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Friday, March 18, 2011

Rheumatism. Disease, fallen in childhood

"I suffer from rheumatism!" - often heard from our grandparents. In fact, they suffer the consequences - echoes of rheumatism in the form of heart defects, when it reduced pump function, which leads to heart failure: the stagnation of blood in internal organs, edema, shortness of breath. The very same rheumatism - that neither is childhood disease. Affects her mostly children and mostly girls from 5 to 15 years.

Rheumatic fever or rheumatic fever, as it is called in English literaterute - systemic inflammatory diseases of the connective tissue with predominant localization process in the cardiovascular system which develops due to an acute streptococcal infection in nasopharyngeal predisposition of persons, mainly in voraste 7 - 15.
The main danger of rheumatism - his vices, and, above all, heart. Rheumatic fever "licks the joints and bites the heart" - the doctors say rheumatologist. Back in the late 19 th century, they noticed that very young patients who complained of pain in the joints, a few years later acquired the proc heart. In those years, reliable methods to combat dangerous disease did not exist. Often, rheumatism, affecting not only the heart but also kronosnye vessels simulated myocardial infarction, and 25-20-year-old men umrah from a heart attack. A heart defect in 10 to 15 years was not considered something extraordinary.
Today rheumatism successfully treated, but patients with heart disease does not become smaller. Unfortunately, the reason why children become chronically ill, often cut out of their parents. Often the "advanced" in issues of healthy lifestyle mom and dad do not hasten formation of schatsya a doctor trying to treat the child's "natural remedies" or irresponsible waiting "itself all pass." In both cases, time-model can be irretrievably lost.What begins rheumatism
As a rule, that the body gets strep. Inflamed tonsils, and the child becomes ill with angina. Organism, trying to "burn" the infection responds the temperature rises. But if the majority of children the inflammatory process remains within the normal range, the body reacts to certain patients with strep too sharply. Because the shell contains a special protein of streptococcus - the M-protein, similar in structure to the structure of the heart tissues and human joints. And instead of destroying intruders is beginning to struggle with their own tissues.
The human body, often a child produces special protective antibodies directed not only at the strep, but also on the inner shell of the heart - endocardium, which forms the heart valves. There is an inflammation of the endocardium - the development of endocarditis, heart defect, with girls more often affected the mitral valve, and the boys - the aortic valve. If the body produces antibodies to the structures of the joints - arthritis begins.
Both clinically and proceeds of rheumatic fever - with weakness, fever, sweating. Endocarditis gives heartbeat, disruptions of the heart, muffled heart sounds, ECG changes. Rheumatoid arthritis is characterized by the "multiplicity and fragility of joint damage, rapid transitions from one joint to another", wrote the great Russian doctor C. Botkin. Predominantly affects the large and medium-sized joints, complete regression of inflammatory changes in the joints occurs in 2-3 weeks under the influence of anti-inflammatory therapy, this period is shortened to several hours or days. There are rheumatic lesions of the nervous system in the form of jerks - hyperkinesis, muscle weakness - hypotension (up to the muscle weakness with simulated paralysis), violations of traffic and neurotic disorders. There are skin changes as a ring- erythema and rheumatic nodules.
Given the infectious cause of disease, it is easy to understand why it is the children suffering from rheumatism. Up to 5 years old child's immune system has not been formed and can not give excessive defensiveness. And after 15, the first rheumatic fever can not begin because by this time everyone is faced with strep, which literally hovers around us. By adolescence we are all safely transferred or sore throat, rheumatic fever or are sick. And when a woman says that he first became ill in 30 years, so children of rheumatic fever gone unnoticed ...There are diagnostic criteria for rheumatism Kisel - Jones (WHO, 1992)More criteria

* Cardio.
* Migratory polyarthritis.
* Chorea (chorea).
* Annular erythema.
* Subcutaneous rheumatic nodules.
Minor criteria

* Clinical: pain in the joints, fever.
* Laboratory: Elevated acute phase reactants: ESR, C-reactive protein, lengthening PR interval on an electrocardiogram.
Confirmation of previous A streptococcal infections:

* Positive A streptococcal cultures isolated from the pharynx, or positive rapid determination of the A strep antigen.
* Elevated or rising streptococcal antibody titers.
When the alert?
The sooner the better. Not for nothing among rheumatologists have a saying that "to better treat rheumatism today than tomorrow and in the morning than the evening, and better at 8 am than at 9. Just in time reduce inflammation save the heart from the formation of the defect.
Usually the child tonsillitis tonsils - acute tonsillitis - lasts 7-10 days. If a timely appeal for help, an audiologist appoints course penitsilinosoderzhaschih drugs - antibiotics. Drink their takes 10 days, as adopted by the international medical standards. And are not limited to 2-3-days, as is often afraid to come "chemistry" parents. The danger is that even if the treatment has been carried out and rheumatism began to form, the child is at first glance seems quite sane. Doctors call this stage "lucid intervals of time." Lasts somewhere in 3-4 weeks, after which the body begins to defeat its own tissues - the heart and joints. By this time, grab his head and stuff the child with antibiotics too late - the streptococcus in the body no longer exists, and antibiotics are useless.Or may not be
Need not guess and do not argue that there are good and bad doctors, and urgently appeal to the district hospital. Believe me, by the Russian medicine is not the worst thing in the world, and by many measures adopted by the World Health Organization - cart - still the best in the world. Any audiologist, physician, any physician general prac-tics is well aware of that sore throat can lead to rheumatic fever. And so after the disease, he must hold a general examination of the body, to determine whether the child is not complaining of weakness, sweating, or shortness of breath, the disruptions of the heart or a pain in the joints. All these symptoms closely indicate that the body is the formation of a minor patient's defect. Additionally, studies of blood, electrocardiogram, ultrasound of the heart (echocardiography) and X-rays confirm that the heart is changed and the patient must be urgently treated.Treatment? It exists!
Most often acute rheumatic fever, rheumatic fever as it is called in English-speaking countries, lasts 4 - 6 months. It was during this period of acute illness respond well to treatment anti-inflammatory drugs. They are appointed by the doctor, guided by the severity of the disease. It may be non-steroidal anti-inflammatory drugs, and others. They reduce and sometimes completely remove the inflammatory response, without giving form heart disease. If rheumatism overly aggressive and the doctors they see a real danger of vice, the patient may be given steroid drugs - hormones, usually prednisone. Well as curative measures necessary to maintain diseased heart: bed rest, vitamins, heart medications.The best treatment - prevention
Responsibility for it lies entirely on the conscience of their parents. Especially important to follow the child if the family has someone suffering from rheumatism. But afraid of "bad" genes should not be - not inherited by the disease itself, but only a predisposition - the probability of its occurrence.
Often, rheumatism develops in areas with large concentrations of children and youth. This children's and sports camps, military training, army ... There often get young people with various strains of streptococcus and the most aggressive forms able to hit people who are prone to rheumatism.
Preventive measures should be carried out in two directions. Primary prevention, when rheumatism yet - it is a struggle with the basis for all ills - angina. And that means, it is necessary to teach a child to a healthy lifestyle: proper, full mode, nutrition, tempering, and sports.
Secondary prevention, when rheumatic fever was already in the child and it is clear that he can make heart disease - is in the application bitsillina Research Institute, from which the streptococci are killed and can not always make him protection. He was appointed after the deferred angina body reacted by rheumatic fever and carditis formation - the defeat of the various membranes of the heart (which, fortunately, does not always leads to heart defects).
There are several regimens bitsillina. Usually the drug is pricked by intramuscular injection once every 3-4 weeks over several years. If you are a heart defect has already been formed or held arthroplasty (replacement heart valves for artificial) bitsillin appointed for life. Doctors believe rheumatism chronic disease. If the body is prone to overreaction, rheumatic fever can recur, and therefore can not throw yourself reception bitsillina.
Unfortunately, to train a heart anymore. Struck by a heart defect similar to a broken engine - eventually it harder to cope with their problems. So a person with heart disease should be constantly observed by a doctor.
It would seem, from the mid 20 th century, due to the widespread use of antibiotics, the disease began to decline. But from time to time in the world there are flashes of rheumatism, and in countries with the highest health-sets and standard of living. The last of these was observed in the United States and Britain in the mid-80's.
The main causes of outbreaks of rheumatic fever in the United States in 1985-1987. were:

* The weakening of alertness of physicians in the ratio of ARF.
* Lack of knowledge of clinical ARF.
* Incomplete examination and treatment of patients with strep tonzillofaringitom.
* Changes in the virulence of Streptococcus ("revmatogenny" streptococcus).
It was found that streptococcus is capable of mutation, and therefore mortal danger remains.

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