Rheumatism in children: symptoms, treatment, prevention

Often in pediatric practice there is such pathology as rheumatism in children. The disease is systemic, that is, in the process may involve various organs and systems of the child's body. Most often affects the heart. The risk group includes children aged 7 to 15 years. The disease is dangerous for its possible complications. The most common of them is the development of chronic heart failure. The children's rheumatism often develops on the background of various infectious diseases (scarlet fever, sore throat). What is the etiology, clinics, treatment of disease and prevention of complications?

peculiarities of the child's rheumatism

Rheumatism in children is a systemic disease of infectious nature, characterized by lesions of the connective tissue.

In most cases, inflammation is found in the cardiovascular system of the child. Rheumatism is diagnosed everywhere in all States of the world. It is important that in poor countries, the rate of primary morbidity are the highest. It is in these countries accounts for a large proportion of the child population of the globe. The average frequency of occurrence of this disease is 0.3 cases per 1,000 children.

Most Often the rheumatism in children identified at school age. Rheumatism begins in children acute. This disease in the absence of timely treatment becomes a cause of disability and the development of heart disease. In Russia the morbidity and mortality rates for rheumatic fever in children has decreased several times. Of great importance in the development of the disease has a social well-being of children. Children older than 10 years account for about 2/3 of the total number of patients. Kids from 1 year to 5 years constitute only 20% of all patients. At a younger age rheumatism is rare.

Types of pathology

Rheumatism in children can occur in three clinical forms: joint, heart and nervous. Much less common types of disease, such as rheumatism skin and reumpleri. Nervous pathology form otherwise known as revocarea. Most common in girls. Depending on how active the disease, there are 3 degrees of development of the pathological process:

• inactive
• moderately active
• as active as possible.

In the first case, the exudation is not expressed. Clinical symptoms and laboratory changes are also mild. For moderate-intensity activity is characterized by the presence of all criteria for the disease (laboratory, instrumental, and physical). While they are moderately expressed. If rheumatism is the most active, children develop high fever, affects the heart and joints. Are pronounced laboratory and instrumental signs of disease.

A Disease Sokolsky-Classic can occur in acute, subacute and chronic form. 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 continues more than half a year, this is a protracted process. Sometimes multiple recurrences of rheumatic fever. It is characterized by the absence of distinct periods of improvement. This condition lasts for a year or more. The most dangerous for children is latent within. It symptoms are mild or absent. All this complicates the diagnosis. This condition discreetly leads to the development of heart defects.

Etiological factors

The Reasons for the development of children's rheumatism are various. The basis of developing the disease are 2 main factors: the infecting organism-beta-hemolytic Streptococcus group A and change the reactivity of the child's body. It is known that beta-hemolytic Streptococcus causes the following diseases: angina, chronic tonsillitis, pharyngitis, scarlet fever. If the treatment of the above pathology was conducted inappropriately, can form chronic foci of infection. They are the main cause of rheumatism.

In children suffering from rheumatism, in the blood are antistreptococcal antibodies. These antibodies are aggressive to their own body tissues. They are obligatory trope to connective tissue. Other possible causes of the disease include genetic predisposition, decreased resistance of the organism to the Streptococcus. The latter, being in the body of the child, produce pathogenicity factors: erythrogenic toxin, streptolysin, proteinase, hyaluronidase. Microbial cells are able to synthesize substances, which is maintained at a constant level inflammatory process. These include peptidoglycan, lipoteichoic acid.

Cutaneous rheumatism appears due to lesions of the vessels. Nervous form – in the backgrounddamage to subcortical nuclei. Contributing factors are the following: features of the Constitution of the child, blood type, poor nutrition, overcrowding groups, poor living conditions, hypothermia. Found that rheumatism most often occurs in children with II or III blood group.

Clinical manifestations

Symptoms of rheumatism in children depend on the form of the disease. Most often develops the following clinical syndromes: articular, heart disease, chorea, erythema. Often the skin of the child has formed specific nodules. Almost always precede the development of rheumatic fever children carry strep infection. All children affected heart. Most often this happens initially. This may itself affect cardiac muscle, the inner layer of the heart together with the valves, pericardium or all layers of the heart. In the latter case, the prognosis is poor. The signs of myocarditis in rheumatism in children may include:

• the change of heart rate;
• increasing the boundaries of the heart;
• pallor;
• shortness of breath.

In severe cases cyanosis, cardiac arrhythmias, pressure drop. During objective examination of a child identified systolic murmur, weakening of the heart sounds. Very often, myocarditis is combined with endocarditis. The main symptoms of endocarditis is: weakness, increased body temperature, increased sweating, reducing body weight, discoloration of the skin (it acquires a grayish hue). May cause rash or thickening of the phalanges of the hands or feet (symptom of sticks).

About half of patients children is arthritis. children With rheumatism articular syndrome is characterized by: the symmetry of inflammation, the appearance of migratory pain, return development. Often affects the joints of large and medium caliber. Nervous form of rheumatism characterized by lesions of the brain. The main symptoms of chorea is:

• irritability of the child;
• tearfulness
• sleep disturbance
• reduced performance in school;
• confusion.

It's early symptoms. Following them may experience involuntary muscle contractions. Reduced muscle tone, disturbed coordination of movements. For chorea is characterized by changes in the psychoemotional sphere. Rarely rheumatism is manifested by erythema, the appearance of subcutaneous nodules, kidney damage, inflammation of the pleura. Rheumatism may develop pneumonia, vasculitis, peritonitis.

Diagnosis and treatment

To put the correct diagnosis, you will need:

• laboratory investigation
• a medical history of disease;
• medical examination of the child;
• physical examination
• instrumental examination.

Of Great importance are the clinical criteria (carditis, polyarthritis, chorea, erythema or nodes). In a survey of the child or its parents it is important to establish the fact of transfer of infectious diseases (angina, scarlet fever). Laboratory analysis in rheumatoid arthritis detected increased content of C-reactive protein, dysproteinemia, increased erythrocyte sedimentation rate, leukocytosis, eosinophilia, increase of fibrinogen, mucoproteins. An important feature is the detection of Ig G, A, M in blood, and anticardiolipin antibodies, antistreptolisin, antigialuronidasy and antistreptokinazy.

Instrumental methods of diagnosis used x-ray examination of the chest, phonocardiography, ECG, MRI, CT, ultrasound of the heart and blood vessels. It is important to exclude mimic pathology (congenital heart disease, non-rheumatic endocarditis, systemic lupus erythematosus, vasculitis and arthritis of other origin). Treatment of rheumatism in children is carried out in 3 stages and includes treatment in a hospital, sanatorium treatment and clinical supervision.

Children are hospitalized. In the period of acute treatment involves bed rest, restriction of activity, use of antibiotics (protected penicillins), NSAIDs ("Diclofenac", "Ibuprofen") and glucocorticosteroids. In protracted rheumatism used "Plaquenil" or "Delagil". Further there is a Spa treatment. What is prescribed in the sanatorium? The main task of this stage is the strengthening of the body and rehabilitation. In this situation, shown physical therapy, massage, mud therapy, physiotherapy, vitamin therapy. After all this child needs to see a doctor. Prevention of recurrence involves the use of antibiotics. Thus, the rheumatic fever in childhood can lead to serious consequences and even death of the child – that is why diagnosis and treatment must be timely.