Rheumatism in children
Content:
- Symptoms of rheumatism in children
- Causes of rheumatism in children
- Diagnosis of rheumatism in children
- Complications of rheumatism in children
- Treatment of rheumatism in children
- Prevention of rheumatism in children
Rheumatism in children is an allergic and infectious disease that systemically affects the synovial membranes of the joints, connective tissue of the heart and blood vessels, serous membranes of the skin, central nervous system, eyes of the lungs, liver and kidneys.
In medical terminology, you can find another name for childhood rheumatism - Sokolsky-Buyko disease.
The average age at which the disease is diagnosed ranges from 7 to 15 years. Rheumatism has no population limitation and is widespread throughout the world.
Symptoms of rheumatism in children
The first signs of the disease can be noticed at least a week after the transferred streptococcal infection and at most in a month.
The symptoms of the manifestation of rheumatism are as follows:
- Rheumatic heart disease. It is characterized by an inflammatory process in several or all layers of the heart wall, can be accompanied by pericarditis (damage to the outer layer of the heart), myocarditis (inflammation of the heart muscle), endocarditis (inflammation of the connective membrane of the heart) and pancarditis (includes inflammation of all layers of the heart). Among the complaints presented by young patients caused by rheumatic heart disease, one can note rapid fatigue, the appearance of shortness of breath, the occurrence of pain in the heart, the development of tachycardia.
- Polyarthritis. It is accompanied by the defeat of mainly large and medium joints, the appearance of pain in them. The disease develops symmetrically.
- Chorea. It affects more often girls and appears in the form of increased irritability, tearfulness, and frequent mood swings. Then the gait begins to suffer, the handwriting changes, the speech becomes slurred. In the most severe cases, the child will not be able to eat and care for himself.
- Annular erythema. It is accompanied by a rash that looks like pale, slightly pinkish rings. Mostly located on the stomach and chest. The affected areas do not itch or flake off.
- Rheumatic nodules. They are formed in the form of subcutaneous formations, localized mainly on the back of the head and in the place where the joints join the tendons.
These are the five leading symptoms that accompany childhood rheumatism. In parallel, the patient may suffer from fever, abdominal pain, nosebleeds. Dangerous repeated attacks of rheumatism that occur a year later. At the same time, the symptoms of intoxication increase, heart defects develop, including: mitral valve prolapse, aortic insufficiency, aortic stenosis, etc.
Causes of rheumatism in children
Among the reasons leading to the development of rheumatism in childhood include:
- Firstly, acute respiratory infections, scarlet fever, pharyngitis, tonsillitis or sore throat caused by group A hemolytic streptococcus. However, infection alone is not enough for rheumatism to develop. It is necessary that the infection provokes a malfunction of the immune system, which, in turn, begins to "attack" healthy cells in the body. This is often due to inadequate or untimely therapy for streptococcal infection.
- Secondly, the hereditary factor. Studies show that rheumatism can be traced in members of the same family.
- Thirdly, long-term carriage of streptococcal infection in the nasopharynx can provoke inadequate functioning of the immune system and cause rheumatism in childhood.
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In addition, there are minor factors affecting the development of the disease. These include overwork, hypothermia and poor nutrition, which, in turn, reduces immunity and increases the risk of contracting infectious diseases.
Diagnosis of rheumatism in children
Both a pediatrician and a pediatric rheumatologist can suspect the presence of an illness in a child.
The reason for further research is the specific criteria that each doctor is guided by:
- Any type of carditis;
- Chorea
- Formation of subcutaneous nodes;
- Erythema;
- Symptoms of polyarthritis;
- Postponed streptococcal infection;
- Hereditary predisposition to rheumatism;
- A positive response to specific therapy.
In addition, there are small evaluation criteria that allow one to suspect a disease, these are: arthralgia, fever, specific blood parameters (accelerated ESR, decreased hemoglobin, neurophilic leukocytosis, etc.).
Therefore, in addition to studying the history, standard examination and questioning of the patient, it is necessary to carry out laboratory tests:
- It also makes sense to take a chest x-ray. This study allows you to determine the configuration of the heart (mitral or aortic), as well as cardiomegaly.
- An ECG will allow you to see abnormalities in the work of the heart, and phonocardiography will determine the presence of a lesion of the valve apparatus.
- In order to indicate the presence of a heart defect in a child, an EchoCG is shown to him.
Complications of rheumatism in children
The disease is dangerous for its complications. Among them, the formation of heart disease can be distinguished. In this case, its valves and partitions are affected, which leads to a violation of the functionality of the organ. Often, the progression of the defect occurs with repeated attacks of the disease on the child's body. Therefore, it is so important to take the patient to a consultation with a cardiac surgeon in time and, if necessary, carry out an operation in a specialized clinic.
Other possible complications include inflammation of the inner lining of the heart, thromboembolism, heart rhythm disturbances, and the formation of congestive heart failure. These conditions are deadly, can provoke the development of a heart attack in such vital organs as the spleen and kidneys. Cerebral ischemia and circulatory failure are common.
To avoid complications of the disease, it is important to notice the signs of rheumatism in time and start treatment.
Treatment of rheumatism in children
Children diagnosed with rheumatism are admitted to hospital for treatment. During the acute period of illness, it is important that the patient adheres to bed rest. Its duration is determined by the condition of the child and the nature of the disease. If rheumatism is mild, then bed rest should be adhered to for about a month. After this period, the child is prescribed physiotherapy exercises. Unlike an adult, children find it difficult to maintain minimal activity. Therefore, parents need to competently organize his leisure time. Board games, coloring pages, books, etc. will come to the rescue.
Drug treatment is reduced to the elimination of the pathogen that led to the development of the disease. Most often, antibiotic therapy based on penicillin is used for this. The agent is administered parenterally for 10 days. The minimum duration of such therapy is a week. The dosage is selected by the doctor individually and depends on the severity of the disease and the weight of the child. Then Bicillin-5 or 1 is used. When a child has an allergic reaction to penicillin, it should be replaced with erythromycin.
When the heart muscle and heart walls are affected, the child is given glucocorticoids in combination with NSAIDs. The "acetylsalicylic acid + prednisolone" scheme is often used. If there is a visible effect, then gradually the drug is canceled by reducing the dose.
Voltaren and methindol are popular modern remedies for rheumatism. They have pronounced anti-inflammatory effects.
When the heart muscle and heart walls are not affected, and the inflammatory process is insignificant, the patient is not recommended to take hormonal drugs. The doctor selects only anti-inflammatory drugs in the appropriate dosage.
In addition, the child needs auxiliary therapy, which consists in prescribing vitamin complexes, taking potassium preparations. Children usually spend up to 2 months in a hospital. Doctors who look after small patients are cardiologists and rheumatologists.
It is important to sanitize all existing foci of inflammation; without this, rheumatism therapy will not be successful. We are talking about caries, sinusitis, tonsillitis.
When the patient is in remission, he is shown sanatorium treatment. For prevention, use a course of NSAIDs in the fall and spring. Reception time - 1 month.
Modern drugs that are advisable to be used for the treatment of childhood rheumatism:
- NSAIDs (indomethacin, voltaren, brufen, etc.);
- Corticosteroid hormones (triamcinolone, prednisolone);
- Immunosuppressants (delagil, chlorbutin, etc.).
With a timely visit to the doctor, the risk of death is minimized. Depending on the degree of heart damage, the severity of the prognosis for the disease will depend. If rheumatic heart disease progresses and recurs, then this poses the greatest threat to the child's health.
During the activation of the disease, it is important for a small patient to adhere to a certain diet, which is based on several principles:
- Elimination of foods rich in simple carbohydrates. This is due to the fact that such products often provoke allergic reactions during an exacerbation of the disease, which might not have been observed earlier.
- The menu should be diversified as much as possible with fruits and vegetables.
- In the acute phase of the disease, it is necessary to eat one egg per day, excluding Sunday.
- If there are serious disturbances in the work of the heart, then for several days (for 3 days), it is necessary to refrain from protein foods, eating only vegetables and fruits. You can drink up to 300 ml of milk a day.
- It is important to saturate the body with vitamin C. Therefore, it is necessary to use greens and citrus fruits.
It should be understood that rheumatism therapy should be comprehensive and based not only on medication, but also on a well-organized diet, and on the correct daily routine.
On the subject: 5 most powerful remedies for rheumatism
Prevention of rheumatism in children
Since the disease is dangerous with serious complications, its timely prevention is important. Regarding rheumatism, it is customary to distinguish both primary preventive measures and secondary ones. The former are aimed at preventing the disease and preventing the infection of the child, and the latter at preventing cases of relapse of the disease, as well as the progression of rheumatism.
In order to avoid illness, preventive measures should be carried out from childhood:
- Firstly, it is necessary to competently organize the child's life, this includes physical education, a long time in the fresh air, hardening, proper nutrition with a low carbohydrate food content.
- Secondly, it is strengthening the child's psyche. These measures will allow you to maintain the defenses at the proper level and, in case of infection, help the body to cope with the infection faster.
- Thirdly, isolation of a patient with streptococcal infection and observation of contact children are considered primary preventive measures. This will make it possible to identify the infected in time and start treatment faster, as well as prevent the spread of the disease in collectives.
- Fourth, if an infection has occurred, then it is necessary to start treatment as soon as possible. It has been proven that if the therapy of streptococcal infection is started no later than on the third day of infection, the risk of developing rheumatism is reduced to zero.
It is important for parents to understand that primary prevention is a necessary intervention that is not limited to healthcare professionals. To preserve the health of the child, it is necessary to be attentive to any symptoms of malaise and seek qualified help in time.
As for secondary prevention, it is due to the tendency of rheumatism to recur. Therefore, children with such a diagnosis are under medical supervision for a long time. They are monitored by a rheumatologist, cardiologist, orthopedist and other narrow specialists.
It is important to maintain the patient's immunity at the proper level, which will ensure the body's high resistance to rheumatism. In addition, under special control, physicians should have children in whose families there are cases of the disease among close relatives, including brothers and sisters.
The author of the article: Sokolova Praskovya Fedorovna | Pediatrician
Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.
