Radiosensitivity of tissues and organs of the body. Radiosensitivity of organs and tissues: definition, methods of changing radiosensitivity. Test questions and assignments

Contrary to popular belief, rheumatism is not a disease of older people. It mainly affects school-age children, but children are at less risk of the disease. The disease gives rise to a series negative consequences for the child, so parents need to know what can trigger it, whether it can be cured and how to prevent it using preventive measures.

The joints most often affected by rheumatism are the joints of the legs.

Causes of rheumatism in children

Rheumatism (its less popular name is acute rheumatic fever) is a disease characterized by acute joint pain, as well as the risk of inflammation of the heart tissue. This can subsequently lead to the development of heart defects in children.

In the vast majority of cases, rheumatism in children occurs as a result of streptococcal infection and can occur several weeks after suffering from tonsillitis, pharyngitis and other diseases of the nasopharynx. Streptococci provoke an appropriate immune response, which is directed against the cells connective tissue body. Since it is represented quite widely in the human body, the inflammatory process affects almost all tissues, including the heart.

Forms and symptoms of the disease

Since rheumatism affects many organs at the same time, this disease has many symptoms. Initially, the disease has the classic signs of an infectious disease: fever, general malaise. A few weeks after infection, symptoms of rheumatism begin to appear. Depending on the form of the disease, its symptoms vary.

Articular form (polyarthritis)

The articular form of childhood rheumatism manifests itself in different ways. Some patients only complain about painful sensations in the joints of the legs, but in some cases the main symptom is accompanied by a rash and other formations on the body, and an elevated temperature persists. In addition to pain in the joint area, there is redness and swelling. The disease mainly affects the joints of the legs. The pain is intermittent and the patient is bothered discomfort now in one area, now in another.

The articular form accompanies inflammatory processes in the cardiac tissue. In this case, the patient appears pale skin, lethargy, tachycardia. Without obvious symptoms, rheumatism is extremely difficult to diagnose and can masquerade as other ailments.

Signs of rheumatic fever appear 2-3 weeks after the onset of an infectious disease: tonsillitis and other pathologies caused by streptococci. The child's temperature rises - first to 37 degrees, and then quickly rises to 39. The condition is complicated by chills, the patient gets a fever.

Rheumatic arthritis is characterized by mirror lesions of the joints, i.e. At the same time, the joints of the legs (knees, ankles) and arms (elbows, shoulders) become inflamed. The pain periodically moves from one joint to another.

At the very beginning of the disease, rashes in the form of pinkish rings on the skin may rarely be observed. Rare symptom rheumatism - small subcutaneous nodules the size of a pea, they are observed in approximately 3% of total number sick. They are painless and localized in the area of ​​inflamed joints.

Cardiac form (rheumatic carditis)

Carditis is the most unpleasant manifestation of rheumatism, which affects the heart tissue. Often accompanied by rheumatic fever. When the heart is damaged, the patient experiences typical symptoms: shortness of breath, rapid heartbeat, prolonged aching and stabbing pains in heart.

If a child complains of pain in the heart, it is necessary to show him to a doctor, as this may be a cardiac form of rheumatism (we recommend reading:)

Neurological form (chorea)

Another form of rheumatism is rheumatic chorea, which affects the patient’s nervous system. It manifests itself in the form of twitching of the muscles of the limbs and face, disturbances in speech and facial expressions. The child cannot perform simple tasks, such as holding a spoon while eating. Symptoms persist throughout the day and disappear completely during sleep.

On average, rheumatic fever persists for 2-3 months. During this time, inflammation goes through all stages. Exacerbation of rheumatism in children occurs within 5 years after past illness, over time the likelihood of its occurrence decreases. Rheumatic attacks further depend on new cases of nasopharyngeal disease through infection with streptococci.

Diagnostic methods

The first stage of diagnosis is examination pediatrician- therapist or rheumatologist. He must carefully examine the child’s joints for swelling, measure the patient’s pulse, blood pressure and body temperature, listen heartbeat, conduct an oral survey of parents. If necessary, a series of tests for neurological pathologies is performed.

After the initial examination, the doctor prescribes a number of tests:

• a general blood test to determine the level of ESR, leukocytes, lymphocytes (we recommend reading:);
• blood chemistry;
• bacterial culture to determine the type of bacteria and select the appropriate antibiotic.

To diagnose the disease, you need to donate blood for general and biochemical analysis

Instrumental diagnostics are used to study the condition of the heart:

• x-ray to detect heart defects and determine its size;
• electrocardiogram to calculate heart rate;
• functional cardiogram to detect heart murmurs and tones.

Stages of treatment and lifestyle of a small patient

It is important to start treatment of rheumatism in a timely manner - the speed of recovery and the likelihood of negative consequences for the child in the future depend on this. Rheumatism requires complex long-term therapy.

The acute phase of the disease requires hospital treatment. If there is an inflammatory process in the heart, the patient is prescribed strict bed rest; in other forms, it is more gentle. Drug treatment consists of the use of:

• antibacterial drugs from streptococcal infection (Amoxicillin, Cefadroxil, etc.);
• anti-inflammatory drugs (Aspirin, Voltaren, Amidopyrine, etc.).

All medications must be taken strictly as prescribed by the doctor, following the instructions

After discharge from the hospital, treatment should be continued in a special sanatorium with a rheumatology department, where the child is prescribed restorative therapy, special physical activity for patients with joint diseases, mud therapy and special therapeutic baths.

In the future, a child with a history of rheumatism is subject to regular monitoring by a dentist, cardiologist, or rheumatologist. Such observation should be carried out in a clinic at the place of residence. Special injections of antibiotics are designed to prevent relapse in the future.

Prevention of rheumatism and its complications in children

The main measure for the prevention of rheumatism is high-quality and timely treatment of diseases of the nasopharynx, such as pharyngitis, etc. Since the disease is mainly caused by streptococcal infection, for which the use of antibiotics is indicated, it is important to strictly follow all doctor’s prescriptions and complete the course of treatment to the end, so as not to provoke relapse.

If the child has already been ill, the main goal of the parents is to prevent the disease from recurring, for which they will have to inject Bicillin for 5 years once a week.

Prognosis for recovery is made in each individual case, based on an assessment of the complexity of the disease:

• At acute form rheumatism, when there are no manifestations of carditis, we can talk about a complete recovery without negative consequences for the heart.
• If inflammation has reached the valvular heart system, the incidence of defects occurs in 25% of patients. At the present stage of development of medicine, the incidence of deaths is 4% of the total number of patients with rheumatism.

Of great importance for the prevention of rheumatism and its complications is the general physical training of the child, strengthening the immune system, and hardening. It is important to follow a daily routine, establish nutrition and include only healthy foods. Parents should pay great attention to the development of the child and the prevention of infectious diseases.

Rheumatism cannot be treated using traditional medicine. At the first suspicion of the onset of the disease, you should urgently seek qualified medical help.

Rheumatism is a severe systemic disease of an infectious-allergic nature affecting many organs, developing at any age. The versatility of clinical manifestations is due to the fact that rheumatism affects not only specific body, but connective tissue, which is found in all human tissues and organs. We will devote this article to rheumatism in children.

Causes of rheumatism in children

The cause of rheumatism is beta-hemolytic streptococcus. But this disease does not develop in everyone who has had a streptococcal infection, but only in the absence of timely antibiotic therapy and in children with an improperly functioning immune system.

Rheumatism is caused by hemolytic streptococcus, which is the cause of scarlet fever, sore throat, and acute respiratory infections. The pathogen enters the child's body through airborne droplets. Rheumatism usually develops after a streptococcal infection untreated with antibiotics.

But rheumatism develops after a streptococcal infection in only 0.3–3% of those who have been ill - only in those who have a malfunction in the immune system. Due to immune disorders, the body begins to produce antibodies against its own connective tissue cells. As a result, the connective tissue of many organs is affected.

Any family member who has a streptococcal infection or is a “healthy” carrier of hemolytic streptococcus can become a source of infection for a child. The child's imperfect immune system cannot cope with the infection.

The presence of chronic foci of infection in the child’s body (chronic tonsillitis, sinusitis, caries, otitis, chronic infection of the urinary system) is also important. There is also a risk of developing rheumatism in children who suffer from frequent colds.

There are others provoking factors for the occurrence of rheumatism:

• hypothermia;
• inadequate, unbalanced nutrition (lack of protein and hypovitaminosis);
• overwork;
• congenital infection with hemolytic streptococcus;
• hereditary predisposition to rheumatism.

A child can get rheumatism at any age. Children aged 7–15 years are most susceptible to this disease.

Classification of rheumatism

Distinguish 2 phases of the rheumatic process– active and inactive.

During the inactive phase after rheumatism, there are no laboratory signs of inflammation. The children’s well-being and behavior remain normal, and hemodynamic disturbances appear only with significant physical activity.

The active phase of rheumatism has 3 degrees:

I – minimal degree of activity: clinical, laboratory and instrumental signs of the disease are weakly expressed;

II – moderate degree activity: clinical and instrumental signs are not pronounced, there may be no fever, laboratory changes are also not sharp;

III – there are clear clinical manifestations of the disease in the form of signs of damage to the heart and joints; clear radiological, electrocardiographic and phonocardiographic changes, sharply expressed laboratory parameters inflammation.

Rheumatism can occur through 5 flow options:

1. Acute course: characterized by rapid development and rapid disappearance of disease manifestations. Signs of II–III stage. activity lasts for 2–3 months, the effectiveness of treatment is good.
2. Subacute: has a slower onset of symptoms; there is a tendency to aggravate the process; active phase from stage II activity lasts 3–6 months.
3. Protracted course – symptoms of the disease and activity of stages I–II. lasts for more than 6 months; periods of remission are unclear, the effect of treatment is weak and unstable.
4. Undulating, continuously relapsing course with unexpressed remissions; activity I–III stage. lasts for a year or more.
5. Hidden, latent, chronic course without manifestation of process activity; The diagnosis is made based on signs of already formed damage to the heart valves (heart disease).

Symptoms of the disease

The articular form of rheumatism is characterized by flying pain, mainly in large joints.

With rheumatism, connective tissue is destroyed in many organs at once. This is precisely what is associated with the versatility of the clinical manifestations of the disease, depending on the form and severity of the process. In response to the action of the pathogen, the body produces a special substance - C-reactive protein. It is this that causes inflammation and damage to connective tissue.

The disease begins 1–3 weeks after a streptococcal infection. The onset is acute, with elevated temperature, severe weakness, and deterioration in general health.

There are cardiac, articular and nervous forms of rheumatism. Often the joints are affected first.

Articular shape

As the temperature rises, swelling and severe pain in the joints and difficulty moving appear.

Characteristics rheumatic lesions joints:

1. Mostly large joints are affected (wrist, elbow, shoulder, knee, ankle).
2. The pain is “volatile”: the knee joint hurts, after 2–3 days the elbow joint hurts, etc.; pain in one joint appears and disappears quickly, “flying” to another joint.
3. After treatment, changes in the joints do not leave deformation, and the function of the joint is completely restored.
4. At the same time as the joints, the heart is affected.

The articular form does not always manifest itself so acutely. In some cases, both temperature and joint swelling are absent. The child may complain of pain in one or another joint. Sometimes heart damage is not detected immediately, and rheumatism remains undiagnosed for a long time. At a young age, joint damage may appear after heart damage, or may be completely absent.

Heart shape

This form can begin acutely or develop gradually. The child has weakness, fast fatiguability, he has difficulty climbing the stairs - fatigue and palpitations appear. Upon examination, the doctor detects an increase in heart rate; rhythm disturbances, heart murmurs and expansion of its boundaries may occur.

The heart can be affected by rheumatism in varying degrees. Sometimes marked faintly severe symptoms damage to the myocardium (heart muscle). Such inflammation can end without a trace.

In some cases, the process also involves the inner lining (endocardium) with the valve apparatus of the heart - endocarditis usually ends with the formation of a heart defect. In this case, the affected valve leaflets do not close completely, and the blood returns from the ventricle to the atrium when the heart muscle contracts.

But the most severe damage is when the outer lining of the heart (pericardium) also becomes inflamed and pericarditis develops. In this case, severe pain in the heart area, severe shortness of breath, and a bluish coloration of the lips and fingers in the area of ​​the nail phalanges appear. The position in bed is forced - semi-sitting. The pulse may be fast or slow. Arrhythmia may occur. The boundaries of the heart are significantly expanded, especially if fluid accumulates in the pericardial cavity.

Severe heart damage leads to the development of heart failure and disability of the child.

In the case of a recurrent course of rheumatism, the development of recurrent rheumatic carditis is possible. Relapses may be associated with a new infection or with the activation of bacteria remaining in the body. With each new attack of rheumatism, damage to the valve apparatus progresses. In junior childhood recurrent rheumatic carditis is observed less frequently than in adolescence.

Nervous form (minor chorea)

Rheumatism can also begin with a lesion nervous system. Chorea is observed in 11–13% of cases of rheumatism and develops more often in girls. Grimacing and involuntary twitching of the muscles of the arms, legs, face, and eyes appear. They resemble a nervous tic.

Impetuous involuntary movements increase with emotions. Muscle tone is reduced. Coordination of movements is impaired: the child drops objects from his hands; may fall from a chair; slowness, absent-mindedness and sloppiness appear.

Often changes in behavior and handwriting, absent-mindedness are first noticed at school and are sometimes regarded as pranks. Change and emotional manifestations: the child becomes whiny and irritable. Speech may become slurred. In severe cases, paralysis may even occur.

Chorea can occur in isolation, but often the symptoms of chorea are accompanied by signs of heart damage.

The duration of chorea manifestations is usually up to 1 month, but in preschool children chorea can have a protracted or recurrent course. With severe damage, inflammation can develop not only meninges, but also the substances of the brain and peripheral nerves.

Other extracardiac manifestations of rheumatism:

• rheumatic pneumonia;
• rheumatic hepatitis;
• rheumatic nephritis;
• rheumatic polyserositis (inflammation of the serous membranes);
• rheumatic skin lesions: rheumatic nodules, anular erythema.

These manifestations are rare during the active period of the process.

The period of activity of rheumatism lasts about 2 months. During the period of remission, the child feels good, unless heart failure develops. But the disease may return.

The more attacks of rheumatism, the more severe the consequences. How younger age child, the more severe the disease and the more serious its complications. Therefore, at the slightest suspicion of rheumatism, you must consult a doctor and carry out the necessary examinations.

Diagnostics

The following methods are used to diagnose rheumatism:

1. Examination by a doctor - pediatrician or rheumatologist: allows you to identify the clinical manifestations of the disease (swelling of the joints, increased heart rate, expansion of the boundaries of the heart, heart murmurs, etc.).
2. Clinical blood test: rheumatism is characterized by an increase in the total number of leukocytes and neutrophils, an accelerated erythrocyte sedimentation rate (ESR).
3. Biochemical blood test: from the second week of the disease, C-reactive protein is detected, the titers of antistreptococcal antibodies and the level of the globulin fraction of serum protein increase.
4. Electrocardiography, echocardiography, phonocardiography, X-ray examination.

Confirmation of the diagnosis of “rheumatism” is a combination of one or more main manifestations of rheumatism (polyarthritis, carditis, chorea) and several additional laboratory and instrumental manifestations.

The described examination methods will help clarify the phase and localization of the process, the degree of its activity.

Treatment of rheumatism in children

Treatment of rheumatism is carried out in 3 stages:

Stage 1 – inpatient treatment (4–6 weeks).

2nd stage – Spa treatment.

Stage 3 – clinical observation.

Stage I

The active phase of rheumatism requires compliance bed rest with a gradual expansion of the child’s motor activity. The duration of bed rest is determined by the doctor depending on the degree of activity of the process. At II–III stage. activity is prescribed for 1–2 weeks of strict bed rest, then for 2–3 weeks bed rest with permission to participate in games in bed and passive movements, breathing exercises. And only after a month and a half, a gentle regime is allowed: the ability to use the toilet, the dining room; Physical therapy is also expanding.

Treatment must be comprehensive. Drug treatment includes: antibacterial drugs, non-steroidal anti-inflammatory drugs, antiallergic drugs, immunosuppressive drugs, and, if necessary, cardiac drugs, diuretics and other medications.

Penicillin antibiotics are used as antibacterial drugs in age-specific doses for 2 weeks. If streptococcus is isolated, antibiotics are prescribed depending on the sensitivity of the pathogen to them. Non-steroidal anti-inflammatory drugs are used acetylsalicylic acid, Voltaren, Indomethacin, Amidopyrine, Butadione and other pyrazolone drugs.

In case of a continuously relapsing process, quinoline drugs (Plaquenil, Delagil) are used. In case of a severe course of the process, corticosteroid drugs are used - the dosage and duration of the course are determined by the doctor.

The duration of hospital treatment is on average 1.5 months. With continuously relapsing rheumatism, treatment may be longer. Physiotherapeutic methods of treatment and physical therapy are also used. Extract is carried out with pronounced positive dynamics of the process and laboratory indicators indicating a decrease in the activity of the process.

Stage II

At any stage of treatment, an important role belongs to a rational, balanced diet rich in vitamins and microelements.

Rehabilitation of children (stage 2) is carried out over 2–3 months in a local sanatorium. At this stage, follow-up treatment is carried out: medicinal products are used at half the dose. Used physiotherapy, aeration, good nutrition, vitamin therapy.

Stage III

Dispensary observation is carried out to identify manifestations of activation of the process and to carry out year-round prevention of relapse. Long-acting antibiotics (bicillin-5) are used. Foci of chronic infection are also being sanitized and study opportunities are being determined (for schoolchildren).

Complex treatment of children with rheumatism can last for several years, taking into account supportive treatment (prophylactic administration of a long-acting antibiotic in the spring and autumn).

Diet

Children suffering from rheumatism must follow a certain diet. Food should be easily digestible and contain sufficient quantity proteins, vitamins (especially rutin, vitamin C and group B) and potassium salts. You should definitely include fruits and vegetables in your diet. In the morning, you can recommend drinking the juice of 1 lemon with hot water on an empty stomach.

Difficult-to-digest foods rich in extractive substances should be excluded. In case of circulatory failure, it is necessary to control the amount of table salt (no more than 5 g per day) and liquid. In case of II-III degree of circulatory failure, the doctor may recommend fasting days.

The amount of carbohydrates (baked goods, sweets, chocolate) should be limited, given their allergenic effect on the body. It is recommended to eat meals in small portions. In each specific case, it is advisable to discuss the child’s diet with a doctor.

Phytotherapy

Herbal treatment for rheumatism has been used since ancient times. But in our time, herbal medicine can only be used as an addition to drug treatment and only in consultation with a doctor. To treat rheumatism, use willow bark collected in early spring, meadowsweet flowers, soapwort root, black elderberry flowers, spring Adonis flowers, wild strawberry herbs, heather, cinquefoil, Birch buds and many other plants. Decoctions and infusions of plants, baths with herbs are used. There are a lot of collection recipes. But they can only be used in the treatment of a child with the permission of a doctor.

Prevention of rheumatism in children

There are primary and secondary prevention of rheumatism.

At primary prevention All measures are aimed at preventing the occurrence of rheumatism. The complex of such activities includes:

1. Prevention and control of streptococcal infection in a child: examination of family members for carriage of streptococcus; the use of antibiotics for diseases of the nasopharynx, sore throat; rehabilitation of chronic foci of infection; for frequent colds, preventive courses of aspirin and bicillin.
2. Hardening the child, creating normal conditions for housing and for school (eliminating overcrowding in classes and classes in 2 shifts), ensuring a rational balanced diet, maintaining a daily routine and ensuring sufficient rest, keeping the child in the fresh air and hygiene of the premises.

The purpose of secondary prevention is to prevent relapses and progression of the disease, i.e. the formation of heart valve disease. It is carried out after completion of treatment of primary rheumatic carditis year-round with bicillin-5 at an age-appropriate dose for 3 years. In addition, foci of chronic infection are sanitized and vitamin therapy, especially vitamin C, is prescribed.

In the next 2 years (if there have been no repeated attacks of rheumatism within 3 years), a preventive course of bicillin-5 and aspirin or other pyrazolone-type drugs in an age-specific dosage is prescribed in the autumn-spring period. Bicillin is also prescribed to children after each case of a cold.

If primary rheumatic carditis resulted in the formation of a heart defect, as well as for children with recurrent rheumatic carditis, year-round prophylaxis is carried out for 5 years. From time to time, children are sent to local sanatoriums.

Forecast

Currently thanks to effective treatment streptococcal infection and preventive treatment are much less common severe course rheumatism. Mortality due to severe heart failure due to heart defects has decreased more than 30 times (compared to the 60–70s of the last century).

Combined and combined heart defects are formed due to repeated relapses of rheumatism. With primary rheumatic carditis, valve disease develops in 10–15% of patients, and with recurrent - in 40%.

Rheumatism with an erased, weakly expressed clinical picture of the disease is of particular danger to children. Often, parents either do not pay attention to their children’s complaints of pain in the arms and legs, or explain them by the child’s bruises and fatigue. Such errors lead to the progression of the disease and the accidental detection of rheumatism already at the stage of irreversible consequences of the process.

Summary for parents

Rheumatism is a serious disease affecting many organs and systems. But this disease can be avoided if you monitor the child’s health and strictly follow all the doctor’s recommendations in case of any, even harmless, in the opinion of the parents, colds rather than self-medicate. If rheumatism develops in a child, you need to remember that preventive treatment no less important than treating an acute attack.

Which doctor should I contact?

If joint pain appears in a child, you should contact a rheumatologist, and if the condition worsens, fever, or signs of intoxication, contact a pediatrician, who will suspect a diagnosis of “rheumatism.” If other organs are affected, a consultation with a cardiologist, neurologist, or less often a pulmonologist, hepatologist or gastroenterologist, nephrologist, or dermatologist is prescribed. It will be useful to consult a nutritionist on diet for rheumatism. To sanitize foci of chronic infection, the child is referred to an ENT doctor and dentist. If a heart defect develops, an examination by a cardiac surgeon is necessary.

Article rating:

(average: 5.00)

Rheumatism is a disease infectious-allergic nature. The pathology occurs in the form of systemic damage to the connective tissues of various body systems.

The disease poses a threat to the child's life and implies complex treatment, consisting of several stages.

Therapy should be carried out under the supervision of specialists. Otherwise risk of complications and death will increase several times. We will talk about the symptoms of rheumatism in children in this article.

Read about the symptoms and treatment of arthritis in children here.

General concept and characteristics

Rheumatism has inflammatory nature.

In medical practice, this disease has several names - rheumatic fever or Sokolsky-Buiko disease.

The pathological process can affect the cardiovascular system, skin, serous membranes of the liver and kidneys, as well as the central nervous system. Inflammation develops mainly in connective tissues, which leads to disruption of the child’s body as a whole.

Peculiarities diseases:

1. In most cases, the pathological process affects the cardiovascular system.
2. The disease is difficult to treat (remission can be long-term, but exacerbations will be regular).
3. The pathology develops against the background of the presence of streptococcal infection in the child’s body.

Those at risk for rheumatism are: children from seven to fifteen years old. In rare cases, the pathological process is detected in young patients at an earlier age.

The main reason for the development inflammatory process the body is considered to be damaged by streptococcal infection. This factor is an obligatory precursor to rheumatism.

The reaction of a child’s body to infection depends not only on the general condition of his body, but also hereditary predisposition, as well as some related conditions.

Reasons rheumatism in children may be due to the following factors:

• genetic predisposition;
• consequences of allergic reactions;
• state of increased reactivity of the body;
• complications of infectious diseases;
• consequences of scarlet fever;
• immune system disorder;
• constant overexertion of the child;
• regular hypothermia of the body.

Can a child have osteochondrosis? Find out the answer right now.

Editorial advice

There are a number of conclusions about the harm washing cosmetics. Unfortunately, not all new mothers listen to them. 97% of children's shampoos use the dangerous substance Sodium Lauryl Sulfate (SLS) or its analogues. Many articles have been written about the effects of this chemistry on the health of both children and adults. At the request of our readers, we tested the most popular brands. The results were disappointing - the most advertised companies showed the presence of those very dangerous components in their composition. In order not to violate the legal rights of manufacturers, we cannot name specific brands. Mulsan Cosmetic, the only company that passed all the tests, successfully received 10 points out of 10. Each product is made from natural ingredients, completely safe and hypoallergenic. We confidently recommend the official online store mulsan.ru. If you doubt the naturalness of your cosmetics, check the expiration date; it should not exceed 10 months. Be careful when choosing cosmetics, this is important for you and your child.

Classification and forms

Rheumatism is different long-term development. As the inflammatory process progresses, symptoms pass into an active or inactive phase.

In the second case, there is an improvement in the child’s health, improvement in the results of tests and examinations by specialized specialists. The inactive phase of the disease can last up to several years.

Relapse of increased symptoms in most cases occurs suddenly. It can be excluded only by full treatment and compliance with clinical recommendations.

Three degrees of the active phase of rheumatism in children:

1. Minimum activity (first degree, characterized by mild symptoms of the inflammatory process in connective tissues).
2. Moderate activity (the second degree is accompanied by increased general symptoms diseases).
3. Maximum activity (the third degree implies a sharp deterioration in the child’s health, test data and other types of examination, as well as the development of fever).

According to the mechanism of development, rheumatism is divided into latent, protracted, acute and subacute form.

In the first case, the symptoms are hidden, and the lack of timely treatment leads to the development of heart disease.

Protracted version of the disease characterized by a long course(up to six months). Acute and subacute forms do not last more than six months. A separate type of rheumatism is the continuously relapsing variant, in which there is no clear remission.

Depending on the type of tissue affected, the following forms of rheumatism are distinguished:

• articular appearance;
• heart shape;
• nervous type

In most cases, rheumatism of the heart in childhood develops against the background of previous symptoms of joint damage.

A distinctive feature of this pathological process is the risk of a long asymptomatic course.

Parents begin to notice deviations in the child’s condition due to a decrease in his activity and complaints of pain in the heart area. The attacks weaken when the baby takes certain positions.

Three types of damage to the cardiovascular system in rheumatism:

• pericarditis (serious violation heart performance, which can cause death in a child);
• myocarditis (considered the mildest form of the disease, can be cured on its own);
• endocarditis(the consequence in most cases is various diseases associated with the condition of the heart).

Rheumatism may be accompanied various symptoms.

The key role is played by the type of connective tissue that is affected by the inflammatory process and the individual characteristics of the child’s body.

The intensity of symptoms directly depends on phases of rheumatism.

In most cases, the pathological process begins to develop a month after the streptococcal infection. Rheumatism can occur as an independent pathology or be accompanied by additional diseases.

Symptoms of rheumatism In childhood, the following conditions may occur:

• general weakness of the body and increased fatigue child;
• pain in the heart area;
• shortness of breath after minor physical exertion;
• rapid heartbeat (after activity or at rest);
• rheumatic nodules in the back of the head and in the joint area;
• pain sensations are wandering in nature;
• pain combined with swelling in the joints;
• blue tint of the skin on the toes and hands;
• emotional disorders;
• movement disorders;
• rash in the form of rings in the chest and abdomen;
• speech disorders.

The pathological process in connective tissues that develops with rheumatism can have an extremely negative impact on the condition of certain organs, disrupting their functionality forever.

Some of the complications can cause death in a small patient or radically change the quality of his life. Most types of consequences of rheumatism can be avoided if treatment is started as early as possible.

Complications diseases can become the following conditions:

• serous pleurisy;
• cerebral ischemia;
• heart disease;
• coronaritis;
• aortitis;
• circulatory failure;
• death.

A child may be suspected of developing rheumatism pediatrician or pediatric rheumatologist. A small patient must be sent for a comprehensive examination if he has polyarthritis, carditis, subcutaneous nodules or chorea.

A recent streptococcal infection increases the risk of confirming the diagnosis.

When diagnosing rheumatism, not only the child is examined by specialized specialists, but also a number of laboratory tests biological material.

The following methods are used for diagnosis:

• blood chemistry;
• clinical blood test;
• chest x-ray;
• tests for ESR and leukocytes;
• EchoCG and ECG;
• phonocardiography;
• immunological blood test;
• consultation with a pediatric neurologist.

How to treat osteoporosis in children? Find out about this from our article.

Several tactics can be used to treat rheumatism in children.

Therapy involves A complex approach and is carried out in a phased, continuous or long-term form.

It is up to the specialist to choose a specific course and select the means of treatment. Incorrect tactics can not only reduce the effectiveness of the procedures, but also cause relapses of the disease and progression of the inflammatory process.

On first stage of treatment For childhood rheumatism, the following methods are used:

1. Inpatient treatment (a prerequisite is the restriction of the child’s physical activity, the duration of this stage is up to six weeks).
2. Antibacterial therapy (predominantly penicillin drugs are used to eliminate the consequences of streptococcal infections).
3. Corticosteroid hormones (Triamcinolone).
4. Nonsteroidal anti-inflammatory drugs to eliminate the inflammatory process (Diclofenac, Ibuprofen, Voltaren).
5. Steroidal anti-inflammatory drugs (Prednisolone).
6. Quinoline drugs (Chloroquine, Hydroxychloroquine, Delagil).

Second phase Treatment of childhood rheumatism involves the implementation of procedures that should consolidate the course of therapy, exclude relapse of the disease and eliminate the consequences of the inflammatory process.

For such purposes, mud therapy, physical therapy, and restorative therapy with the use of vitamins appropriate to the child’s age are used.

For some time the little patient will have to be observed by specialized specialists(ENT doctor, cardiologist, rheumatologist, etc.).

Additionally, at the second stage of treatment the following may be prescribed: procedures:

• breathing exercises;
• therapeutic diet;
• physiotherapy;
• long-acting antibiotics (Bicillin-5).

Third stage includes the prevention of relapse of the disease, and differs in maximum duration.

Restoring the child’s body’s performance depends on its individual characteristics and the timeliness of the therapy.

In some cases, consultation with specialized specialists and lifestyle changes are necessary throughout the patient's life. For significant complications physical activity will have to be limited to the maximum extent.

It is necessary to monitor the child’s body after treatment for rheumatism for at least three years. During this period any deterioration in general condition should be a reason for comprehensive examination in a medical facility.

The doctor may prescribe a long course of therapy, including taking special medications. Deviate from treatment schedule under no circumstances. For five years after the main therapy, children are recommended to undergo annual sanatorium treatment.

For rheumatism in childhood, the following must be observed: recommendations:

1. Balanced diet (the diet should contain rutin and protein in large quantities).
2. Relaxing and healing baths with decoctions medicinal plants(strawberry leaves, birch buds, etc.).
3. The obligatory presence of vegetables and fruits (especially lemons) in the diet.
4. Elimination of unnecessary or excessive physical stress on the body.
5. The diet should be free of hard-to-digest foods.
6. Limit the consumption of carbohydrates and sweets.

The prognosis for childhood rheumatism has been improved thanks to the development of medicine. For many decades the disease was one of the fatal diseases. With timely diagnosis and adequate therapy, prognoses can be improved.

The most common consequence of rheumatism is the development of heart disease, but with such a diagnosis, patients can live a long and fulfilling life.

In the absence of timely treatment, risk of disability or death child.

Preventive measures to prevent childhood rheumatism include basic rules that parents must follow. For the baby's health must be monitored from the first days of his life.

If symptoms of rheumatism are present, an examination should be carried out immediately.

Streptococcal infection, which is considered an obligatory precursor to pathology, is of particular danger.

This disease should be treated timely and complete.

Prevention of rheumatism in childhood includes the following: recommendations:

• gentle hardening from an early age;
• monitoring the child's nutrition;
• adherence to daily routine;
• physical activity according to age;
• avoiding contact with sources of infections;
• increasing the child's immunity;
• timely treatment of any diseases;
• compliance with personal hygiene rules;
• full-fledged sanitization premises;
• prevention of streptococcal infection;
• sanitation of foci of chronic infections.

Timely treatment of rheumatism in a child improves prognosis, but does not exclude complications that may appear in adulthood.

If a small patient is diagnosed with such a diagnosis, then his health should be given special attention.

The child should be regularly examined and observed by specialized doctors. Rheumatism is dangerous disease, and the tendency towards recovery can only be the transition of pathology into an inactive phase.

We kindly ask you not to self-medicate. Make an appointment with a doctor!

In this article we will take a closer look at how rheumatism manifests itself in a child. Symptoms, varieties, treatment features, diagnosis and prevention - these are the main issues that we will focus on.

Let us immediately draw your attention to the fact that rheumatism can develop at absolutely any age. This is a disease of infectious-allergic nature. The variety of clinical manifestations is due to the fact that rheumatism does not affect any specific organ, but connective tissues that are present in all human organs. Let's look at the signs of rheumatism in children.

What it is?

Let's start our article with the very concept of “rheumatism”. What kind of disease is this? This is the name for an inflammatory disease that simultaneously affects the entire body (that is, it is systemic). The origin of rheumatism is infectious-allergic. It also has another name: Sokolovsky-Buyo disease.

The disease is characterized by damage to connective tissue. The connective tissues of the cardiovascular and central nervous systems are mainly affected. There is statistical information that shows that women most often suffer from of this disease- three times more than men. However, this difference disappears in later life.

What are the features of rheumatism in children? Symptoms and treatment of the disease in childhood are slightly different. This is due to the fact that childhood rheumatism has some features, such as:

• more pronounced severity of damage to the cardiovascular system;
• changes in other systems and organs;
• the possibility of the disease becoming chronic (the percentage of probability in childhood is very high);
• occurrence of relapses.

The chronic form manifests itself as follows: after treatment there is a period of rest, but after some time the problem arises again. It is worth noting that relapses of rheumatism are observed very often in children.

Symptoms of rheumatism in children 2 years old or 10 years old are practically no different from each other. Please note that children between seven and fifteen years of age are especially susceptible to the disease. Children's rheumatism faces a number of complications, including heart failure. Rheumatism often begins to develop after infectious diseases. These include scarlet fever, tonsillitis, and so on.

The focus is especially often found in the cardiovascular system. Rheumatism is common throughout the world, especially in disadvantaged countries where rates of the disease are very high.

We will look at the symptoms and diagnosis of the disease in childhood in more detail later, but now I would like to draw attention to the Jones criteria. It is important to note that he distinguishes between major and minor criteria. If at least one sign from the first category is observed, then this is enough to diagnose the disease.

Symptoms

Now we will look in detail at the symptoms of rheumatism in a child. As mentioned earlier, rheumatism can destroy connective tissue in several organs at once. This can explain a large number of various manifestations of the disease. It all depends on the form and severity of the processes.

The causative agent of rheumatism stimulates the production of a substance called C-reactive protein. It is this that causes inflammation and damage to connective tissue. Again, we draw your attention to the fact that rheumatism does not appear out of nowhere. The process of its development begins after an infectious disease. In total, there are three forms of the disease, we will talk about them a little later. The main feature of rheumatism is its acute onset. Symptoms include:

• a sharp increase in body temperature;
• severe weakness;
• deterioration of health.

The common initial symptoms have now been listed. In young children (2 years old), symptoms of rheumatism may include:

• irritability;
• tearfulness;
• sleep disorders and so on.

Then they will gradually be joined by other symptoms that characterize one of the forms of rheumatism. Rheumatism in children, the symptoms and treatment of which we discuss in the article, can manifest itself in different ways, but in approximately 85% of cases the disease threatens with heart complications.

Classification

There are three forms of the disease:

• articular;
• cardiac;
• nervous.

We'll talk about them in detail a little later.

It is worth noting that the symptoms of streptococcal rheumatism in children do not go away without leaving a trace. The disease always entails consequences in the form of complications, or rheumatism becomes chronic.

The symptoms of rheumatism in children 10 years of age and younger are absolutely no different. An experienced specialist can easily diagnose the disease at any stage.

Rheumatism has two phases:

• active;
• inactive.

What are the criteria for disease activity? These include:

• severity of manifestations;
• changes in laboratory markers.

Based on this, three degrees of rheumatism are distinguished. They are presented in the table below.

Articular shape

Now let's look at the symptoms of rheumatism in a child with articular form. Let's start the chapter with some statistical information. Infants very rarely fall into this category. In almost 20% of cases, articular rheumatism manifests itself between the ages of one and five years; and in almost 80% - from ten to fifteen years.

Symptoms of rheumatism of the joints in children can manifest themselves as follows:

• fever;
• weakness;
• headache;
• joint pain;
• redness and swelling over the joints and so on.

Despite the fact that cases of the disease are numerous, the causative agent has not yet been identified. Undoubtedly, rheumatism is infectious in nature. This infection in most cases affects the lymph nodes located in the nasopharynx. The diseases are associated with previous tonsillitis, caries, and inflammatory processes.

It is worth noting that there are several theories about the occurrence of the disease. Rheumatism of the joints in children, the symptoms and treatment of which we discuss in this article, according to the majority, is infectious and allergic in nature. This is the most common theory. If you adhere to this opinion, then rheumatism is a consequence allergic reaction in the human body. Due to the entry of bacterial waste products into the cells during the incubation period, the body is reconfigured. Streptococci in this case can cause the above symptoms of rheumatism.

It has already been said earlier that the cause of the development of rheumatism is often a previous infectious disease (in particular scarlet fever). However, other examples can be given:

• hypothermia;
• overvoltage.

Many symptoms indicate that the CNS (central nervous system) is involved in this process. These symptoms include:

• chorea;
• movement disorders;
• mental illness;
• nervous diseases and so on.

It is important to note that all of the above diseases are very often accompanied by rheumatism. Research shows that the reactivity of the cerebral cortex is significantly reduced. This can be easily determined by an experienced specialist. Why is this happening? This is usually associated with an increase in the excitability of subcortical centers, which affects the entire body.

Heart shape

Now we propose to talk in a little more detail about the cardiac form of rheumatism in a child, the symptoms of this disease. We immediately draw your attention to the fact that heart problems can begin either simultaneously with the articular form of rheumatism, or manifest themselves gradually. The severe form of rheumatism is characterized by the fact that the symptoms of cardiac dysfunction appear very slowly, that is, the disease develops unnoticed.

We said earlier that a distinctive feature of articular rheumatism is an unexpected and violent attack. Sharp pain appears, and so on. However, some children may complain of slight joint pain and fatigue. Even then, heart problems may develop. To avoid serious consequences and begin treatment in a timely manner, consult a specialist even with such complaints.

Rheumatism of the heart in children, the symptoms and treatment of which we will consider right now, is commonly called rheumatic carditis. initial stage practically does not manifest itself at all. Symptoms may include:

• fatigue;
• refusal to play;
• reluctance to run;
• shortness of breath;
• cardiopalmus;
• pale skin.

The severe form is accompanied by elevated temperature, usually not exceeding thirty-eight degrees. The general condition of the child is deteriorating daily.

The cardiac form of rheumatism can lead to several heart disorders, presented in the table below.

All this leads to the development of heart disease, that is, the inflammatory process spreads to the valves. It is very important to know that timely treatment and adherence to the prescribed regimen are the key to a happy future. Many children who suffer from heart defects lead a normal life (go to school, hang out with friends, attend clubs, and so on). If the case is advanced, then the disease takes on a severe form, which affects well-being as follows:

• presence of circulatory disorder;
• swelling of the limbs;
• severe shortness of breath;
• liver enlargement.

Another distinctive feature of the severe form of the disease is ring-shaped rash on the skin. At the first symptoms, seek medical help immediately! Timely treatment is a chance for normal life a child that should not be missed.

Nervous form

IN this section In this article we will pay attention to the nervous form of rheumatism in children. Symptoms and treatment of the disease are the main issues that we will try to cover in this article.

A distinctive feature of the nervous form of rheumatism in children is chorea, damage to certain parts of the brain. Chorea develops gradually, symptoms may include:

• change of mood;
• irritability;
• tearfulness;
• muscle twitching (note that this symptom can progress; some parents think that the child is grimacing and playing pranks, without even realizing the true state of affairs);
• lack of discipline;
• negligence;
• change of handwriting;
• the appearance of slurred speech;
• loose gait.

Regarding the lack of discipline and negligence, it is also worth making some clarifications. In fact, this is not the child's fault. He really can't tie his shoes neatly and often drops forks, spoons, pens and other objects. Pay attention to these symptoms. Many people confuse this with fatigue or carelessness. In fact, the child needs your help. These symptoms will appear for about three months. Pay more attention to the child’s behavior and condition so as not to miss the right moment and start treatment on time.

The good news for this disease is that heart damage in the nervous form of rheumatism is extremely rare. If the disease has caused any complications to the cardiovascular system, then the disease progresses very easily. If you notice any changes in your child’s behavior, consult a doctor.

Now let's pay a little attention to hyperkinesis. This is a condition that occurs at the very height of the disease. During this period, a person is always in motion (he cannot sit, stand or lie quietly). Observed involuntary contractions muscles that can interfere with the child’s eating (contractions of the muscles of the tongue, lips, and so on). They also spread to other muscle groups, and the following symptoms may appear:

• constant flashing;
• tongue sticking out;
• grimacing.

Please note that during sleep all symptoms of hyperkinesis disappear. In addition to all of the above symptoms, examination may reveal decreased muscle tone. No special examinations are required in severe forms, when it is visible to the naked eye. A child with severe illness cannot hold his head up or sit up. Typically, all symptoms last from three weeks to three months. Then they gradually subside. Be sure to keep in mind that relapses are quite common (the time of manifestation is about a year after the last case, sometimes much earlier).

With chorea, body temperature may rise slightly (up to 37.5 degrees). Swelling and pain in the joints may appear.

Causes

In this section of the article we will try to examine in detail the issue of the causes of rheumatism in children. As stated earlier, even modern medicine cannot give an exact answer to this question. There are several theories, and based on them, we can conclude: many factors can serve as reasons.

	Explanation
Recent infectious diseases	These include acute respiratory infections, tonsillitis, scarlet fever, tonsillitis, and so on. It is important to note that they are caused by group A streptococcus. It is worth clarifying that infection is not the main condition for the development of rheumatism. This requires a malfunction of the immune system. Only in this case does it begin to attack healthy cells. This manifests itself in cases where treatment was started untimely (belated) or it was simply incorrect.
The second factor is hereditary	In the course of a number of studies and surveys, it was found that hereditary factors also play a role in the development of rheumatism. It has been noted that this disease often occurs among members of the same family.
Long-term carriage of streptococcal infection	As a rule, streptococcus can live in the nasopharynx for a long time, as a result of which the immune system malfunctions. The result is the development of rheumatism.
Minor Factors	No matter how strange it may sound, there are other (minor) factors that can cause the development of rheumatism in childhood. These include: hypothermia, overwork, poor nutrition. How does this affect the development of the disease? It's simple, these factors have an adverse effect on the child's immune system. As a result, the likelihood of developing rheumatism increases several times.

Diagnostics

What is rheumatism in children (symptoms, photos, causes are given in the article), now, we hope, is clear. Let's move on to diagnosing the disease. To begin with, it must be said that absolutely anyone can suspect that a child has a disease, from parents and teachers to a pediatrician or rheumatologist.

The clinic of rheumatism in children (clinical manifestations) is varied. It is important to know the main criteria:

• carditis (any type);
• chorea ( this disease we paid a lot of attention earlier);
• the presence of nodules under the child’s skin;
• erythema;
• polyarthritis;
• recent streptococcal infection;
• hereditary factor.

If a child experiences at least one of the listed symptoms, it is necessary to immediately consult a doctor. In addition to these criteria, there are others:

• arthralgia;
• fever;
• altered blood counts.

For diagnosis, examination and questioning of the patient is not enough. To make an accurate diagnosis, it is necessary to conduct a series of laboratory tests, which include chest X-ray, ECG, EchoCG.

X-ray helps determine the configuration of the heart, ECG will show abnormalities in the heart (if any), EchoCG determines the presence of a heart defect.

Treatment

We looked at the diagnosis and symptoms of rheumatism in children. Treatment of the disease is the next question. In this case, an integrated approach is required. Treatment of rheumatism is aimed at:

• relief of symptoms;
• impact on streptococcal flora.

Rheumatism in children (symptoms, treatment and photos of which we are considering) is treated in a hospital. Please note that therapy is carried out even if this disease is suspected.

The child needs:

• bed rest with a gradual increase in vigorous activity;
• proper nutrition, the diet contains an increased amount of potassium;
• proper organization of leisure activities.

Drug therapy is based on:

• antibacterial drugs;
• hormonal;
• anti-inflammatory;
• vitamin complexes;
• potassium preparations;
• immunostimulants.

All these drugs help fight pathogenic microflora. As a result, the inflammatory process is relieved and the symptoms of the disease are noticeably reduced. It is important to note that drug treatment may have some side effects:

• development of ulcers;
• stomach bleeding;
• disturbances in the functioning of the endocrine glands.

Prevention

This section is devoted to the prevention of rheumatism in children. There are primary and secondary prevention. In the first case, attention is paid to the proper development of the child:

• hardening;
• proper nutrition;
• sport;
• fight against group A streptococcus infections.

Secondary is aimed at preventing relapses:

• “Bicilin 5” - 1.5 million units once every four weeks for schoolchildren;
• "Bicilin 5" dosage of 0.75 million units once every two weeks for preschoolers.

Forecast

Many mothers were able to cope with this disease by going to the hospital in time for medical help. If rheumatism is prevented, a relapse will not be life-threatening. We examined in detail the issue of rheumatism in children, symptoms, reviews. What are the forecasts?

Note that rheumatic carditis in approximately 25 percent of cases is accompanied by the development of heart disease. Repeated manifestations leave no chance of avoiding valve damage. As a result, cardiac surgery is necessary. The fatal outcome from heart failure is approximately 0.4%. It is worth noting that the outcome of the disease depends on the correctness and timeliness of treatment.

Rheumatism in children

Rheumatism in children– an infectious-allergic disease that occurs with systemic damage to the connective tissue of the cardiovascular system, synovial membranes joints, serous membranes of the central nervous system, liver, kidneys, lungs, eyes, skin.

With rheumatism, children may develop rheumatic polyarthritis, rheumatic carditis, minor chorea, rheumatic nodules, ring-shaped erythema, pneumonia, nephritis.

Diagnosis of rheumatism in children is based on clinical criteria, their connection with past streptococcal infection, confirmed by laboratory tests and markers. In the treatment of rheumatism in children, glucocorticoids, NSAIDs, quinoline and penicillin drugs are used.

Rheumatism in children (rheumatic fever, Sokolsky-Buyo disease) is a systemic inflammatory disease characterized by damage to the connective tissue of various organs and etiologically associated with streptococcal infection.

In pediatrics, rheumatism is diagnosed mainly in school-age children (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 long-lasting over many years, with alternating periods of exacerbations and remissions. Rheumatism in children is a common cause of acquired heart defects and disability.

Causes of rheumatism in children

The experience accumulated in rheumatology makes it possible to classify rheumatism in children as an infectious-allergic disease, which is based on an infection caused by β-hemolytic streptococcus of group A (M-serotype) and altered reactivity of the body.

Thus, a child’s incidence of 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 most patients of antistreptococcal antibodies - ASL-O, antistreptokinase, antistreptohyaluronidase, antideoxyribonuclease B, which have tropism for connective tissue.

An important role in the development of rheumatism in children is played by hereditary and constitutional predisposition.

In some cases, a family history of rheumatism can be traced, and the fact that only 1–3% of children and adults who have had a streptococcal infection develop rheumatic fever suggests the existence of a so-called “rheumatic diathesis.”

The leading virulence factors of β-hemolytic streptococcus are its exotoxins (streptolysin-O, erythrogenic toxin, hyaluronidase, proteinase), which cause pyrogenic, cytotoxic and immune reactions, causing damage cardiac muscle with the development of endomyocarditis, disorders of myocardial contractility and conductivity.

In addition, streptococcal cell wall proteins (lipoteichoic acid peptidoglycan, a polysaccharide) initiate and maintain the inflammatory process in the myocardium, liver, and synovial membranes.

M-protein of the cell wall suppresses phagocytosis, has a nephrotoxic effect, stimulates the formation of anticardiac antibodies, etc.

The basis for damage to the skin and subcutaneous tissue in rheumatism in children is vasculitis; rheumatic chorea is caused by damage to the subcortical nuclei.

The development of rheumatism in children is divided into active and inactive phases. The criteria for the activity of the rheumatic process are the severity of clinical manifestations and changes in laboratory markers, and therefore three degrees are distinguished:

• I (minimal activity)- absence of exudative component of inflammation; weak clinical and laboratory signs of rheumatism in children;
• II (moderate activity)– all signs of rheumatism in children (clinical, electrocardiographic, radiological, 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 radiological, electro- and phonocardiographic signs of carditis. Drastic changes laboratory parameters – high neutrophilic leukocytosis. Sharply positive CRP, high levels of serum globulins, a significant increase in titers of antistreptococcal antibodies, etc.

The inactive phase of rheumatism in children is observed 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, low-grade fever and malaise persist, and carditis progresses with the formation of valvular heart defects or cardiosclerosis.

The inactive phase of rheumatism in children can last from several months to several years.

The course of rheumatism in children can be acute (up to 3 months), subacute (from 3 to 6 months), prolonged (more than 6 months), continuously relapsing (without clear periods of remission lasting up to 1 year or more), latent (hiddenly 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, minor chorea, anular erythema and rheumatic nodules.

All forms of rheumatism in children are characterized by clinical manifestation 1.5-4 weeks after the previous streptococcal infection.

Heart damage during rheumatism in children (rheumatic carditis) always occurs; in 70-85% of cases – primary.

With rheumatism in children, endocarditis, myocarditis, pericarditis or pancarditis may occur.

Rheumatic carditis is accompanied by lethargy, fatigue of the child, low-grade fever, tachycardia (less often bradycardia), shortness of breath, and heart pain.

A repeated attack of rheumatic carditis, as a rule, occurs after 10-12 months and is more severe with symptoms of intoxication, arthritis, uveitis, etc.

As a result of repeated attacks of rheumatism, acquired heart defects are detected in all children: mitral regurgitation, mitral stenosis, aortic insufficiency, aortic stenosis, prolapse mitral valve, mitral-aortic disease.

In 40-60% of children with rheumatism, polyarthritis develops, both isolated and in combination with rheumatic carditis.

Characteristic signs of polyarthritis in rheumatism in children are the predominant damage to medium and large joints (knees, ankles, elbows, shoulders, less often - wrists); symmetry of arthralgia, migrating nature of pain, rapid and complete reverse development of articular syndrome.

Per share cerebral form Rheumatism in children (chorea minor) accounts for 7-10% of cases.

This syndrome mainly develops in girls and manifests itself emotional disorders(tearfulness, irritability, mood swings) and gradually increasing motor disturbances.

First, handwriting and gait change, then hyperkinesis appears, accompanied by impaired speech intelligibility, and sometimes the inability to independently eat and care for oneself. Signs of chorea completely regress after 2-3 months, but tend to recur.

Manifestations of rheumatism in the form of anular (ring-shaped) erythema and rheumatic nodules are typical for childhood. Ring-shaped erythema is a type of rash in the form of rings of pale pink color, localized on the skin of the abdomen and chest.

There is no itching, pigmentation or flaking of the skin. Rheumatic nodules can be found in the active phase of rheumatism in children in the occipital region and in the joint area, at the sites of tendon attachment. They look like subcutaneous formations with a diameter of 1-2 mm.

Visceral lesions in rheumatism in children (rheumatic pneumonia, nephritis, peritonitis, etc.) are practically never encountered at present.

Rheumatism in a child can be suspected by a pediatrician or 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 connection of the onset of the disease with streptococcal infection, the presence of a “rheumatic history” in the family , improving the child’s well-being after specific treatment.

The reliability of the diagnosis of rheumatism in children must be confirmed laboratory. Changes in the hemogram in the acute phase are characterized by neutrophilic leukocytosis, accelerated ESR, and anemia.

A biochemical blood test demonstrates hyperfibrinogenemia, the appearance of CRP, an increase in α2 and γ-globulin fractions and serum mucoproteins.

An immunological blood test reveals an increase in titers of ASH, ASL-O, ASA; increase in CEC, immunoglobulins A, M, G, anticardiac antibodies.

For rheumatic heart disease in children, chest x-ray reveals cardiomegaly, mitral or aortic configuration of the heart.

Electrocardiography for rheumatism in children can record various arrhythmias and conduction disturbances (bradycardia, sinus tachycardia, atrioventricular block, atrial fibrillation and flutter).

Phonocardiography allows you to record changes in heart sounds and noises indicating damage to the valve apparatus. In identifying acquired heart defects in rheumatism in children, echocardiography plays a decisive role.

Differential diagnosis of rheumatic carditis is carried out with non-rheumatic carditis in children, congenital heart defects, and infective endocarditis.

Rheumatic arthritis must be distinguished from arthritis of other etiologies, hemorrhagic vasculitis, SLE.

Presence of a child cerebral syndrome requires the involvement of a pediatric neurologist in the diagnosis and the exclusion of neurosis, Tourette syndrome, brain tumors, etc.

Treatment of rheumatism in children

Therapy for rheumatism in children should be comprehensive, continuous, long-term and gradual.

In the acute phase, inpatient treatment with restriction of physical activity is indicated: bed rest (for rheumatic heart disease) or gentle treatment for other forms of rheumatism in children.

To combat streptococcal infection, antibacterial therapy with penicillin drugs is carried out for a course of 10-14 days.

In order to suppress the active inflammatory process, non-steroidal (ibuprofen, diclofenac) and steroidal anti-inflammatory drugs (prednisolone) are prescribed.

With a prolonged course of rheumatism in children in complex therapy turn on basic drugs quinoline series (hydroxychloroquine, chloroquine).

At the second stage, treatment of rheumatism in children continues in a rheumatological sanatorium, where restorative therapy, exercise therapy, mud therapy, and sanitation of foci of infection are carried out.

At the third stage, observation of the child by specialists (pediatric cardiologist-rheumatologist, pediatric dentist, pediatric otolaryngologist) is organized in a clinic setting.

The most important area of ​​clinical observation is antibiotic prophylaxis of relapses of rheumatism in children.

Forecast and prevention of rheumatism in children

The primary episode of rheumatic carditis is accompanied by the formation of heart defects in 20-25% of cases; however, recurrent rheumatic carditis leaves no chance of avoiding damage to the heart valves, which requires subsequent cardiac surgery. Mortality from heart failure caused by heart defects reaches 0.4-0.1%. The outcome of rheumatism in children is largely determined by the timing of initiation and adequacy of therapy.

Primary prevention of rheumatism in children involves hardening, good nutrition, rational physical culture, sanitation 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 had rheumatic fever and include the administration of long-acting penicillin.

Rheumatism in children is called inflammatory systemic diseases, which primarily affects the cardiovascular system. The connective tissue of the heart is affected. Typically, the disease begins to be diagnosed in children over 7 years of age. Teenagers are also susceptible to it.

It is especially important to monitor the condition of children with genetic predisposition. Some infections can trigger the disease.

In particular, monitor your child after suffering from a sore throat, otitis media, sinusitis, or sinusitis. This is the main cause of the disease.

Complications due to streptococcal infection are also common.

Causes

Prevalence. The incidence of rheumatism averages 5 per 100,000 of the world's population, but in developing countries, according to WHO, it is much higher (2.2 per 1000 children).

In the Russian Federation, the prevalence of rheumatism is on average 0.3 per 1000 children. The primary incidence of children in Moscow is quite low (0.03 per 1000).

The development of rheumatism in children is caused by the activity of hemolytic streptococcus A. The enzymes secreted by this type of bacteria have a toxic effect on heart tissue.

In addition, such microorganisms have antigenic substances similar to heart tissue, which is why the child’s body attacks the heart, confusing it with an infectious agent (an autoimmune reaction develops).

Classification

The main division of joint rheumatism in children is based on the existence of two forms of the disease. Thus, the rheumatic process occurs:

Rheumatism in children can occur in three clinical forms: articular, cardiac and nervous. Much less common are types of disease such as cutaneous rheumatism and rheumopleuritis. The nervous form of the pathology is otherwise called rheumochorea. Most often found in girls. Depending on how active the disease is, there are 3 degrees of development of the pathological process:

• inactive;
• moderately active;
• as active as possible.

In the first case, exudation is not expressed. Clinical symptoms and laboratory changes are also mild.

For moderate activity characterized by the presence of all criteria for the disease (laboratory, instrumental, physical). However, they are expressed moderately.

If rheumatism is as active as possible, children develop a high temperature and the heart and joints are affected. There are pronounced laboratory and instrumental signs of the disease.

Sokolsky-Buyo disease can occur in acute, subacute and chronic forms. In the first case, the disease lasts no more than 3 months.

In subacute rheumatism, symptoms may persist for 3-6 months. If the disease lasts more than six months, we are talking about a protracted process.

Sometimes a continuously relapsing course of rheumatism is possible. It is characterized by the absence of clear periods of improvement.

This condition lasts up to a year or more. The most dangerous for children is the latent course.

With it, symptoms are mild or may be absent. All this makes it difficult to make a diagnosis.

This condition quietly leads to the development of heart defects.

Signs of childhood rheumatism

Symptoms of joint damage:

• 2-3 weeks after ARVI and other infections, weakness, joint pain, fever or simply high body temperature appear.
• Inflammation affects large and medium-sized joints.
• The joints become temporarily swollen.

Inflammation from one joint most often “jumps” to others. Gradually, the disease can affect the cardiovascular system.

The good news is that if rheumatism treatment is started in time, the consequences of the disease quickly disappear. Therefore, if your child begins to complain of pain in the legs and arms after a recent sore throat, acute respiratory infection or other infectious disease, do not ignore the symptom, but consult a doctor.

After a sore throat, a competent doctor will schedule a follow-up visit after a certain time. If necessary, it is better to get tested.

Sometimes joint pain goes away and children stop complaining about it. Parents calm down, thinking that the discomfort was caused by overwork.

But the primary symptoms cannot be ignored.

Rheumatism with damage to the cardiovascular system is manifested by the following symptoms:

• Weakness, increased fatigue during physical activity, even after walking.
• The skin is pale, bluish in color.
• Heart murmurs are heard.

Heart lesions are reflected on the ECG, so it is important to make a diagnosis in time. The cardiovascular system in childhood rheumatism is affected to varying degrees - from mild, barely noticeable, to heart defects.

Therefore, be attentive to children who are often sick, especially those who are prone to sore throats and other infections.

The third form of childhood rheumatism is nervous. Another name for the disease is “minor chorea.” What symptoms should parents be wary of?

The main symptom is joint damage, which develops against the background of infectious diseases (flu, scarlet fever, tonsillitis): a child may develop rheumatism immediately or after 15-20 days. Parents should be alert if, after suffering an acute respiratory infection, during recovery they appear following symptoms:

The first signs and symptoms of rheumatic changes in the body in children who have had an infection become noticeable only a few weeks after recovery.

At first, babies feel weakness and pain in the joints. Sometimes the temperature may rise, although to a small limit.

You should take your child to the doctor if your child or teenager gets tired easily and often feels weak after exercise or sports, or if he or she has chorea.

A sign of incipient rheumatism of the heart may be problems when rising even to a slight elevation and shortness of breath. Blue discoloration of the fingers is often observed.

When resting, children take a position that causes minimal pain in the sternum, in particular the heart. Rheumatic diseases in children can take the forms of myocarditis, endocarditis and pericarditis. How rheumatism is treated in children will be discussed below.

Symptoms

A similar disease has distinctive feature– it begins acutely, but there are alternating periods of exacerbation of symptoms and relapses.

All types of the course of the disease are characterized by one factor - the onset of manifestation approximately 1.5-4 weeks after the end of the course of the streptococcal infection.

Features of rheumatism in children are the variability and variety of clinical manifestations. The main symptomatic syndromes are:

It is noteworthy that the heart is predominantly affected - in such situations, myocarditis, pancarditis and pericarditis develop. Rheumatic carditis has the following symptoms:

• lethargy and general weakness of the body;
• rapid fatigue of children;
• slight increase in temperature;
• heart rate disturbance;
• shortness of breath - it appears not only after physical activity, but also at rest;
• source of pain in the heart.

Rheumatic carditis is characterized by repeated attacks that appear after about one year, and is supplemented by the appearance of signs of acute intoxication, arthritis and uveitis. Against the backdrop of a recurring course, all children are susceptible to heart complications.

Every second patient develops polyarthritis, which can occur either alone or in combination with rheumatic carditis. Specific symptoms rheumatism of the joints in children is represented by involvement in the pathology of medium and large segments of the upper or lower extremities.

Symptoms also quite often consist of:

• symmetry of joint pain and weakness;
• migration of pain;
• rapid and complete reversibility of the syndrome.

Damage to the nervous system in rheumatism is diagnosed in approximately 10% of situations and is expressed in the following clinical signs:

• increased tearfulness of the child;
• causeless irritability;
• frequent mood changes;
• increasing movement disorders;
• changes in handwriting and gait;
• hyperkinesis;
• speech disorder - it becomes slurred;
• inability to independently eat food and perform basic household tasks.

The above symptoms of rheumatism in children often disappear after three months, but it should be noted that they tend to regress.

Clinical picture of rheumatism

The disease most often develops 2 to 4 weeks after a sore throat, scarlet fever or acute nasopharyngitis. Diffuse lesion connective tissue causes pronounced polymorphism of the clinical picture.

The most typical manifestations of the disease in children are carditis (rheumatic carditis), polyarthritis, and chorea.

The onset may be acute or gradual and even unnoticed (in such cases, the diagnosis is made retrospectively on the basis of detected carditis or heart disease).

The first signs of the disease in most children are fever, malaise, and joint pain. The examination reveals changes in the heart, leukocytosis, increased ESR, anemia.

Sometimes rheumatism in children begins with chorea. Clinical severity individual symptoms and their totality can be very different depending on the nature of the course and the degree of activity of rheumatism.

Primary rheumatic carditis - this damage to the heart determines the severity and prognosis of the disease. Early manifestations in children are fever and general malaise. Complaints of pain or discomfort in the heart area are extremely rare.

Objective symptoms are determined by predominant damage to the myocardium, endocardium or pericardium. In children, the most common, and sometimes the only manifestation of cardiac pathology in rheumatism is myocarditis (100% of cases).

Clinically, in 75 - 80% of children, moderate and mild rheumatic carditis predominates, and in 20 - 25% - pronounced (most often in the puberty period).

During an objective examination, tachycardia and bradycardia may be observed; in a third of patients, the heart rate is normal. In the majority of patients (up to 85%), there is an expansion of the borders of the heart, mainly to the left (clinically and radiologically), with a weakening of heart sounds.

Almost everyone has a systolic murmur, often at the V point or at the apex, which does not extend beyond the cardiac region.

With pronounced myocarditis, the exudative component of inflammation predominates with diffuse changes in the myocardial interstitium. The general condition of the child is serious; pallor, shortness of breath, cyanosis, weak pulse, decreased blood pressure, and rhythm disturbances are noted.

The boundaries of the heart are significantly expanded, heart sounds are sharply weakened. Signs of heart failure also develop.

On the ECG, homotopic rhythm disturbances, slowing of atrioventricular conduction, as well as changes in bioelectrical processes in the myocardium (reduction and deformation of the G wave, downward displacement of the ST segment, prolongation of electrical systole) are most often observed.

The severity of ECG changes corresponds to the severity of the manifestation of rheumatic carditis.

On FCG, a decrease in amplitude, expansion and deformation of the first tone are noted. Pathological sounds III and IV can be detected, and a muscular systolic murmur is recorded.

Endocarditis is almost always combined with myocarditis and is observed in 50 - 55% of sick children. Valvulitis most often develops, mainly of the mitral valve, symptoms of which often appear from the first days of the disease.

Main clinical symptom is a systolic murmur of a “blowing” nature in the projection area of ​​the mitral valve (apex, V point). Over time, as well as in a lying position, on the left side and during physical activity, its intensity increases. The noise is well carried into the axillary region.

On FCG it is recorded as high- and mid-frequency pansystolic or protosystolic murmur of small or medium amplitude with an epicenter at the apex. On radiographs, in addition to the expansion of the left border, the mitral configuration of the heart is determined.

In approximately 10% of patients, the aortic valve is affected, which is manifested by a diastolic murmur along the left sternal border with a possible decrease in diastolic pressure. In this case, high-frequency - protodiastolic - noise of the same localization is recorded on the FCG.

Echocardiography records thickening of the mitral valve, changes in the nature of echo signals (“shaggyness”) 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; with a comprehensive instrumental study, including echocardiography, this percentage is much higher.

By nature, it can be dry, fibrinous and effusion - exudative. With fibrinous pericarditis, pain is possible and a pericardial friction noise is heard (intermittently) along the left edge of the sternum, which is compared to the rustling of silk or the crunch of snow underfoot.

A serial ECG study reveals pointed P waves and typical dynamics of changes in the ST interval and T wave. The echocardiogram shows thickening and separation of the epicardium and pericardium.

Effusion serous-fibrinous pericarditis affects general state sick. It sharply worsens, pallor is noticed, and with a large accumulation of exudate - puffiness of the patient’s face, swelling of the neck veins, shortness of breath, forced semi-sitting position in bed.

There may be chest pain, signs of hemodynamic disorders rapidly increase, intensifying in the horizontal position of the patient. Pulse is frequent, small in filling, arterial pressure reduced.

Sometimes the cardiac region bulges, the apical impulse is not detected. The boundaries of the heart are significantly expanded, the sounds are dull.

The ECG shows a decrease in the electrical activity of the myocardium. On the radiograph, along with the expansion of the boundaries and small amplitude of pulsation, the contours of the heart are smoothed, its shadow often takes the shape of a ball or trapezoid.

An echocardiogram reveals an echo-negative space separating the epi- and pericardium, the size of which can be used to judge the amount of exudate in the cavity of the cardiac membrane.

Most often, rheumatism develops at school age in the form of an acute attack, which is manifested by febrile temperature and symptoms of intoxication. As a rule, 2-3 weeks before the attack, a child is diagnosed with a respiratory disease. Along with fever, children experience joint pain (often large and medium-sized) and inflammation.

In the acute phase of the disease, the heart muscle becomes inflamed (rheumatic myocarditis develops), as indicated by the following symptoms:

• Weakness.
• Pale skin.
• Increased or slowed heart rate.
• Expanded boundaries of the heart.
• Dull or split tones.

In most children, these signs are mild, and in some children the general condition does not worsen. Also, every second child develops endocarditis, which mainly affects the aortic or mitral valve. Pericardial involvement is rare.

The first attack in children can affect not only the joints and heart, but also other organ systems. Some babies experience skin damage in the form of erythema or the appearance of subcutaneous nodules, abdominal pain, involuntary movements of the limbs due to damage to the nervous system (they are called minor chorea). With chorea movement disorders accompanied by emotional disturbances.

Relapses of the disease begin acutely and occur with the same symptoms as the first attack. In this case, the main symptoms depend on the cardiac pathology. Rheumatism most often causes the formation of the following defects:

• Mitral valve insufficiency.
• Aortic valve insufficiency.
• Mitral stenosis.
• Aortic stenosis.

Diagnostics

A pediatrician or pediatric rheumatologist knows how to treat rheumatism and how to recognize it in a child, based on the presence of one or more characteristic clinical syndromes in the patient. Despite this, a whole range of measures is involved in diagnosing the disease.

First of all, the clinician must independently:

• study the medical history to establish the fact of a previous streptococcal infection;
• collect and analyze the patient’s life history to identify predisposing factors that could increase the chances of developing such a disease;
• carefully examine the patient - this should include assessing the condition of the skin and motor functions, measuring temperature and heart rate;
• interview the patient or his parents in detail to determine the intensity of symptoms, which will make it possible to determine the nature of the course of inflammation.

Laboratory diagnosis of rheumatism in children consists of:

• general clinical blood test;
• blood biochemistry;
• immunological tests;
• serological tests;

Among the instrumental procedures, the most valuable are:

• X-ray of the sternum;
• phonocardiography;
• ECG and EchoCG.

Rheumatism in a child should be differentiated from:

To make a correct diagnosis, you will need:

• laboratory test;
• collection of anamnesis of the disease;
• medical examination of the child;
• physical examination;
• instrumental research.

Clinical criteria (presence of carditis, polyarthritis, chorea, nodes or erythema) are of great importance. When interviewing a child or his parents, it is important to establish the fact of an infectious disease (sore throat, scarlet fever).

Using laboratory analysis for rheumatism, it is possible to detect an increase in the content of C-reactive protein, dysproteinemia, an increase in ESR, leukocytosis, eosinophilia, an increase in fibrinogen, and mucoproteins.

An important sign is the detection of Ig G, A, M in the blood, as well as anticardiac antibodies, antistreptolysin, antihyaluronidase and antistreptokinase.

From instrumental methods diagnostics applied X-ray examination chest, phonocardiography, ECG, MRI, CT, ultrasound of the heart and blood vessels.

It is important to exclude pathology with similar symptoms (congenital heart defects, non-rheumatic endocarditis, systemic lupus erythematosus, vasculitis and arthritis of other origins).

Treatment of rheumatism in children is carried out in 3 stages and includes in-patient therapy, sanatorium-resort treatment and dispensary observation.

Children are hospitalized. During an exacerbation, treatment involves bed rest, limiting exercise, using antibiotics (protected penicillins), NSAIDs (Diclofenac, Ibuprofen) and glucocorticosteroids.

For prolonged rheumatism, Plaquenil or Delagil is used. Next, sanatorium-resort treatment is carried out.

What do they prescribe at the sanatorium? The main task of this stage is strengthening the body and rehabilitation. In this situation, exercise therapy, massage, mud therapy, physiotherapy, and vitamin therapy are indicated.

After all this, the child should be observed by a doctor. Prevention of relapse includes the use of antibiotics.

Thus, rheumatism in childhood can lead to serious consequences and even death of the child - which is why treatment and diagnosis must be timely.

Diagnosis of rheumatism in children

The diagnostic criteria for rheumatism were developed by A.A. Kisel (1940), Jones (1944), supplemented by A.I. Nesterov (1963).

Main manifestations

• Carditis.
• Polyarthritis.
• Chorea.
• Subcutaneous nodules.
• Ring-shaped erythema.
• “Rheumatic” history (connection with a previous nasopharyngeal streptococcal infection, presence of cases of rheumatism in the family).
• Proof of exjuvantibus is an improvement in the patient’s condition after a 23-week course of specific treatment.

Additional manifestations of rheumatism

• Increased body temperature.
• Adynamia, fatigue, weakness.
• Paleness of the skin.
• Sweating.
• Nosebleeds.
• Abdominal syndrome.

B. Special (laboratory indicators)

Leukocytosis (neutrophilic).

Dysproteinemia: increased ESR, hyperfibrinogenemia, appearance of CRP, increased concentration<х2 и углобулинов, повышение концентрации сывороточных мукопротеинов.

Changes in serological parameters: the appearance of streptococcal Ag in the blood, increased titers of antistreptolysinO, antistreptokinase, antistreptohyaluronidase.

Increased capillary permeability.

Currently, the most common WHO criteria (1989), developed by the American Rheumatological Association (Table).

Table. Criteria for diagnosing rheumatism

Evidence of streptococcal infection

Increased titer of antistreptococcal AT, antistreptolysin O, group A streptococcus cultured from the throat, recent sore throat.

The presence of two major or one major and two minor criteria in a patient indicates a high probability of acute rheumatism, especially with confirmed data on a previous infection caused by group A streptococci.

Differential diagnosis for the treatment of rheumatism in children

Rheumatic polyarthritis is differentiated from reactive arthritis, the onset of JRA and juvenile spondyloarthritis, SLE, and hemorrhagic vasculitis. Rheumatic carditis should be distinguished from non-rheumatic carditis, MVP, congenital heart disease, and infective endocarditis.

Chorea is differentiated from functional tics, hyperkinesis in SLE, thyrotoxicosis, and brain tumors.

To identify rheumatism in a child, its clinical symptoms and examination results are assessed, which are divided into basic and additional criteria.

Diagnosis requires the presence of two main criteria, or one main and two additional ones.

To clarify the diagnosis, the following examination methods are used:

• Blood test - general, biochemical, immunological.
• Chest X-ray.
• Electrocardiography.
• Echocardiography.

Modern pediatrics has methods and materials that make it possible to identify rheumatic heart disease in a child and its symptoms in the early stages, when it is effectively treated. Chorea is also detected. With a high degree of probability, you can suspect rheumatism in a child:

• for any manifestations of carditis;
• in the case when chorea is diagnosed;
• if the formation of subcutaneous nodes is noticed;
• after suffering erythema;
• when signs of polyarthritis or streptococcal infection are noticed;
• if a genetic predisposition to this disease is identified.

In addition, a pediatrician or rheumatologist can refer the child for laboratory tests, which include:

• fluoroscopy of the child's chest;
• electrocardiogram,

These tests, in addition to identifying rheumatic pathologies in a child, avoid many complications.

Treatment

If a diagnosis is made, comprehensive treatment is usually prescribed. Sometimes it takes several months to completely eliminate the consequences of the disease.

During therapy, the main thing is to eliminate the source of infection, streptococci are especially insidious. With the help of medications, foci of inflammation are removed and the immune system is strengthened.

Treatment in a hospital is often required, so do not be afraid to go to the hospital, listen to the recommendations of doctors. Physiotherapeutic procedures and physical therapy are included in the complex treatment of rheumatism in children.

It is important to pay attention to diet; nutrition should be rational and contain many vitamins and essential microelements. Magnesium and potassium are especially necessary during the recovery period.

After hospitalization, you may need sanatorium treatment or semi-bed rest at home. A child who has suffered from rheumatism in any form should be observed by a doctor for some time.

Elimination of such a disease is carried out only with the help of conservative methods.

The initial stage of treatment for rheumatism in children lasts approximately 1.5 months and includes:

• strict bed rest;
• gradual expansion of physical activity;
• breathing exercise;
• gentle diet;
• exercise therapy course;
• taking antibiotics, NSAIDs, antiallergic substances, diuretics, immunomodulators, heart medications.

Often patients need a nursing process for rheumatism, which consists of adequate care for the child.

The second step in treating the disease is aimed at rehabilitating the patient, which consists of a three-month sanatorium stay. In this case, it is also necessary to use medications, but in half the dose. This is supplemented by exercise therapy for rheumatism, a nutritious diet and vitamin therapy.

The third stage is clinical observation. This is done to early detect relapses of the disease and prevent the development of complications. The question of the possibility of resuming studies is decided on an individual basis. In total, treatment of rheumatism in children can take several years.

In addition, all patients must adhere to a gentle diet, the rules of which include:

• all food should be easily digestible;
• enriching the menu with proteins and vitamins;
• a large amount of fruits and vegetables;
• ingestion of large amounts of liquid;
• exclusion of difficult-to-digest foods;
• reducing daily amounts of table salt to 5 grams;
• limited consumption of carbohydrates and sweets;
• frequent and fractional food consumption.

Our country has developed a coherent system of measures, including the provision of therapeutic and preventive care to the population at various stages of the pathological process.

The key to successful treatment is early diagnosis, which means recognition of rheumatism in the first 7-10 days from the onset of the attack, as well as early initiation of therapy (from 10-14 days).

The main principles of pathogenetic therapy for 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:

Every child with active rheumatism must be treated in a hospital (stage 1). The correct organization of the motor regime is extremely important.

Patients with rheumatic carditis of II-III degree of activity should be on strict bed rest for 1-2 weeks, and then another 2-3 weeks on bed rest with possible participation in board games in bed.

During this period, breathing exercises and passive movements are indicated. After 1 - 1/2 months (taking into account the results of functional tests), children are transferred to a gentle regimen with permission to use the dining room and toilet; The physical therapy complex is expanding.

Subsequently, in the sanatorium (stage 2), the children are transferred to the training regime. The diet should be easily digestible, enriched with protein, vitamins and foods containing potassium salts.

Table salt is limited to 5-6 g per day and liquid, especially in case of circulatory failure. To treat rheumatism, split meals are recommended (5 - 6 times a day).

Indigestible foods, pickles, and extractive substances are excluded. Sometimes fasting days are carried out (in case of circulatory failure of II - III degree).

Treatments for rheumatism in children

Drug therapy includes antibacterial drugs aimed at eliminating streptococcal infections, non-steroidal anti-inflammatory and immunosuppressive drugs, as well as symptomatic (diuretics, cardiac) and corrective drugs.

Penicillin or its analogues are prescribed in an age-appropriate dose for 12 to 15 days. At the same time, acetylsalicylic acid or pyrazolone drugs are used.

Acetylsalicylic acid is prescribed at the rate of 0.2 g, amidopyrine - 0.15 - 0.2 g per 1 year of a child’s life per day.

Corticosteroids have a rapid anti-inflammatory and anti-allergic effect, which are especially indicated for primary rheumatic carditis and a pronounced exudative component of inflammation.

Prednisolone is usually used, prescribed at a dose of about 0.75 - 1 mg/kg per day. The duration of use of the maximum daily dose of prednisolone is determined by the results of treatment.

Its reduction begins when the patient’s condition improves, fever, exudative component are eliminated, and ESR is normalized. The total duration of the course of treatment is 30 - 40 days; with a continuously relapsing course of rheumatism, it may be longer.

In recent years, new anti-inflammatory non-steroidal drugs have become widespread - voltaren and indomethacin, which are successfully used in the general treatment complex.

With a protracted and continuously relapsing course in children, long-term use of quinoline drugs (Delagil, Plaquinil) at 5 - 10 mg/kg per day is indicated.

Discharge from the hospital is carried out after 11/2~2 months, subject to improved health, clear positive dynamics of the pathological process and a decrease in its activity.

Aftercare and rehabilitation of patients (stage 2) is carried out in a local sanatorium for 2 - 3 months. At this stage, drug treatment continues at half the dose, the volume of physical activity expands, therapeutic exercises, general strengthening measures, and aeration are carried out.

Children receive adequate nutrition and vitamins.

In the acute period, the disease is treated in a hospital, since the child requires bed rest. Drug treatment includes antibiotics, anti-inflammatory drugs (including hormonal drugs in severe cases), potassium supplements, vitamins and other medications.

The child stays in the hospital for 1.5-2 months, after which he undergoes a rehabilitation period.

For rheumatism, treatment is usually carried out in a hospital, especially in the acute stage of the disease, if there are pronounced symptoms. A severe form of the disease requires bed rest. How long it will last directly depends on the baby’s well-being and the nature of the rheumatic infection itself.

If chorea is detected in a relatively mild form, then the patient can be released from bed rest after a month, after which exercise therapy will be required.

Drug therapy for rheumatism of the heart in children and adolescents consists of combating the causative agent of rheumatic infection, that is, hemolytic streptococcus.

For this purpose, antibacterial drugs are used, which are based on penicillin, if the child is not allergic to it.

If, due to rheumatism, the heart muscle or the septum of that organ has undergone changes, glucocorticoids in combination with NSAIDs are used for therapy. Currently, doctors often prescribe anti-inflammatory drugs Metindol and Voltaren for rheumatic diseases.

Under no circumstances should you try to relieve the pain of rheumatism with massage performed by unqualified persons. All procedures must be prescribed exclusively by a doctor.

Possible complications

In situations where the signs of rheumatism in children go unnoticed and there is no treatment at all, there is a high risk of the following complications:

Prevention

• prevention of streptococcal infection;
• hardening and other methods of strengthening the immune system;
• fight against chronic infectious processes;
• healthy and balanced diet;
• avoiding physical and emotional stress;
• spending a lot of time in the fresh air;
• giving up bad habits – applies to teenagers;
• regular examination by a pediatrician.

Prevention of complications involves the administration of penicillin for three years - the dosage must correspond to the age category of the patient, as well as annual (5 years) sanatorium treatment.

The prognosis for this disease is relatively favorable - heart defects develop in only every fifth patient. The fatal outcome from heart failure is 0.4%. In general, the outcome of the disease is dictated by the timing of the start of therapy and its adequacy.

Since there are no vaccines to prevent the disease, the main preventive measure to prevent the disease is the general strengthening of the child’s body:

• risk group - long and frequently ill children- should be seen by a rheumatologist
• good nutrition
• physical exercise
• hardening.

If your child has been diagnosed with rheumatism, do not become discouraged. Rheumatism in children is a dangerous and formidable disease, but medicine does not stand still and successfully copes with this disease.

Haven't liked it yet?

20.07.2016 Doctor kids

In order to prevent the development of rheumatism in childhood, it is important to exclude situations where the child is infected with streptococcal infection. This type of prevention is called primary prevention and includes:

• Complete nutrition.
• Hardening procedures.
• Moderate physical activity.
• Optimal daily routine with sufficient rest.

If streptococci have caused a respiratory tract disease in a child, it is very important to promptly and completely cure such an infection. To prevent rheumatism from progressing and the number of relapses to decrease, secondary prevention is also needed, which consists of the use of long-acting antibiotics.

The symptoms of rheumatism were first described by the ancient Greek physician Hippocrates. In his medical treatise, he mentioned fever and migrating joint pain. It was believed that this pathology was caused by a toxic liquid spreading through the blood vessels. This is where the name “rheumatism” came from, which translated from Greek means “fluidity.” The disease was identified as a separate nosological unit in the 19th century after the works of Sokolsky and Buyo, outstanding specialists in medical practice. They associated a history of streptococcal infection with further damage to connective tissue elements in the cardiovascular system, joints and other organs.

In pediatrics, rheumatism is a pressing problem, despite the constant improvement of diagnostic and treatment methods. According to research, the prevalence of the disease ranges from 0.3 to 18.6 cases per 1 thousand school-age children. It depends on the level of socio-economic development of the region. Recently, rheumatism in children has been reported somewhat less frequently, which indicates the progressive efforts of the medical industry in all countries of the world.

CAUSES

Nasopharyngeal infection caused by certain strains of streptococcal bacteria plays a key role in the development of rheumatism. It has been proven that the pathogenic microorganism belongs to group A.

At the end of the last century, a toxic-immunological hypothesis of the pathogenesis of the disease was formulated. Experts from the World Health Organization have identified 2 main links in the formation of rheumatism.

Toxic-immunological hypothesis:

• Damage to cardiac tissue by waste products and toxic enzymes secreted by streptococci.
• The development of an autoimmune inflammatory process due to the similarity of the antigenic structure of cardiomyocytes with some strains of the pathogen. This proximity allows not only streptococci to remain in the human body for a long time, but also makes heart cells a target for their own specific immune complexes.

The pathogenesis of childhood rheumatism is not fundamentally different from the above hypothesis.

In addition to streptococcal infection of the nasopharynx, predisposing factors play an important role in the development of rheumatism in children, which include:

• genetic predisposition;
• the presence of foci of chronic infection in the oral cavity or respiratory organs;
• defects in the child’s immune system;
• endocrine pathology.

CLASSIFICATION

The modern classification of pathology was proposed by the founder of the national school of rheumatologists A.I. Nesterov. He divided the disease according to four main criteria:

• degree of activity;
• the nature of the flow;
• severe circulatory failure;
• the nature of organ lesions.

Depending on the severity of each criterion, symptoms and treatment in children change.

SYMPTOMS

Symptoms of rheumatism in children appear within 15–20 days after a nasopharyngeal infection. The first attack of the disease is characterized by a staged development of the clinical picture.

The patient has the following complaints:

• increase in body temperature to 38–39 degrees;
• general weakness;
• insomnia;
• decreased appetite;
• headache and muscle pain.

At the same time as signs of intoxication, symptoms of joint damage appear.

Characteristics of polyarthritis:

• Large joints are most often affected;
• the location of pain changes;
• the intensity of the pain syndrome is high, due to which the range of active movements is significantly reduced;
• rapid regression of symptoms when using anti-inflammatory drugs.

Such signs of rheumatism in children indicate the acute phase of the disease and are observed in 80% of cases. With weak activity of the inflammatory process, symptoms of polyarthritis may be absent.

Heart damage

In children, rheumatism is accompanied by various heart lesions, the most common of which is myocarditis. Most patients note minor signs of pathology, including:

• change in general condition;
• pale skin;
• interruptions in heart function;
• discomfort in the chest.

With high activity of the autoimmune inflammatory process, other organs and systems are affected.

Extracardiac pathology:

• Damage to the nervous system is manifested by decreased attention, increased irritability, and involuntary contractions of the body muscles.
• Involvement of the pleura in the pathological process is accompanied by pain, intensifying at the height of inspiration, shortness of breath, and the appearance of a dry cough.
• With rheumatism with a predominance of dermatological symptoms, patients develop erythema, petechial rash, and nodules.
• It is quite rare to diagnose abdominal syndrome - pain in the abdominal cavity, disturbance of physiological functions, nausea and vomiting

DIAGNOSTICS

Special criteria developed by specialists from the World Health Organization help diagnose rheumatism in children. The presence of 2 major or 1 major and two minor criteria with a confirmed streptococcal infection in the anamnesis indicates a high risk of developing rheumatism in children.

Large criteria:

• heart damage;
• multiple inflammatory process in the joints;
• pathology of the nervous system;
• erythema;
• rheumatic nodules.

Minor criteria:

• increased body temperature;
• pain in the joints;
• increased erythrocyte sedimentation rate;
• the appearance of acute phase proteins;
• changes in the electrocardiogram.

It is worth remembering that rheumatism in children does not have specific symptoms, so early detection and treatment of rheumatism in children with such symptoms depends on the qualifications of the doctor. In addition to a number of basic studies, the pediatrician may prescribe additional methods for differential diagnosis:

• phonocardiography, which allows you to determine the characteristics of a heart murmur and determine its location;
• echocardiography is an ultrasound method for studying the structural elements of the cardiovascular system;
• determination of the titer of antistreptococcal immune complexes.

The syndromic diagnosis proposed by Nesterov is highly effective for the early detection of rheumatism. It includes 3 components:

• Anamnestic connection with a previous streptococcal infection.
• Clinical and immunological syndrome - asthenic manifestations of the disease in combination with an increase in the titer of specific antibodies.
• Cardiovascular syndrome is instrumental confirmation of damage to the heart muscle, joints, and internal organs.

TREATMENT

When treating rheumatism in a child, an integrated approach is used. It is important not only to alleviate the symptoms of the disease, but also to influence the cause - the streptococcal flora. The necessary therapy is carried out in a hospital setting, even if rheumatism is suspected.

General activities:

• bed rest for the entire period of the acute phase of the disease with a gradual expansion of activity;
• therapeutic nutrition with increased potassium content;
• proper organization of the child’s leisure time.

Drug therapy

To combat pathogenic microflora, reduce the activity of the autoimmune inflammatory process and reduce symptoms, use:

• antibacterial drugs of the penicillin series;
• hormonal therapy;
• non-steroidal anti-inflammatory drugs;
• multivitamin complexes;
• potassium preparations;
• immunostimulants.

Side effects of therapy:

• development of ulcerative defects in the digestive tract;
• stomach bleeding;
• disruption of the functioning of the endocrine glands.

In the treatment of symptoms of childhood rheumatism of the legs, special orthopedic devices are used to relieve stress from the inflamed joints of the lower extremities.

COMPLICATIONS

In a child, rheumatism can be complicated by the following conditions:

• Development of heart defects. The mitral and aortic valves are most often affected. This is accompanied by hemodynamic disturbances, the development of hypertrophy of the corresponding parts of the heart and congestion in the pulmonary or systemic circulation.
• Heart failure, manifested by a decrease in the contractility of the heart, disturbance of its rhythm.
• Pericarditis, developing as a result of involvement of the pericardial sac in the pathological process.
• Bacterial embolism of small capillaries of internal organs.

PREVENTION

Prevention of rheumatism in children is divided into two main areas:

• primary;
• secondary.

Primary prevention

According to the recommendations of the World Health Organization, primary prevention is aimed at preventing infection with streptococcal infection and adequate therapy when the first symptoms of childhood rheumatism appear. In the latter case use:

• penicillin antibacterial agents;
• anti-inflammatory drugs;
• other etiotropic and symptomatic medications.

Secondary prevention

It is used to prevent recurrent rheumatic attacks. It is based on the constant year-round use of bicillin preparations. The duration depends on the activity of the inflammatory process, the frequency of relapses, the presence of complications and can range from three to five years.

Non-drug methods of prevention:

• balanced diet rich in vitamins;
• normalization of physical activity;
• sanitation of foci of chronic infection;
• spa wellness.

PROGNOSIS FOR RECOVERY

The prognosis for rheumatism in children directly depends on the severity of cardiac damage, because after the first attack of the disease, heart defects occur in a sixth of patients.

Factors that worsen the prognosis:

• excessive or minimal activity of the inflammatory process;
• early appearance and rapid progression of circulatory failure;
• frequent repeated attacks of the disease;
• cases of death from rheumatic lesions in close relatives.

In children with rheumatism of the heart, adequate therapy and preventive measures aimed at preventing complications play an exceptional role. The clinical experience of healthcare professionals shows that with full treatment in the first three days after the initial attack, significant cardiac damage can be avoided.

Found a mistake? Select it and press Ctrl + Enter

Rheumatism is a systemic inflammatory disease of connective tissue with possible damage to the heart. This disease does not only affect adults. Rheumatism in children is also common. More than two-thirds of cases are observed in children from ten to fifteen years of age, about twenty percent of cases are from one to five years of age; in younger children, rheumatism occurs very rarely.

The concept of rheumatism includes three forms of the disease - articular, cardiac and nervous. Each of them has its own characteristics and, accordingly, its own symptoms.

Articular shape

So, signs of the disease identified in the area of ​​the joints indicate an articular form of rheumatism. The causes of the disease in this case are most often various infections. For example, children's rheumatism in some cases begins due to a sore throat; in such a case, the infection affects the child's tonsils. You can see the principle of development in the photo. In addition, scarlet fever can serve as a reason for the development of rheumatism. But in any case, the true causes of the disease lie not in the pathogen itself, but in the allergic restructuring of the body, in which rheumatism is caused by streptococci. In part, the reasons may lie in simple hypothermia.

Symptoms of the disease are pain in the joints of the legs, most often the knees and ankles. The child also experiences an increase in temperature and swelling of the affected areas of the legs. Typically, pain moves from one part of the body to another, from one joint to another and rarely appears in the area of ​​the same joints for more than a week; most often, pain in one place lasts two to three days. In some cases, the child does not have a fever and there is no swelling in the affected areas, but there are complaints of pain in the joints of the arms or legs, which are also signs of rheumatism. The pain may go away quickly enough, but there is a danger of heart damage. It is important to recognize the symptoms of the disease in time and begin treatment of the joints in order to protect the child from severe manifestations of rheumatism, especially those affecting the heart.

Heart shape

Another form of the disease is cardiac. In this case, rheumatism carries the risk of heart valve disease. The symptoms in this situation are different. First of all, they touch the heart. The child does not complain of pain in the joints of the arms or legs. Signs in this case are fatigue during running and rapid heartbeat. It is necessary to urgently consult a doctor, be examined and make an accurate diagnosis. A late visit to the doctor can put your heart at risk. Rheumatism is a dangerous disease that should not be joked with.

Nervous form

Rheumatism, which occurs with the participation of the nervous system, first causes mental disorders in the child, for example, excessive excitability and irritability, the child often cries for no reason. Twitching of the muscles of the face, arms, and legs often begins. A child with these symptoms and signs should be seen by a doctor immediately. This form of the disease threatens paralysis and speech problems. This type of rheumatism is also called chorea and is most often observed not in adults, but in children and adolescents. Moreover, girls are susceptible to it much more often than boys.

Prevention

An important component of the fight against this disease. Prevention involves a number of rules: it is necessary that the body does not become overcooled, it is important to keep the feet warm, the child’s body must receive enough vitamins and minerals. Proper nutrition is important. You should carefully monitor the hygiene of the oral cavity and tonsils, since it is through these routes that infection usually enters the body.

It is necessary to support the child’s immunity to avoid common diseases, such as sore throats and colds. Hardening helps to maintain immunity; it is recommended to take multivitamin complexes created specifically for children, who especially need useful substances due to their growth. In case of immunodeficiency, immunostimulant drugs are used. But when choosing a drug, you need to consult a doctor.

If various signs of inflammatory diseases occur, the child requires bed rest and ingestion of large amounts of fluid in order to remove the microbes that cause inflammation from the child’s body as quickly as possible. It is also necessary to periodically visit a specialist to check the functioning of the heart. Prevention of rheumatism in children will help to significantly reduce the percentage of cases.

Treatment

With rheumatism, it is necessary to notice the signs of the disease in time, make an accurate diagnosis and begin treatment. Timely diagnosis of rheumatism is very important. With rheumatism, especially in children, self-medication is inappropriate, so a specialist must take care of children's health.

A sick child diagnosed with rheumatism must be treated in a hospital, observing strict bed rest for one to two weeks. The next stage, which takes about two to three weeks, is the same bed rest, but in a less strict version. For example, a child is allowed to participate in board games and does breathing exercises.

After which the patient is transferred to a regime with visits to the dining room and toilet. In the treatment of rheumatism, a diet containing all the necessary vitamins and minerals, including potassium salt, plays a huge role. It is recommended to take food several times a day in small portions. Salty foods and hard-to-digest foods should be excluded from the diet.

If rheumatism takes a nervous form, it is necessary to take into account that the patient needs complete rest, so it is better to keep him in a separate room. Soothing warm baths are indicated. Coffee and cocoa, which can negatively affect the child’s nervous system, should be excluded from the diet.

Folk remedies

Among the folk remedies there are those that improve the condition of joints in childhood rheumatism. Naturally, treatment of children must be carried out in consultation with a doctor.

It is useful for a child with a disease of the joints of the legs to eat wild berries, such as blueberries, lingonberries and cranberries. It is also good to include watermelon in your child's diet. Before breakfast, mix the juice squeezed from lemon with hot water and give it to your child to drink. Extremely beneficial honey is highly recommended. It is useful to mix it with cranberry and lingonberry juice.

In case of pain in the joints of the legs, make compresses from potato pulp (grate fresh potatoes). The photo shows the sequence of this procedure. Compresses are also made from aspen leaves. Fresh leaves must be steamed first. To prepare medicinal foot baths that can cope with rheumatism, use black currant leaves and a decoction made from pine buds. Another remedy available in the summer is a decoction of black currant leaves; you need to drink half a glass three times a day.

At the present stage, the situation with rheumatism is improving. The incidence of severe manifestations of the disease has become much less frequent, and the number of deaths has decreased significantly. This is due to the constant fight against streptococcal infections.

Parents must remember that hardening, taking vitamin complexes and supporting children's immunity are the main components of the prevention of rheumatism and other serious diseases in children. We wish you and your baby health with all our hearts!