β-hemolytic streptococcus. Can carried out biopsy joint and Arthroscopy . Ultrasound examination of the heart and ECG are suitable for detection of heart defects.
Treatment of acute rheumatic fever
The first symptoms of acute rheumatic fever require compliance with bed rest and the use of drugs to help cope with the symptoms and prevent relapse. Diet for acute rheumatic fever - a low-salt and high - vitamins and minerals. The diet is necessary to enrich the fruit and vegetables, eggs, chicken, buckwheat, fish, dried apricots, as well as foods rich in vitamin C (citrus fruits, peppers, rose hips) vitamins B1 . AT 6 . R and RR That accelerate the metabolic processes in the body.
To eliminate the causes of the disease - streptococcus organism used antibiotics series penicillins ( Amoxicillin ) Or macrolides ( roxithromycin . clarithromycin ). After completing the course of treatment to take antibiotics prolonged action.
In addition, to reduce the appearance of inflammation of the joints help anti-inflammatory drugs (e.g. Ibuprofen and diclofenac ), Who are appointed by the attending physician. When fluid retention can be assigned to diuretics ( Furosemide ). Sometimes it may be assigned and drugs that stimulate the immune response of the organism, such as gamma globulin and others.
When manifestations of rheumatic heart disease take drugs to stimulate cardiac activity, for example, digoxin .
Sometimes using a regimen: administered prednisolone Gradually decreasing doses (starting with 20-25 mg per day), and acetylsalicylic acid at a dose of 4 g per day.
Formed defects treated with antiarrhythmic drugs, nitrates and diuretics. The duration and characteristics of treatment depend on the severity of defect, presence of heart failure, etc. When diagnosis of acute rheumatic fever shows the presence of severe heart disease, there is usually the need for surgery on the heart valves, or plastic prosthetic valve.
Along with medical drugs treatment of acute rheumatic fever includes physiotherapy, for example, infrared radiation and heating of the UHF lamps. On the affected joints is useful to apply the mud and paraffin baths, taking oxygen and radon baths. After the treatment you need to take a course of massage therapy and regularly engage in recreational gymnastics.
Prevention of acute rheumatic fever
Prevention of rheumatic fever is timely and correct treatment of various streptococcal infections ( sore throat . pharyngitis . skin infections ) By prescribing antibiotics. Usually, treatment continues for at least one and a half weeks. For treatment tonsillitis Caused by a streptococcal infection, used Biseptol . ofloxacin .
Prevention of acute rheumatic fever after infectious diseases includes a number of remedial measures. First of all antibiotics are prescribed long-acting, bitsillinoprofilaktika ( ekstentsillin and retarpen ) For a period of approximately 5 years. More than 5 years of treatment continues for those who suffered rheumatic heart disease.
Observe the correct order of the day, eat regular meals, exercise, quit smoking and alcohol consumption, to temper the organism, to walk in the fresh air. Do not forget that disease-causing organisms, especially streptococci, quite a lot in the environment they are in dust and dirty things, so it is often necessary to carry out wet cleaning, ventilate the room. Also, do not leave not cured carious teeth . tonsillitis . genyantritis and sinusitis .
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