Rheumatism in children: symptoms and treatment

Rheumatism in children

Rheumatism in children- Infectious-allergic disease, which proceeds with systemic involvement of connective tissue cardiovascular system, synovial membranes of the joints, serous membranes of the central nervous system, liver, kidneys, lungs, eyes, and skin.

With rheumatism, children can develop rheumatic polyarthritis, rheumatic carditis, small chorea, rheumatic nodules, annular erythema, pneumonia, nephritis.

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

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

In pediatrics, rheumatism is diagnosed mainly in children of school age (7-15 years). The average population frequency is, the case of rheumatism per 1000 children. Rheumatism in children is characterized by an acute onset, often prolonged, over the years, with a course with alternating periods of exacerbations and remissions. Rheumatism in children is a common cause of the formation of acquired heart defects and disability.

Causes of rheumatism in children

The experience accumulated in rheumatology allows to attribute rheumatism in children to an infectious-allergic disease, in the basis which is caused by an infection caused by beta-hemolytic streptococcus of group A (M-serotype), and altered reactivity organism.

Thus, the incidence of a child with 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 the majority of patients anti-streptococcal antibodies - ASL-O, antistreptokinase, anti-streptogialuronidase, antidexoxyribonuclease B, which have tropicity to connective tissue.

An important role in the development of rheumatism in children is assigned to hereditary and constitutional predispositions.

The leading factors of virulence of β-hemolytic streptococcus are its exotoxins (streptolysin-O, erythrogenic toxin, hyaluronidase, proteinase), causing pyrogenic, cytotoxic and immune reactions that cause damage to the heart muscle with the development of endomyocarditis, contractility and conduction of the myocardium.

In addition, the proteins of the cell wall of streptococcus (lipoteichoic acid peptidoglycan, polysaccharide) initiate and support the inflammatory process in the myocardium, liver, synovial membranes.

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

In the basis of lesions of the skin and subcutaneous tissue in rheumatism in children lies vasculitis; Rheumatic chorea is caused by the defeat of subcortical nuclei.

In the development of rheumatism, children are allocated active and inactive phases. Criteria for the activity of the rheumatic process are the severity of clinical manifestations and changes in laboratory markers, in connection with which three degrees are distinguished:

• I (minimum activity)- absence of exudative component of inflammation; weak severity of clinical and laboratory signs of rheumatism in children;
• II (moderate activity)- all signs of rheumatism in children (clinical, electrocardiographic, radiographic, laboratory) are not clearly expressed;
• III (maximum activity)- the predominance of the exudative component of inflammation, the presence of high fever, signs of rheumatic carditis, articular syndrome, polyserositis. The presence of distinct X-ray, electro- and phonocardiographic signs of carditis. Sharp changes in laboratory parameters - high neutrophilic leukocytosis. Sharply positive CRP, a high level of serum globulins, a significant increase in anti-streptococcal antibody titers, etc.

The inactive phase of rheumatism in children is noted 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 is preserved subfebrile and malaise, there is a progression of carditis with the formation of valvular heart disease or cardiosclerosis.

The course of rheumatism in children can be acute (up to 3 months), subacute (from 3 to 6 months), protracted (more than 6 months.), continuously-relapsing (without clear periods of remission of up to 1 year or more), latent (secretly leading to the formation 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, small chorea, anuricular erythema and rheumatic nodules.

For all forms of rheumatism, children manifest a clinical manifestation 4 weeks after the previous streptococcal infection.

The defeat of the heart with rheumatism in children (rheumatic heart disease) always occurs; in 70-85% of cases - primarily.

With rheumatism, children may experience endocarditis, myocarditis, pericarditis, or pancarditis.

Rheumatic carditis is accompanied by lethargy, fatigue of the child, subfebrile condition, tachycardia (rarely bradycardia), shortness of breath, pain in the heart.

Repeated attack of rheumatic heart disease usually occurs after 10-12 months and proceeds more severely with symptoms of intoxication, arthritis, uveitis, etc.

As a result of repeated attacks of rheumatism, all children are diagnosed with acquired heart defects: mitral insufficiency, mitral stenosis, aortic insufficiency, aortic aortic stenosis, mitral valve prolapse, mitral-aortic vice.

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

Cerebral form of rheumatism in children (small chorea) accounts for 7-10% of cases.

This syndrome mainly develops in girls and is manifested by emotional disorders (crying, irritability, change of mood) and gradually growing motor violations.

First, handwriting and gait change, then there are hyperkinesis, accompanied by a violation of the intelligibility of speech, and sometimes - the inability to eat and self-serve independently. The signs of chorea completely regress after 2-3 months, but tend to recur.

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

Itching, pigmentation and peeling of the skin are absent. Rheumatic nodules can be found in the active phase of rheumatism in children in the occipital region and in the region of the joints, in the places of attachment of tendons. They have the appearance of subcutaneous formations 1-2 mm in diameter.

Visceral lesions in rheumatism in children (rheumatic pneumonia, nephritis, peritonitis, etc.) are practically not found at present.

Rheumatism in a child may be suspected by a pediatrician or a children's rheumatologist based on the following clinical criteria: one or more clinical syndromes (carditis, polyarthritis, chorea, subcutaneous nodules or annular erythema), debut connection diseases with streptococcal infection, the presence of "rheumatic anamnesis" in the family, improving the child's well-being after a specific treatment.

Biochemical blood analysis demonstrates hyperfibrinogenemia, the emergence of CRP, an increase in the fractions of α2 and γ-globulins and serum mucoproteins.

Immunological examination of blood reveals an increase in the levels of ASG, ASL-O, ASA; an increase in the CIC, immunoglobulins A, M, G, anticardial antibodies.

When rheumatic carditis in children, carrying out chest X-ray reveals cardiomegaly, mitral or aortic configuration of the heart.

Electrocardiography in rheumatism in children can record various arrhythmias and disorders conductivity (bradycardia, sinus tachycardia, atrioventricular blockades, fibrillation and flutter auricles).

Phonocardiography allows you to record changes in heart sounds and noise, indicating the defeat of the valve apparatus. Echocardiography plays a crucial role in the detection of acquired heart defects in rheumatism in children.

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

Rheumatic polyarthritis should be distinguished from arthritis of another etiology, hemorrhagic vasculitis, SLE.

The presence of cerebral syndrome in a child requires the involvement of a children's neurologist and the exclusion of neurosis, Tourette's syndrome, brain tumors, etc.,

Treatment of rheumatism in children

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

In acute phase, inpatient treatment with physical activity restriction is shown: bed rest (with rheumatic carditis) or sparing regimen for other forms of rheumatism in children.

To combat streptococcal infection, antibacterial therapy with penicillin drugs is given for 10-14 days.

With prolonged course of rheumatism in children, the basic drugs of quinoline series (hydroxychloroquine, chloroquine) are included in the complex therapy.

At the second stage, the treatment of rheumatism in children continues in the rheumatological sanatorium, where general restorative therapy, exercise therapy, mud therapy, sanitation of foci of infection.

At the third stage, the observation of the child by specialists (a pediatric cardiologist, a rheumatologist, a children's dentist, a children's otolaryngologist) is organized in a polyclinic.

The most important direction of dispensary observation is the antibiotic prophylaxis of relapses of rheumatism in children.

Prognosis and prevention of rheumatism in children

The primary episode of rheumatic heart disease is accompanied by the formation of heart defects in 20-25% of cases; however, Rheumatic carditis does not leave a chance to avoid damage to the heart valves, which requires subsequent cardiosurgical interference. Mortality from heart failure, caused by heart defects, reaches up to, %. The outcome of rheumatism in children is largely determined by the timing of the onset and the adequacy of therapy.

Primary prevention of rheumatic fever in children involves hardening, nutrition, rational physical culture, sanation 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 suffered rheumatic fever and include the administration of penicillin prolonged action.

A source: http://www.krasotaimedicina.ru/diseases/children/rheumatism

Rheumatism in the child: manifestations and therapy

Children's rheumatism is a systemic disease that is inflammatory in nature and affects the connective tissue of many organs and systems.

The etiological factor of the disease is streptococcal infection. If you believe the statistics, in the practice of a pediatrician, the incidence of rheumatism is three cases per 1, 00 children.

This pathology affects most schoolchildren from 7 to 15 years.

Rheumatism begins as an acute process and can proceed for a long time, with periods of exacerbation and remissions.

The danger of this ailment lies in the defeat of the valvular apparatus of the heart with a violation of hemodynamics.

Let's consider in detail why the development of rheumatism in children, symptoms and treatment of this disease.

The causes of rheumatism

The main reasons for the development of rheumatism in children are:

1. Infectious diseases that occur against the background of the introduction of hemolytic streptococcus. Most often it is sore throat, scarlet fever, ARVI. However, not all children who have had these diseases suffer from rheumatism. To develop this pathology, it is necessary that the infection can provoke a malfunction in the protective system. Emerging autoimmune processes lead to the fact that healthy cells in the body begin to suffer. Often this happens with inadequate therapy or lack of it.
2. A significant role in the development of rheumatism in the child is played by hereditary factors. After ascertaining this disease and studying a family history, a similar disease is found among family members.
3. Violation of immunity also occurs as a result of chronic infection in the nasopharynx.
4. As provoking factors, which can cause the onset of the disease, are permanent psycho-emotional overload, physical overwork, hypothermia and inferiority food.

Variants of the course of the disease

The rheumatic process proceeds in the form of two phases - active and inactive. In the latter case, there are no symptoms and laboratory signs of the disease. Minor violations of hemodynamic processes can occur only with pronounced physical overloads.

The active phase is divided into three stages:

• With a minimal degree, clinical signs are usually poorly expressed. During the carrying out of additional research methods, minor changes are revealed.
• Moderate degree occurs with slightly expressed symptoms. The same can be said about laboratory indicators. Fever is absent.
• The active degree is characterized by pronounced manifestations with joint inflammation and damage to the heart muscle. When carrying out an X-ray and electrocardiographic study, as well as as a result of phonocardiography, there are clear signs of this disease. The results obtained in the laboratory indicate a strong inflammatory process.

Rheumatism in a child can occur in several ways:

1. The acute course of the disease consists in the rapid development and rapid disappearance of symptoms. Signs of activity persist for several months. The prescribed treatment, as a rule, gives a good effect.
2. In subacute, the symptoms do not appear so quickly. There is a propensity for exacerbations, the active phase can last for six months.
3. The prolonged course of the pathological process is manifested in such a way that all the symptoms last for a long time (more than 6 months). At the same time, there is almost no remission, and the prescribed treatment gives an insignificant result.

Symptoms of childhood rheumatism

Since this disease causes the destruction of connective tissue fibers in many organs at the same time, the symptomatology of rheumatism in children is variable. This leads to the fact that the clinical picture of such ailment is quite diverse, and depends on the degree of defeat and the severity of the course of the disease.

The manifestation occurs one or three weeks after the ailment caused by streptococcal infection. In acute form, the temperature rises sharply, there is weakness, and the overall well-being suffers.

Rheumatism has several forms, depending on the primary lesion of this or that system in the body.

Articular form

With this variant of the disease, the following symptoms occur:

• swelling in the area of ​​large joints and pronounced soreness, as a result of which movement in them is limited;
• pain syndrome is characterized by inconsistency, first one joint can hurt, and a few days later another;
• at the end of the active phase, joint deformation does not occur, and their function and mobility are completely restored;
• at the same time there are changes in the heart.

This form is often not manifested as an acute process.

It happens that the fever and puffiness of the joints are absent, and the symptomatology consists in volatile pains of an unexpressed nature.

Often, this type of rheumatism is not diagnosed on time, and is detected after the development of the defect.

Heart Attack

The cardiac form of the disease most often develops sharply, and gradual development is noted less often. The child becomes weak, he hardly does the usual physical work, quickly gets tired while walking or climbing the stairs. Frequent palpitations appear.

When auscultation, the doctor can listen to various rhythm disturbances, heart murmurs, percutaneously determined cardiomegaly.

The degree of heart damage varies. In some cases, a slight myocarditis develops, after which the inflammation passes without damage to the valve apparatus.

In this case, the following symptoms are noted:

• pain behind the sternum on the left;
• a feeling of lack of air;
• blue lips and fingertips;
• rapidity or sharp slowing of the pulse;
• disturbance of rhythm of pulse;
• significant increase in the boundaries of the heart;
• for some relief of the condition the patient is forced to occupy the sitting position, with his legs flat.

This kind of rheumatism often leads to the development of cardiac insufficiency and disability. If there is a recurring course, then each new attack increases the damage to the valves.

Violation of the nervous system

This type of disease has a second name - small chorea. With this form, the lesion begins with the nervous system.

More often it occurs in girls, they have involuntary twitching of certain muscle groups, which increase with emotional stress.

During the inspection, it becomes apparent that the overall muscle tone is reduced and coordination is impaired.

The nervous form of rheumatism sometimes proceeds in isolation. But in a number of cases, cardiac pathology joins it.

There are other non-cardiac manifestations of this ailment in the form of pneumonia, nephritis, polyserositis or hepatitis. There may also be lesions on the skin in the form of rheumatic nodules or erythema.

How is the treatment performed?

Treatment of rheumatism in children should be full and complex. In the active phase it consists in observing strict bed rest, taking medications and using other methods.

Medical assistance includes the following types of drugs:

1. antibacterial agents (most often used antibiotics penicillin series);
2. non-steroidal anti-inflammatory drugs (NSAIDs);
3. antiallergic;
4. immunosuppressors;
5. heart means;
6. diuretics;
7. corticosteroids are used in especially severe cases, the necessary dose and duration of administration of these drugs is recommended only by a doctor.

The average length of stay of a child in a hospital is about one and a half months.

If rheumatism has a continuously recurring course, then this period may be prolonged.

After some relief, physiotherapy and exercise therapy are used.

The final terms of discharge are determined by improving the general condition of the patient, as well as obtaining positive results from laboratory and instrumental studies.

The second stage of care requires rehabilitation, which is carried out in a sanatorium. After reaching remission, the child is put on dispensary records.

Regular observation and carrying out of preventive measures, for which the attending physician is responsible, guarantees full recovery or maximum remission flow.

Folk treatment

Folk methods can act only as an additional aid for rheumatism, and can not replace medicines:

• The manifestation of pain in joints with rheumatism is stopped with the help of a saber. Its dry stems are applied, which are cut into columns of 2 centimeters and placed in a container at half its volume. After that, they are poured with vodka and insisted for 21 days in a place protected from sunlight. The agent can be used to rub the joints or as a compress.
• Rheumatism is helped by heather. To do this, you need dry shredded grass, which should be taken in the amount of two large spoons, and pour one liter of water. Then bring to a boil, and soak for another 10-15 minutes over a low heat, and then insist overnight. The next morning after straining drink instead of tea all day, dividing the entire dose into several doses. The course of this treatment should be three months, and then you need to take a break for 3 weeks, and again to repeat it.
• From polyarthritis well helps harvest from herbs. For its preparation take in equal parts ledum, a leaf of a cowberry, a turn and a camomile. Then two large spoons of such collection are poured with boiling water in quantity, liter. After boiling for 10 minutes, the broth is infused for one hour, filtered and taken 1 glass, three times a day, only after eating.
• You can cook and another collection. It will require a goat willow bark, a grass horsetail, a four-piece blossom, a birch leaf in the number of 3 parts, as well as 1 part of the flowers of cornflower and calendula, bark of buckthorn and fruit juniper. A nettle leaf (2 parts) is also added here. For one glass of boiling water you need to take three grams of the collection, and insist it for 50 minutes. The remedy can be drunk like tea several times a day.
• In the case when rheumatism occurs in the acute phase, folk healers recommend taking 4 parts of a sheet of birch, on 2 parts of elderberry black, horsetail, color of linden, nettle and 1 part of yarrow with addition of 3 parts of flowers the twigs. One small spoonful of the collection should be poured with 250 liters of boiling water, and after insisting half an hour, and drink the same as the previous gatherings.
• As a local treatment you can use radish juice, bee honey and vodka (one and a half, one, and a glass respectively). All components must be mixed and add a tablespoon of salt. Use for rubbing.
• With articular pathology helps celery juice. To do this, you need to get it from a fresh plant, and drink two small spoons, 2 times a day.

Prevention of disease in children

Prevention of rheumatism in children is primary and secondary.

In the first case, all activities are aimed at preventing the development of the disease, for this it follows:

• timely treatment of acute processes caused by streptococcal infection with antibiotic therapy;
• to sanitize chronic infection in the nasopharynx;
• to raise the immunity of the child with the help of hardening procedures;
• ensure rational and adequate nutrition;
• to monitor the observance of the regime of the day.

Secondary prevention is to prevent the development of another relapse in the presence of a disease.

1. year-round use of Bicillin 5, at least three years after treatment of rheumatic heart disease;
2. elimination of chronic infection in the body;
3. reception of vitamins.

In the absence of activation of the process for three years, the child is recommended to carry out a preventive course in the spring and autumn with the help of Bicillin and anti-inflammatory drugs. Bicillin 5 should also be taken to children who have suffered from rheumatism, with every cold disease.

If the disease is complicated by heart disease or rheumatism has a return form, then prevention is carried out all year round for 5 years, with periodic stay of patients in the sanatorium.

A source: http://FitoInfo.com/lechenie-travami/infekcionnye-zabolevaniya/revmatizm-u-detej.html

Rheumatism in children: causes, symptoms, treatment, prevention, photos, video

Rheumatismis an inflammatory process in connective tissue with a probable heart disease.

The disease occurs not only in mature people, but also in the youngest.

In adolescents from 10 to 15 years, about,% of cases are observed, andapproximately 20% of patients have an age from 1 year to 5 years.At the child less than year such illness arises seldom.

Causes

The cause of rheumatism is hemolytic streptococcus. The causative agent is in the body through the nasopharynx airborne droplets.

The disease progresses after an infectious lesion that has not been treated with antibiotics, but only in those with a weak immune system.

As a rule, about 2% of children with rheumatism previously had a strep infection.

A child may become infected from an adult family member who is infected with streptococcus.

Immunity immunity of the child up to a year can not yet cope with many diseases, so it falls ill.

Also, the causes are infectious diseases of the mouth, caries, sinusitis, chronic tonsillitis or diseases of the genitourinary system.

Additional factors for the development of this type of disease may be hypothermia, malnutrition, frequent fatigue, hereditary predisposition. Frequent illness of ARI and sore throat are also causes of rheumatism.

Forms

In the course of the disease, connective tissue collapses, and many internal organs suffer. There are all sorts of clinical signs, depending on the form of pathology and the presence of complications.

In the child's body, a C-reactive protein is produced in response to the infection, which causes tissue damage.The incubation period lasts from one to three weeks, after which the disease begins.

At first, the body temperature rises, and the state of health worsens.

If the signs of pathology are manifested in the joint zone, then the patient has an articular type. The causes are different infections, for example, angina, in which the child's tonsils are affected. Also, the cause for the disease is scarlet fever.

Symptoms of the joint type are pain in the joints of the feet, especially in the knees and ankles.The temperature rises, swollen affected areas of the legs.

Pain sensations arise in one place, then move to another place.

Pain is felt for one to three days, then stops and moves to another leg joint site.

Depending on the individual characteristics of the organism,some children have a fever, others may not have the heat.

Painful sensations pass quickly, however, there is a possibility of heart disease.

Cardiac

Another type of pathology is cardiac rheumatism. There is a risk of heart valve defects. Symptoms mainly affect the heart area.

Children do not complain of pain in the joints of the extremities, but they feel excessive fatigue when running or walking fast, heart beat increases.

It is necessary to come as soon as possible to an appointment with a doctor, go through all the necessary studies, take a blood test, so that a qualified specialist has put the correct diagnosis and started treatment. Untimely treatment of a doctor threatens the development of a serious heart defect.

Nervous

In the event that the disease affects the nervous system of the patient, then manifestations of mental disorder are possible.

The child becomes irritable, agitated, he can start crying for no reason, depression develops.As a result, the muscles of the legs, arms, or face are twitching.

Noticing such symptoms, you should immediately contact a doctor.

Usually, rheumatism is observed after the child has had pharyngitis or sore throat.

The earliest signs of the disease are painful joint sensations (rheumatoid arthritis). These symptoms are detected in almost all cases.

Rheumatoid arthritis is characterized by pain in the middle joints of the legs, knees, elbows and ankles.

Heart disease is defined in 75% of cases. Heart complaints are most expressed in the rapid heartbeat, dyspnea, other cardiac disorders. In addition, often the patient feels fatigue, exhaustion, general malaise, fatigue.

A source: http://LechenieDetej.ru/serdechno-sosudistaya-sistema/revmatizm.html

Rheumatism in children: symptoms and treatment, prevention and complications

Before the introduction of antibiotic therapy into medical practice, children's rheumatism was a rather frequent complication after a streptococcal infection.

However, at present the incidence has sharply decreased, especially in regions with a good level of medical care.

Nevertheless, the incidence of rheumatism is still high in countries with warm climates and poor quality of medicine.

Causes of the disease

Why do some people develop rheumatism after a sore throat, and in others it passes without a trace, has not been fully explained to this day. There is an assumption about the role of certain genetic factors that create the prerequisites for the development of the disease.

In addition, provoking factors can be:

• poor social conditions;
• inadequate hygiene;
• lack of qualified medical care;
• violations in the immune status.

How it develops

Rheumatism is an autoimmune disease that is caused by a specific bacterium - beta-hemolytic streptococcus A.

When the causative agent enters the body, the immune system produces antibodies that bind to the receptors on the surface of the microbe and make it recognizable to the immune system.

Thus, the child's organism neutralizes the causative agent of infection.

For some time, even after the symptoms of the disease disappeared, the antibodies still circulate in the blood of the sick child. If re-reinfection occurs, they quickly and effectively neutralize the causative agent of the disease, that is, the immune system is formed.

However, in some cases it happens that antibodies can not correctly identify the source of danger and bind to the receptors of the child's own cells.

This phenomenon is called an autoimmune reaction, that is, the body's reaction against itself.

In the case of infection with beta-hemolytic streptococcus, autoimmune processes occur much more often than when exposed to other pathogens. This is due to the similarity of receptors on the surface of streptococcus and human cells, as a result of which antibodies "confuse" them ("molecular mimicry").

Since the reason for the appearance of rheumatism is the lack of adequate treatment with streptococcal antibiotics tonsillitis or tonsillitis, parents should be especially careful if the child has the following symptoms:

• a sore throat;
• temperature increase;
• headache, weakness;
• reddening of throat, tonsils with purulent plugs;
• enlarged cervical or submandibular lymph nodes.

Variants of flow

To date, a classification has been developed depending on the activity of inflammatory changes, the nature of the course, the presence of complications of the disease. So, with the flow of rheumatism can be:

• sharp;
• subacute;
• corpulent;
• recurrent;
• latent.

Symptoms of rheumatism in children

Rheumatism in a child is a complex of characteristic symptoms. They can have varying degrees of severity and can be combined individually for each patient.

After the acute inflammatory process subsides, a period of relative well-being begins in the nasopharynx, which lasts from two to three weeks. After this, acute rheumatic fever develops, in children it is characterized by the following symptoms:

• pain in the joints, redness of the skin and swelling over them;
• cardiac pathology (endocarditis, myocarditis, pericarditis);
• defeat of the nervous system (chorea);
• skin signs;
• temperature increase.

Symptoms of rheumatism in children may be mild and in some cases ignored by parents. Also, there may be no pain in the large joints with reddening of the skin above them.

Or, on the contrary, severe pain is accompanied by a lack of edema and redness to the child.

In this case, the absence of antibiotic therapy will become a provoking factor for the further progression of the pathological process.

It is manifested by "volatile" pain in the joints, which takes place in a few days, rapid reddening of the skin over them and swelling of the joints.

As a rule, the child suffers several large joints (hip, elbow, knee), and the inflammatory process "migrates" from the joint to the joint.

These phenomena are considered harmless, since they rarely lead to serious consequences or complications from the musculoskeletal system.

Heart Attack

This is the most serious and dangerous for the child sign of rheumatism. In this case, it is possible to suspect a disease:

• increased heart rate;
• the occurrence of pain in the heart, even with minor physical exertion.

The defeat of the heart is confirmed during examination of the pediatrician during auscultation (listening to heart tones).

Less often, children develop pericarditis or myocarditis. In the latter case, the process can lead to a weakening of the pumping function of the heart and the development of heart failure, which manifests itself by shortness of breath, coughing, edema on the legs.

When immune cells attack the nervous system, the child develops Sydenham's small chorea. It is characterized by the defeat of deep structures of the brain and manifests itself:

• behavioral disorders;
• involuntary twitching of the muscles.

In young children, it manifests itself as uncontrolled and unstable movements, which outwardly looks like uneasiness when performing the usual actions. For example, a child who was previously neat can spill soup or break an unintentionally toy.

Schoolchildren early signs of chorea include the appearance of shivering, which causes difficulties in writing, problems in performing stereotyped movements and observing personal hygiene rules. They can occur at a certain time during the day and disappear during sleep or stress.

In addition, for children with chorea characterized by constant fatigue and personality changes, there is capriciousness, groundless resentment. Schoolchildren are falling academic achievement, there are problems with concentration of attention.

Usually, such neurological disorders, in contrast to heart lesions, have a favorable prognosis. Chorea Sidengam with adequate treatment disappears in a few months.

These are less common signs of rheumatic fever in children, often they look like areas of ring reddening or subcutaneous seals of small size (nodules).

In the latter case, the skin over such formations is not changed, they are painless and dense to the touch.

Often they are on the elbows, wrists, in the area of ​​the knees and the Achilles tendon.

Skin manifestations occur in less than five percent of rheumatic cases in children. Often they are ignored or not identified, especially if they are located in places difficult to access for inspection.

Remote consequences

More distant symptoms appear after years or decades from the onset of the disease. In this case, they are caused by structural and irreversible changes in tissues. As a rule, complications occur at an older age and are a consequence of disorders that occurred in childhood.

Most often, children are concerned about complaints from the cardiovascular system. Cardiological pathology persists throughout life and requires a certain therapeutic correction. Such babies can be diagnosed with:

1. mitral valve prolapse;
2. aortic valve disease;
3. myocardiosclerosis.

If the process is significant, these changes lead to the development of heart failure, heart rhythm disturbances. This is the cause of disability of the child and even death.

The presence of pain in the joints and fever, especially if a history of angina is mentioned a few weeks ago, should always prompt the doctor to develop rheumatism. To establish a clinical diagnosis, the criteria developed by Johnson in 1944 are used:

• arthritis;
• carditis;
• rheumatic nodules;
• skin rashes;
• chorea.

However, given the clinical variety of variants of the disease, it is not always possible to put the correct diagnosis at the primary examination. In this case, additional methods of examination are recommended:

1. general clinical analysis of blood;
2. rapid test for the detection of streptococcal infection;
3. determination of the antistreptolysin titer;
4. titres of anti-DNase B.

To assess the possible damage to the heart, ultrasound and electrocardiography (ECG) are additionally used.

Which states should be distinguished from?

Differential diagnosis of rheumatism is carried out with other diseases that have a similar symptomatology:

• arthritis of another etiology;
• lyme disease (infectious disease transmitted by a tick);
• blood diseases (leukemia);
• congenital heart defects;
• cardiological pathology of non-rheumatic nature.

Post-streptococcal arthritis

This condition is isolated in a separate form from rheumatism due to clinical differences. It takes a long time, as a rule, for at least two months.

Usually one or more large joints (knee, elbow, ankle, shoulder) are affected.

The disease can recur several times during life.

The defeat of the joints is manifested by pain, redness and swelling. Sufficiently strong pain sensations sometimes lead to disruption of movements in the limb and restriction of movement.

How to treat in an acute period

Treatment of rheumatism in children in the acute period provides for the finding of a child in a profile hospital. At this stage, pharmacotherapy is carried out, aimed at eliminating the inflammatory process. Medicamental therapy of rheumatism includes several groups of drugs.

1. Antibiotics. According to existing clinical recommendations, they are the main element of the treatment of rheumatism. Penicillin preparations (Penicillin, Amoxicillin) are used for pharmacotherapy, also cephalosporins ("Cefuroxime") and macrolides ("Azithromycin") are recognized as effective. The use of antibacterial therapy can reduce the risk of complications by 80%.
2. Anti-inflammatory. This means non-steroidal (non-hormonal nature). They are included in the treatment regimen in the presence of cardiac pathology. Prescribe drugs such as Ibuprofen or Naproxen.
3. Glucocorticoids. Assign in addition for serious violations of the heart. Most often used "Prednisolone".

At this stage of the therapy, the nursing process includes quality care for a patient who is in a semi-fast mode. Recommended nutrition with sufficient intake of protein, vitamins and trace elements.

In the acute phase of rheumatism, it is not recommended to treat a child with folk remedies, since they are at least ineffective. In the worst case, they can trigger the progression of the disease and lead to serious complications.

Therapy during remission

At the stage of rehabilitation, which is carried out at home or in a sanatorium, LFK, massage, sanation of foci of chronic infection are recommended.

In the case of the formation of a heart valve defect with severe functional deficiency, surgical intervention is recommended.

Children who have suffered a rheumatic attack, especially if a heart attack has been diagnosed, a dispensary observation in a pediatric cardiologist and a prophylactic reception of an anti-relapse therapy. In this case, the so-called secondary prevention of rheumatic fever in children is carried out. It includes the following points:

• introduction of once every three to four weeks of prolonged penicillin;
• examination at a cardiologist twice a year;
• bi-annual course of non-steroidal anti-inflammatory drugs.

The duration of such prevention is determined by the presence or absence of heart damage. In the presence of cardiac pathology, it is recommended to 21 years, in the absence of - for five years.

Prevention

The basis of prevention is the timely detection of streptococcal infection in a child with sore throat and fever. In this case, an examination of the doctor and carrying out of investigations for the detection of streptococcus is mandatory. In addition, primary prevention of rheumatism includes:

1. treatment of chronic nasopharyngeal diseases;
2. quenching, vitamins and other recreational activities;
3. observance of the regime of work and rest, especially among schoolchildren.

These activities are especially necessary for children who have a hereditary predisposition, in the family of whom there are already patients with rheumatism.

Treatment of rheumatism in a child is a rather complicated process. However, the use of modern antibacterial drugs significantly increases the chances of recovery.

The prognosis for rheumatism in many respects depends on how timely it was diagnosed and the medical measures were started.

If the therapy was carried out at the initial stage of the process and in the absence of cardiac pathology, the prognosis for the child is favorable in most cases.

A source: http://kids365.ru/diseases/revmatizm/