Causes, symptoms and treatment of rheumatism in children and adults

Rheumatism

Angina

Scarlet fever

Arthritis

27350 05 May

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Rheumatism: causes, symptoms, diagnosis and treatment methods.

Definition

From the point of view of modern medicine, rheumatism (rheumatic fever) is a systemic inflammatory process of an infectious-allergic nature that affects the connective tissue of the body. First, inflammation occurs, to which the body responds with an immune response, and then an autoimmune attack begins on the connective tissue of the body’s own. Rheumatism is often associated with joint pain and rheumatoid arthritis, but this is only part of the symptoms of the disease. Rheumatic fever affects the heart muscle tissue, skin, blood vessels, brain and nervous system. Rheumatic lesions of the respiratory system, vision, and gastrointestinal tract are much less common.

The intensity of joint pain is so great that it drowns out most of the symptoms, so a person does not immediately feel other disorders of the body.

It is rheumatic diseases that make the greatest contribution to decreased performance, deterioration of the patient’s general health, and an increase in the number of visits to primary care doctors. Rheumatic diseases occur in people of any age. The first episode of acute rheumatic fever most often develops between 5 and 15 years; it practically does not occur in children under three years of age. The disease affects girls three times more often than boys.

Causes of rheumatism

The main cause of rheumatism is a respiratory streptococcal infection of group A. As a rule, the disease is preceded by tonsillitis, tonsillitis, pharyngitis, scarlet fever, etc., during which the immune system actively produces specific antibodies to fight streptococci. Antibodies detect infectious agents by certain protein molecules, but in some people the same proteins are present in the connective tissue of the heart and blood vessels. As a result, anti-streptococcal antibodies attack their own tissues, causing an inflammatory process in them.

In some cases, we can talk about a genetic predisposition, since the incidence of the disease in children is much higher in those families where one of the parents is diagnosed with rheumatism.

The pathological process is autoimmune in nature, so the disease occurs in waves, exacerbating under the influence of infection or nonspecific factors (hypothermia, physical stress, emotional stress, etc.).

The following factors contribute to the development of rheumatic fever:

• incorrect treatment of streptococcal infection;
• genetic predisposition;
• hypothermia;
• deficiency of vitamins and microelements;
• the presence of autoimmune diseases (systemic lupus erythematosus, scleroderma, etc.).

Classification of the disease According to the nature of the course,
the following are distinguished:

• acute form (up to 3 months);
• subacute form (3-6 months);
• protracted form (more than 6 months);
• latent (hidden) form - occurs without characteristic symptoms, without laboratory changes, is detected after the formation of heart defects;
• recurrent form - has a wave-like course with the rapid development of internal organ failure.

In addition, there are active and inactive phases of the disease.
In the active phase, a specific laboratory picture is observed. According to clinical manifestations:

• rheumatic carditis - inflammation of the heart tissue;
• polyarthritis ー multiple joint damage;
• ring-shaped erythema - a specific rash on the skin;
• chorea - severe neurological symptoms (hand tremors, muscle weakness, involuntary movements);
• subcutaneous nodules in the joint area.

Symptoms of rheumatism
The initial symptoms of rheumatism usually occur 2-3 weeks after a streptococcal infection and are a combination of damage to the joints, heart, skin and central nervous system. Symptoms depend on the nature of the process and which organs are affected by inflammation. A typical clinical picture appears in the second or third week after suffering a streptococcal infection - the patient develops a fever, develops weakness, and experiences increased sweating and headache.

At an early stage, arthralgia is noted - rapidly increasing pain in large joints (knees, elbows, shoulders, ankles, wrists) with limited mobility.

With rheumatism, the joints, as a rule, are not deformed, but they can swell and increase in size.

Changes in the musculoskeletal system manifest themselves in the form of rheumatic arthritis. Migratory polyarthritis is the most common manifestation of acute rheumatic fever, often accompanied by fever. “Migratory” means that the arthritis appears in one or more joints, resolves, but then occurs in others, causing the pain to seem to move from one joint to another. A feature of rheumatic arthritis is its rapid reversal when antirheumatic drugs are prescribed. Sometimes joint damage manifests itself only as polyarthralgia - pain in the joints without the development of arthritis.

Cardiac dysfunction is characterized by murmurs, arrhythmias, tachycardia and decreased blood pressure, leading to heart failure. Patients complain of mild pain or discomfort in the heart area, mild shortness of breath on exertion. As a rule, heart tissue is affected from the inside to the outside, i.e. valves and endocardium, then myocardium and finally pericardium. Rheumatic disease is formed as a result of the course of chronic rheumatic heart disease over decades and is primarily manifested by valve stenosis. The most commonly involved valves are the mitral and aortic valves.

Rheumatic carditis in some young patients and children can be severe - from the very beginning of the disease there is severe shortness of breath on exertion and at rest, constant pain in the heart area, and rapid heartbeat. Symptoms of circulatory failure in the systemic circle may appear in the form of swelling and heaviness in the right hypochondrium (due to an enlarged liver). All these symptoms indicate severe diffuse myocarditis.

Loss of coordination, muscle weakness, and uncontrolled movements may be signs of rheumatic damage to the nervous system. The disease can affect the psyche and the functioning of the speech apparatus.

Lesions of the nervous system and sensory organs are extremely rare, mainly in children.

Skin pathologies associated with rheumatism are expressed by redness and irritation in the form of round spots. Subcutaneous nodules may appear on the arms and legs, but they are not painful and may disappear without treatment.

Features of rheumatism in children:

In children, rheumatic fever is more severe than in adults, and heart defects develop more often and faster. The articular syndrome is mild, and other extracardiac manifestations (ring-shaped erythema, subcutaneous nodules, chorea) are more common with more pronounced manifestations.

However, in children, the disease responds better to drug treatment, which helps avoid relapses.
Diagnosis of rheumatism
Rheumatism is diagnosed based on clinical and laboratory parameters. Main criteria: polyarthritis, carditis, chorea, annular rash, subcutaneous nodules.

Diagnostic measures include:

• general blood analysis;

Early diagnosis

To make a diagnosis of ARF, the disease criteria must match in one of the following ratios:

• two main ones;
• one main and two minor;
• three minor ones.

Main criteria:

• twitching;
• inflammation of the heart membranes;
• joint inflammation;
• dense nodules under the skin;
• red blisters.

Minor:

• body temperature more than 38.5°C;
• joint pain;
• increased ESR and ASLO, increased reactive protein.

Prevention of arthritis in children

First of all, it is necessary to eliminate, if possible, all provoking factors. Of course, if we are talking about genetic predisposition, then there is nothing much you can do. But you can treat a sore throat in time, properly distribute physical activity, provide the child with proper nutrition, avoid contact with people with ARVI, harden up, follow a work-rest schedule, periodically take multivitamins, and so on.

If your family has close relatives with arthritis, it is recommended to visit a rheumatologist at least once a year for a preventive examination. This will allow you to identify arthritis in the early stages and begin treatment in a timely manner.

Sources:

1. Chronic arthritis in children. Bregel L.V., Knyazeva T.S., Krupskaya T.S., Baturina L.M. Siberian Medical Journal (Irkutsk), 2002. p. 100-104
2. Problems of early diagnosis of arthritis. Kazantseva N.Yu. Siberian Medical Journal (Irkutsk), 2007. p. 28-29
3. Arthritis in primary immunodeficiencies. Boyarchuk O.R., Volyanskaya L.A., Kovalchuk T.A., Kinash M.I. Pain. Joints. Spine No. 1, 2017. p. 15-20

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

How to treat?

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

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

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

Why is it dangerous?

In case of severe, protracted or recurrent course of the disease, the patient may develop complications of rheumatism. As a rule, they manifest themselves in the form of impaired cardiovascular function. These are atrial fibrillation, circulatory failure, myocardiosclerosis, heart defects, etc. The result can be thromboembolism of various organs, cavity adhesions of the pleura or pericardium. With thromboembolism of the main vessel or decompensated heart muscle defect, death is possible.

Symptoms of arthritis in children

The main signs of arthritis in a child:

• limited mobility in the area of ​​the affected joint - if the baby does not yet walk, he will try to limit movements of the affected arm or leg; older children begin to limp and take care of the affected limb;
• redness of the skin over the lesion;
• swelling at the site of inflammation;
• general weakness;
• increased body temperature not associated with infectious diseases - in acute arthritis, the temperature can rise to 39 degrees Celsius; in the chronic form, low-grade fever is observed (around 37 degrees Celsius).

If one or more of the above symptoms is present, it is recommended to immediately take the child to the doctor and undergo an examination. The sooner treatment for arthritis is started, the better the prognosis of the disease.

Medical diagnostic methods

To diagnose rheumatism, the patient is usually prescribed:

• ECG to detect disturbances in the contractile rhythm of the heart;
• an x-ray of the heart, which reveals changes in the configuration of heart tissue and signs of a decrease in its contractile function;
• Heart ultrasound or echocardiography to identify defects;
• laboratory tests, the results of which show the presence of streptococcal infection, inflammatory process and immune pathology.

According to the generally accepted diagnostic rule, the presence of the disease is confirmed by identifying two major criteria or two minor and one major criterion for rheumatism.