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People have been catching on for centuries between severe colds, sore throats and the subsequent occurrence of joint problems and general malaise. However, the scientific study of rheumatism began only at the end of the XNUMXth century. Today it is already clear – this is the defeat of all the connective tissue that is in the body, and inflammation is associated with our own immunity.
Therefore, today the term “rheumatism” has been replaced by a more precise definition of the disease: in the ICD-10, the disease is described as acute rheumatic fever, and it is specified which organs or tissues are most affected (endocarditis, chorea, arthritis).
Acute rheumatic fever is thought to be most common in school-age children, although rheumatic fever may occur in adults. Usually these are persons 18 – 25 years old. The inflammatory process occurs in the connective tissue that makes up the frame of the internal organs, covers the articular surfaces of the bones and forms the valves of the heart. The cause of the disease is considered to be changes in the immune system that are triggered by a special microbe – beta-hemolytic streptococcus A-group. Moreover, rheumatism does not develop in everyone who has been ill with streptococcal tonsillitis, scarlet fever or pharyngitis, but only in a part of people who have a hereditary predisposition.
With angina, bacterial toxins, and then the antibodies that the body produces in response to an infection, affect the connective tissue fibers in the heart, causing inflammation of the inner lining of the heart – endocarditis, or the heart muscle – myocarditis. In addition, heart valves are affected.
In addition to the heart, antibodies produced by the immune system attack cartilage and ligaments in the joints, connective tissue fibers in blood vessels, and kidneys. In addition, antibodies also damage the nervous system. Such a process develops if the immune system initially has a defect, that is, a person is genetically predisposed to rheumatism.
Symptoms of rheumatism in adults
You can expect the first signs of the disease 2 to 3 weeks after acute tonsillitis, scarlet fever or pharyngitis, which are caused by streptococcus. It is important to emphasize that the symptoms of rheumatism in adults do not begin with lesions of the joints or heart, but with a bout of fever. Against the background of a general disturbance of well-being, weakness and weakness, the temperature rises from 37 to 38,5 – 39 ° C, accompanied by severe chills and profuse sweat.
The temperature can last up to 5 days, and against the background of it, the joints become inflamed – they swell, the skin over them turns red, there is pain that does not subside even at rest. Most often, both knees are damaged symmetrically, or ankle, shoulder or elbow joints. But inflammation quickly passes from one joint to another – a couple of days my knees hurt, then my elbows, then my ankles. Moreover, after taking anti-inflammatory drugs, pain and inflammation quickly disappear. As the temperature decreases, so does the arthritis.
Some patients report a rash of pink rings (erythema) on the skin that does not itch and resolves quickly. In rare cases, nodules under the skin, similar to grains of rice or peas, may appear in the back of the head or inflamed joints.
The key manifestation of rheumatism is severe heart damage (carditis). The further prognosis for the patient largely depends on how severely the membranes of the heart, valves and large vessels are affected. Available:
- endocarditis – inflammation of the inner lining of the heart and valves;
- myocarditis is a lesion of the heart muscle itself;
- pancarditis – when all the membranes of the heart suffer to one degree or another.
The main manifestations are palpitations (tachycardia) and pain in the region of the heart, which has aching, pinching or stabbing character. Against the background of pain, shortness of breath occurs at the slightest load, arrhythmias (rhythm disturbances). Almost in 1/4 of patients, especially with untimely treatment, a heart disease is formed, since the inflammatory process destroys the heart valves.
According to neurologist of the highest category Evgeny Mosin, rheumatism also affects the nervous system, neurologists even have a separate term to describe the disease – neuro-rheumatism. Damage to the nervous system is possible both during the period of rheumatic fever (due to acute disorders of cerebral circulation, psychoses or rheumatic neurosis), and after some time, due to the inflammatory process of connective tissue elements in the nervous system (myelitis, encephalitis or neuritis).
The most common neurological manifestation of rheumatism is chorea (damage to the subcortical centers of the brain responsible for movement). This pathology is characterized by twitching of the arms and legs, which have a chaotic character. Due to the contraction of the muscles in the face, there is a feeling that the person is grimacing, although he does not control these actions. Intelligibility of speech may be disturbed, handwriting suffers, it is difficult to hold cutlery in hands. On average, the symptoms, as Yevgeny Yurievich notes, persist for up to three months.
The duration of acute rheumatic fever lasts up to 6 – 12 weeks. During this period, the inflammation process goes through successive stages of development, from reversible initial changes to severe, fatal complications.
The most unpleasant thing about rheumatism is that after the attenuation of the process, in the first 4-5 years of remission, new outbreaks of inflammation are possible. They are associated with repeated episodes of microbial tonsillitis and pharyngitis.
Treatment of rheumatism in adults
To confirm the diagnosis and start treatment as early as possible, a number of diagnostic studies and tests are needed to confirm streptococcal infection and subsequent autoimmune inflammation.
Diagnostics
If after suffering scarlet fever or tonsillitis after 2-3 months a heart defect is detected, the diagnosis is made automatically. If no heart disease is detected, doctors use the so-called major and minor criteria for rheumatism (with mandatory confirmation of a previous streptococcal infection).
Big Criteria:
- the presence of typical joint damage (polyarthritis);
- signs of heart damage (carditis);
- erythema annulare on the skin or subcutaneous nodules;
- symptoms of chorea, confirmed by a neurologist.
Small Criteria:
- the presence of pain in symmetrical joints;
- long-lasting fever;
- typical changes in laboratory tests;
- ECG changes.
Streptococcal infection is confirmed by cultures from the nose and pharynx with the definition of group A streptococcus, a positive test for the determination of type A streptococcal antigen, an increase in the blood plasma level of antibodies against group A streptococcus.
In order to make a diagnosis, the doctor prescribes the following procedures:
- Complete blood count, which reveals acute inflammatory signs – increased ESR, an increase in the level of leukocytes.
- Biochemical study of blood plasma – determine the levels of C-reactive protein, the level of fibrinogen protein, rheumatoid factor, uric acid, antistreptolysin-O, changes in the amount of proteins – albumin and globulins.
- Also, high levels of antistreptococcal antibodies, changes in the level of immunoglobulins M and G are detected in the blood plasma.
When assessing the ECG, arrhythmias and impaired conduction of the myocardium, thickening of the heart due to inflammation of the heart muscle are determined. On ECHO-KG using Dopplerography, damage to the heart valves, impaired contractility of the heart muscle, its pumping functions, and inflammation of the pericardium (heart bag) are determined.
Modern treatments
With early detection of acute rheumatic fever, active treatment is possible with the prevention of heart defects and the complete suppression of inflammation without serious consequences. But the treatment of rheumatism in adults is carried out only in a hospital, under the supervision of specialists. Strict bed rest is important, a balanced diet with sufficient protein intake, a decrease in fats, carbohydrates and salt.
To combat streptococcus, antibiotics are used, to which microbes are sensitive – they are used according to modern clinical protocols for managing patients. Therapy is supplemented with anti-inflammatory drugs – this can be a course of steroid hormones in the acute phase, with the transition to non-steroidal anti-inflammatory drugs as the condition improves. Specific medications are chosen by the doctor depending on the severity of the inflammation.
After improving the condition and suppressing inflammation, it is necessary to continue therapy in rehabilitation centers or sanatoriums in order to support and strengthen the heart muscle, and completely restore the body after the inflammatory process.
After all stages of treatment, a person is registered with a general practitioner and a rheumatologist, every year he undergoes control examinations – he takes tests, undergoes an ECG and ECHO-KG.
Prevention of rheumatism in adults
The basis for the prevention of rheumatism in adults is a healthy lifestyle with strengthening immunity, with the exception of tonsillitis and pharyngitis. It is important not to self-medicate at the slightest sign of tonsil damage (sore throat, fever, swollen lymph nodes in the neck) and immediately consult a doctor.
If a person has previously suffered from acute rheumatic fever, it is important for him to ensure that it never returns. It is important to regularly undergo dispensary examinations, immediately treat any colds, and take medications prescribed by a doctor for preventive purposes.