Rheumatism (acute rheumatic fever) - symptoms and treatment

So-called rheumatism or acute rheumatic fever (according to new terminology) is a systemic inflammatory disease of connective tissue, in which the pathological process has a tropism towards the membranes of the heart and joints.

Even at the beginning of the 20th century, the concept of “rheumatism” meant almost any disease of the joints - doctors did not have the need or opportunity to differentiate these ailments, especially since the range of healing procedures was not diverse. Today, a rheumatologist has a wide range of diagnostic methods in his arsenal, allowing him to distinguish rheumatism from many other rheumatological diseases, each of which has its own treatment strategy.

Rheumatism is a disease predominantly of children aged 6 to 15 years, and only 1 child in 1000 suffers in this age group.

Primary rheumatism in adult patients is observed less frequently. According to statistics, women are 2-3 times more likely to suffer from this disease than men.

Rheumatism usually begins some time after a streptococcal infection of the nasopharynx, and after a few years it can turn into a chronic, incurable disease. Fortunately, only 1-3% of patients who have an infection become victims of rheumatic fever.

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Consultation with a rheumatologist

2 Consultation with a rheumatologist

3 Consultation with a rheumatologist

Causes of rheumatism

Why do some people get rheumatism, while others under the same conditions do not? People who often suffer from ENT diseases are more likely to get rheumatism. Those at risk are those whose relatives have this disease and those who have the B-cell marker D8/17 in their blood.

So, the risk factors:

• streptococcal infection (angina, scarlet fever, pharyngitis);
• defects of the immune system, the presence of autoimmunity;
• genetic predisposition to the disease.

How to treat?

Since the disease is systemic in nature, treatment of rheumatism is carried out under the strict supervision of medical specialists. As a rule, complex therapy is used, the main goals of which are to suppress infection, stop the inflammatory process and prevent or treat cardiovascular pathologies. The therapy consists of three stages.

1. Hospital treatment. It includes drug therapy - taking non-steroidal anti-inflammatory drugs, antibiotic therapy, and other prescriptions depending on the symptoms. If necessary, to eliminate the source of chronic infection, tonsils can be removed, but not earlier than 2-3 months after the onset of the disease. In addition, the patient is prescribed nutritional therapy and exercise therapy. Special diets for rheumatism involve split meals (at least 5-6 meals a day), a high protein content and a minimum of carbohydrates, fresh and processed vegetables. Protein foods are mainly fish, eggs and dairy products.
2. Cardio-rheumatic sanatorium. The therapy started in the hospital continues, dosed physical activity, walks, hardening and restorative physical procedures, and dietary nutrition are added to it.
3. Dispensary observation. At this stage, the goal of treatment efforts is preventive measures to prevent relapses and stop the process.

Timely detection and adequate therapy, as a rule, lead to complete recovery of patients.

Clinical picture of rheumatism

The trigger for the development of rheumatism is the entry of streptococcus into the body, as a result of which the immune system begins to produce antibodies to fight the infection. However, in the body itself, namely in connective tissues and heart muscle, there are molecules of the same structure. Due to the presence of this factor, the immune system begins to “fight” its cells. As a result, connective tissue is damaged, and this is fraught with heart defects and joint deformation.

Forms of rheumatism

• cardiac form (cardiac rheumatism), when all the membranes of the heart are affected (pancarditis), myocardium (myocarditis), endocardium (endocarditis);
• articular form (rheumatism of the joints);
• cutaneous form;
• pulmonary form (pleurisy);
• rheumatic chorea (St. Vitus' dance).

How to recognize the disease

The external signs of rheumatism are varied, and the course of the disease can be acute, subacute, protracted or recurrent. Symptoms depend on the nature of the process and which organs are affected by inflammation. A typical clinical picture appears in the second or third week after a streptococcal infection. The patient's temperature rises, weakness, increased sweating, and headaches develop. At an early stage, arthralgia is possible - painful sensations in large or medium-sized joints. They are present in almost all patients.

After two to three weeks, to the listed symptoms of rheumatism, signs indicating damage to the heart tissue are added. Various manifestations in the form of pain localized in the heart area, rapid heartbeat, and shortness of breath are recorded in 70-80% of patients. The disease affects all the membranes of the heart or some of them. Most often, the inflammatory process involves the tissues of the myocardium and endocardium, less often with the involvement of the pericardium.

Almost all patients experience asthenic syndrome, including fatigue, lethargy, and a feeling of malaise.

In approximately 10% of patients in the most acute phase of the disease, an annular rash appears on the skin - ring-shaped pink rashes that do not protrude above the surface. Very rarely, the inflammatory process affects other organs - lungs, kidneys, liver, etc. This mainly happens in the most severe form of the disease.

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Symptoms of rheumatism

Rheumatism has a wide variety of manifestations: damage to the heart, joints, nervous and respiratory systems. 2-3 weeks after contracting a sore throat or pharyngitis, the first signs of rheumatism appear: fever, weakness, fatigue, headache. In some people, acute rheumatism begins 1-2 days after hypothermia, even without connection with infection.

Rheumatism of the heart

Already at the beginning of the disease, pain in the heart begins, increased heartbeat, shortness of breath even at rest.

Rheumatic arthritis

With articular rheumatism of the legs and arms, pain appears in the knee, elbow, wrist, and shoulder joints. The joints swell, active movements in them are limited. As a rule, after taking non-steroidal anti-inflammatory drugs, pain from rheumatism quickly disappears.

Skin rheumatism

With cutaneous rheumatism, vascular permeability increases. Therefore, skin rashes appear on the lower extremities.

Rheumatic pleurisy

A fairly rare manifestation of the disease. Main symptoms: body temperature remains above 38 degrees, severe pain in the chest, dry cough, shortness of breath, pleural noise can be heard on auscultation. More often the disease is limited to a fairly mild form of pleurisy.

1 ECG

2 Echocardiography with Doppler analysis

3 X-ray examination

Rheumatic manifestations of damage to the nervous system

Sometimes rheumatism can provoke damage to the meninges, subcortex and medulla. One of the manifestations of the disease is the dance of St. Vitus. With this complication, convulsive, involuntary contraction of the muscles of the face, torso of the arms and legs occurs. With a sharp contraction of the glottis, suffocation can occur, which is very dangerous for human life.

Abdominal syndrome

This type of complication is typical for children and adolescents. Accompanied by elevated body temperature, nausea, vomiting, and abdominal pain in the form of contractions.

Rheumatism should not be left to chance or treated by relying on the advice of friends and relatives, even those familiar with this disease. Loss of time leads to progression of the disease and dangerous complications in rheumatism. There is a threat of developing atrial fibrillation and myocardiosclerosis. Possible damage to the lungs and kidneys. And the most dangerous thing is thromboembolism (blockage of the pulmonary artery by a blood clot), which can suddenly end the patient’s life.

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Rheumatism is a disease that develops unnoticed and gradually. It occurs after a streptococcal infection and consists of inflammation of the connective tissue, which is found in all organs and systems of the body. The heart, blood vessels and joints are primarily involved.

In modern medical literature, this term has been replaced by the generally accepted throughout the world “ acute rheumatic fever ”, which is due to the contradictory understanding of the term “rheumatism” in Russia.

Causes

The disease is triggered by special bacteria - group A beta-hemolytic streptococci. Once inside our body, they can cause tonsillitis (tonsillitis), pharyngitis, and lymphadenitis. However, rheumatism can be a consequence of this infection only if the person has certain defects in the immune system. According to statistics, only 0.3-3% of people who have had an acute streptococcal infection develop rheumatism.

Etiology . Infection with β-hemolytic streptococcus of group A. The presence of foci of infection in the nasopharynx (angina, chronic pharyngitis, chronic tonsillitis). Scarlet fever. Genetic predisposition.

Risk factors for developing rheumatism:

• the presence of rheumatism or systemic connective tissue diseases in first-degree relatives (mother, father, brothers, sisters);
• female;
• age 7 - 15 years;
• previous acute streptococcal infection and frequent nasopharyngeal infections;
• content in the body of a special protein - B-cell marker D8/17

What's happening?

When streptococcus enters the body, the human immune system begins to fight it by producing specific antibodies. They “recognize” streptococcus by special molecules on its surface. However, the connective tissue and heart muscle of people predisposed to rheumatism contain molecules that are similar in structure. And antibodies attack the tissues of their own body. This leads to the development of an inflammatory process in the connective tissue, mainly in the heart and joints. In this case, the tissue can become deformed - this is how heart defects and joint curvatures occur.

How does it manifest itself? Typically, the first signs of rheumatism appear two to three weeks after a sore throat or pharyngitis. The person begins to experience general weakness and pain in the joints, and the temperature may rise sharply. Sometimes the disease develops very secretly: the temperature is low (about 37.0), weakness is moderate, the heart and joints work as if nothing had happened. Usually a person begins to worry only after he develops serious joint problems - arthritis.

Most often, the disease affects large and medium joints: pain appears in the knees, elbows, wrists and feet. Painful sensations can appear suddenly and disappear just as quickly, even without treatment. But make no mistake, rheumatoid arthritis has not gone away.

Another important sign of rheumatism is heart problems: irregular pulse rates (too fast or too slow), irregular heart rhythms, heart pain. A person is worried about shortness of breath, weakness, sweating. This is associated with the development of inflammation of the heart - rheumatic carditis. In 25% of cases, rheumatic carditis leads to the formation of heart disease.

After the first rheumatic attack, repeated ones with similar manifestations may occur months or years later. They can also lead to joint deformities and heart defects.

If the nervous system is affected by rheumatism, the patient experiences involuntary movements of various muscles (face, neck, limbs, torso). This is manifested by grimaces, pretentious movements, impaired handwriting, slurred speech and is called minor chorea (the old name is the dance of St. Vitus). This disorder occurs in 12-17% of patients with rheumatism, more often in girls 6-15 years old.

Pathogenesis Pathogenesis is associated with two factors: Toxic effects of a number of streptococcal enzymes that have a cardiotoxic effect. The presence of some strains of streptococcus in common antigenic substances with cardiac tissue.

Diagnosis Only a rheumatologist . To avoid mistakes, he must conduct a comprehensive examination.

First, order a general clinical blood test in order to identify signs of inflammation.

Secondly, conduct an immunological blood test to identify specific substances characteristic of rheumatism. These substances appear in the blood no earlier than a week after the onset of the disease and reach a maximum by 3-6 weeks.

To clarify the extent of heart damage, electrocardiography (ECG) and echocardiography of the heart are necessary. An x-ray will help assess the condition of the joints. If necessary, arthroscopy, joint biopsy, and diagnostic puncture of the joint with examination of joint fluid are also performed.

In case of rheumatic damage to other organs, consultation with specialized specialists may be necessary.

Clinic Symptoms appear 1-3 weeks after acute streptococcal infection. Rheumatism manifests itself in 5 syndromes:

Rheumatic carditis (cardiac form) is an inflammatory lesion of the heart involving all the linings of the heart (rheumopancarditis), but primarily the myocardium (rheumomyocarditis).

Manifestations:

Symptoms of intoxication (weakness, fatigue, sweating, loss of appetite); Pain in the heart area of ​​a pulling, stabbing nature; Increased body temperature to febrile levels (more than 38 degrees); Moderate hypotension; Tachycardia (palpitations); Changing the boundaries of the heart; Addition of symptoms of left ventricular and right ventricular heart failure; Weakening of tones, most often muting of the first tone; With severe myocardial damage, a gallop rhythm may be auscultated; A diastolic murmur may be auscultated, characterized by blood turbulence during the transition from the atria of the heart to the ventricles due to the operation of a valve affected by rheumatic endocarditis with thrombotic masses superimposed on it; In the early stages of the disease, rheumatic endocarditis is indicated by a rough systolic murmur, the sonority of which increases after physical activity; sometimes it becomes musical.

Rheumatic polyarthritis (articular form) is an inflammatory lesion of the joints, with changes characteristic of rheumatism.

Manifestations:

Predominant damage to large joints (knees, elbows, ankles); A remitting fever (38-39 degrees) appears, accompanied by sweating, weakness, and nosebleeds; Pain in the joints: feet, ankles, knees, shoulders, elbows and hands; Symmetry of the lesion; Rapid positive effect after using non-steroidal anti-inflammatory drugs; Benign course of arthritis, joint deformation does not remain.

Rheumochorea (St. Vitus's Dance) is a pathological process characterized by the manifestation of vasculitis of small cerebral vessels. Mostly occurs in children, more often in girls.

Manifestations:

Motor restlessness, activity; Grimacing, impaired handwriting, inability to hold small objects (cutlery), uncoordinated movements. Symptoms disappear during sleep; Muscle weakness, as a result of which the patient cannot sit, walk, swallowing and physiological functions are impaired; Changes in the patient’s mental state - aggressiveness, selfishness, emotional instability appear, or, on the contrary, passivity, absent-mindedness, increased fatigue.

Cutaneous form of rheumatism.

Manifestations:

Ring erythema - rashes in the form of pale pink ring-shaped rims, painless and not raised above the skin; Erythema nodosum is a limited thickening of dark red skin areas ranging in size from a pea to a plum, which are usually located on the lower extremities. Sometimes, with significant capillary permeability, small skin hemorrhages appear; Rheumatic nodules are dense, inactive, painless formations located in the subcutaneous tissue, joint capsules, fascia, aponeuroses; Pale skin, sweating;

Rheumopleurisy.

Manifestations:

Pain in the chest when breathing, worsening with inspiration; Temperature increase; Nonproductive cough; Dyspnea; On auscultation, a pleural friction noise is heard; Lack of breathing on the affected side. The digestive organs are relatively rarely affected by rheumatism. Sometimes there are acute abdominal pains (abdominal syndrome) associated with rheumatic peritonitis, which are more common in children. In some cases, the liver is affected (rheumatic hepatitis). Quite often, changes in the kidneys are detected: protein, red blood cells, etc. are found in the urine, which is explained by damage to the vessels of the kidneys, and less often - the development of nephritis.

Laboratory diagnostics

1. The acute phase of rheumatism is characterized by moderate leukocytosis with a shift in the leukocyte formula to the left; subsequently, eosinophilia, mono- and lymphocytosis may be observed.
2. ESR is always increased, in severe cases up to 50-70 mm/h.
3. Dysproteinemia is characteristic: a decrease in the amount of albumin (less than 50%) and an increase in globulins, a decrease in the albumin-globulin ratio below one. The proteinogram shows an increase in α2-globulin and γ-globulin fractions;
4. The fibrinogen content increases to 0.6-1% (normally not higher than 0.4%). C-reactive protein appears in the blood, which is absent in healthy people;
5. The level of mucoproteins increases, which is detected by the diphenylamine (DPA) test. The titers of antistreptolysin, antihyaluronidase, and antistreptokinase increase significantly.
6. Conduction disturbances are often found on the ECG, especially atrioventricular block of the I-II degree, extrasystole and other rhythm disturbances, and a decrease in the voltage of the ECG waves. Violation of the trophism of the heart muscle due to its inflammatory damage can lead to changes in the T wave and a decrease in the S-T segment.
7. FCG reflects changes in tones characteristic of rheumatic carditis and registers the appearance of noise.

The duration of the active rheumatic process is 3-6 months, sometimes much longer. Depending on the severity of clinical symptoms and the nature of the course of the disease, there are 3 degrees of activity of the rheumatic process:

• Maximum active (acute), continuously relapsing;
• Moderately active, or subacute;
• Rheumatism with minimal activity, sluggish current, or latent. In cases where there are neither clinical nor laboratory signs of activity of the inflammatory process, they speak of the inactive phase of rheumatism.

Rheumatism is characterized by relapses of the disease (repeated attacks), which occur under the influence of infections, hypothermia, and physical stress. The clinical manifestations of relapses resemble the primary attack, but the signs of damage to blood vessels and serous membranes are less pronounced; symptoms of heart damage predominate.

Prevention Includes hardening the body, improving living conditions, working hours at work, and fighting streptococcal infections. To prevent relapses in the spring and autumn, drug prophylaxis is carried out with bicillin in combination with salicylates or ortofen (Voltaren), indomethacin, hingamine, or year-round prophylaxis is carried out with monthly administration of bicillin-5.

Diagnosis of rheumatism

When diagnosing the disease, the following methods are used:

• ECG;
• Ultrasound of the heart;
• X-ray examination (helps to see changes in the size and shape of the heart);
• general blood test (can show ESR level, anemia, etc.);
• immunological blood test (appearance of C-reactive protein, presence of streptococcal infection).

1 General blood test

2 Immunological blood test

3 Diagnostics of rheumatism in MedicCity

Features of the course of rheumatism in children

Rheumatic fever is more severe in children than in adults. The leading clinical form is carditis; heart defects form more often and faster in children.

Articular syndrome in children is less pronounced, and other extracardiac manifestations (annular rash, subcutaneous nodules, chorea) are more common with more pronounced manifestations.

But, despite its more severe course, the disease in children responds better to drug treatment, and relapses can be avoided. If symptoms of rheumatism appear, hurry up and show your child to the pediatrician. Do not deny your child medical care, follow all recommendations, all the appointments of the pediatrician, this can be vital.