Rheumatic fever is repeated. Scho provokuє Gostra is rheumatic fever (rheumatism)

Gostra rheumatic fever (abbreviation - GRL) is an important firing process in the lesions of the structures of the heart, slopes, shkiri, nervous system and institutes of the brain. It is possible for mothers to end up with negative traces, as it is not a matter of time not to take a liking. About the pathogenesis and etiology of rheumatic fever in children and adults, the history of ailments, the formulation of diagnosis and diagnostic criteria, read our current material.

specialties of ailments

Lichomaniac winy in viglyadі іslіdnenja іnfіkuvannya lіmphatichesky tissue of migdalin (tonsilitis,), pharynx (scarlet fever), provoked by aggressive beta-hemolytic streptococcus from group A. Pathogenesis of dressings:

• s vid_lyayut toxins streptococcal enzymes, wiklikayut otrunnya clitin in the tissues of the heart.
• due to the similarity of the antigenic complexes of the pathogen and tissue of the myocardium, which provokes immunity to aggression against "native" cells, which are lost as aliens.

In the video below, the following information is presented on rheumatism and HRL:

Classification of GRL

Standard classification of rheumatic fever in children and adults:

cause

Officials see the main reasons for the development of a feverish woman.

Aggression of beta-hemolytic streptococcus A-type

Rheumatic fever, typically developing in 3 - 4 years for scarlet fever, angina or pharyngitis, and those who are sick with gram-positive streptococcus, which may cause high levels of contagion. When the pathogen is introduced into the roof, the normal functioning of the immune complexes in the body will break down.

M-cells of the streptococcal microorganism are close to the structure of the cells of the tissue of the myocardium, loam and sinoval shell (inner ball of the loam). For reasons of immunity, reacting to the penetration of an alien agent into the body, an attack by a powerful cell, provoking ignition processes.

slump factor

The development of the pathogenesis of rheumatic fever depressions is due to the greatest frequency of ailments, which have been accelerated and are promoted in the environment. Spadkova slenderness before GRL, viclikan appears in the body specific antigen, It is revealed in all cases of ailments and in dermal diseases 6 - 7 are not ailments.

Gostra rheumatic fever has its own symptoms, forgive and talk about it.

symptoms

foreign signs

More, less in half of the children and the ear of an attack of rheumatic fever is manifested:

• unsuccessful i a sharp strik sleepless temperature;
• the appearance of symmetrical pains in colony, liktovy, tazostegnovyh slopes, start to change localization;
• swelling and soil tissue near ignited slopes;
• signs - inflamed structures of the heart (pain behind the sternum, temporal lumen, s and more often, stretching the empty heart, lowering the grip).

In some cases of pathology, there are clearly pronounced symptoms of arthritis or rheumatic heart disease (rare).

Young children 15 - 19 years old have a cob of sickness, do not call it the same gostre, as with young children:

• temperature, as a rule, out of reach 38.5 C;
• arthralgia (ailment) in great slopes does not supervise turning over fiery and bulging;
• show carditis - pomirnі.

Specific signs in case of advanced forms of ailment

rheumatic arthritis

Rheumatic arthritis gives symptomatology in case of persistent atats of GRL in 70 - 100% of patients. tse:

• soreness, swelling of tazostegnous, interstitial, lactic, homilky, colonic slopes through the purchase of vipota into slopes sumts (synovitis);
• frayed with ruffleness through bіl;
• the specificity of arthritis, acute GRL is a "mild" character of the burned up (in some slopes it takes 1 - 4 days to develop in 1 - 4 days, changing in different ways), and also - the rapidity of the turnover of symptoms in the presence of pharmacological prototypes.

carditis

Carditis is susceptible to be more susceptible to HRL in 85 - 95% of patients. Some degrees of severity of symptoms are muffled, but in any case appear:

• rozlad heart rhythm;
• zadishka;
• , Preciousness and strong stomachability.
• However, it quickly consumes elasticity and appearance as it grows crooked and shrinking, skipping shelter (see if symptoms are erased and moderate and slight interruption of rheumatic carditis).

Anomalous changes in the valves are not easy to come across (fired by the tissue of the heart and the outer shell), to cause the heart to break down, if there is noise, created by the ton, the widened empty.

The specifics of rheumatic heart disease (as well as rheumopolyarthritis), which is of great importance in diagnosing HRL - there is a clear indication of all the symptoms in the pathology of intensive therapy.

With active and hourly conducting of the procedure, the restoration of the normal rhythm of the fast heart and cordon of the myocardium, sonority of tones, lowering of the level of abnormal noises, signs of damaged blood flow is observed.

rheumatic chorea

Rheumatic chorea (synonymy - mala chorea, seen in the middle of the middle dance of St. Vitus) is a pathology that develops with advanced processes burning on the tissue of the brain. Appear (inflamed) of other cerebral vascular disease and symptoms of lesion of the central cerebral vascular disease and spinal cord and peripheral nerves.

The target of pathology is, in the main, children of a young age (15 - 30%), before they are children in pubertal period, after 35 - 65 dib, in addition, as a child, she underwent a hospitalization of streptococcal microorganism. The most frequent visitor is the children of the female stati.

Symptoms of little chorea common syndromes:

• rukhové népokonnya, uncontrolled posmikuvannya (hyperkinesi) m'yazyv, hands and nig, grimacing, how to stay in the period of sleep;
• the inviolability of moving, stomlennya, the snake of walking, the unwillingness to utrimate other objects;
• hypotension (more weak, similar to parallel), deterioration of the function of communication, physiological changes;
• apathy, tearfulness, aggressiveness, gratitude, sleep disturbance.

Name the symptoms of chorea to be associated with carditis and rheumatic arthritis, albeit in malignant fever (in 5 - 7 children out of 100 ailments), chorea is the only obvious symptom of rheumatic fever. In cases where there are signs of GRL in the daytime, the diagnosis of little chorea should be given for the onset of some of the most common causes of neuropsychiatric disorder.

k_lcepod_bna eritema

Cycle-like erythema in HRL appears on the peak of ailments in horny ring-like beaches with a size of 50 - 100 mm, then it appears on the skin of the breasts, arms, nig and back, then disappears. In addition to them, hanging around the viewers of small vuzliks - painless, dark-reddish apparitions, grows wider in the nasal-angled fabrics - above the ridges, the protrusions of p'yat, ankles, pylits. Only children can be seen. Disappear for 25 - 30 days.

Erythema and rheumatic high schools are rather specific signs of rheumatic fever, which may be of great importance for accurate diagnosis. Differential diagnostics of hostile rheumatic fever will be discerned.

diagnostics

Diagnosis of GRL is often foldable, some basic manifestations (including the problem and the universities) are not in charge of the pathology, but are diagnosed in case of some ailments. With mild symptomatology of carditis, the diagnosis is significant, and the following:

• from vicories. The price of improvement is the possibility of assessing changes in the structure of the heart, coronary blood flow, the appearance of the feet and the nature of the damaged valves, firing the pericardium (the outer shell of the heart);
• It is permissible at all times to signify, chi є destruction in the rhythm of a very hearty mead.

laboratory analyzes

During the state medical examination of the GRL, the following should be started:

• in the blood - adduction of SHOE (more than 40 mm / year) і CRP (number of C-reactive battery, which is accepted in the furnace when it is hot), in some - the increase of leukocytes, neutrophils;
• increased concentration of anti-streptococcal antibodies (AT) (in 82% of ailments);
• hemolytic streptococcal agent during bacteriological pre-lactation smear taken from empty mouth.

Differential diagnosis

Classical signs of HRL are not often detected, therefore, for accurate diagnosis, it is necessary to recognize HRL from other pathological conditions with similar manifestations.

There is no clear link between streptococcal aggression and rheumatic heart disease;

• - information on valves;
• viral myocarditis (inflamed tissue of the heart);
• (Dobryakisna pukhlin in the front of the heart).

Important to the nobility:

• Chorea with GDD is associated with encephalitis, neuropsychiatric PANDAS, and provoked by streptococcal infections.
• Arthritis, carditis and shkirna erythema are manifested in lymoborreliosis, if the infection appears as a tick bite (spirochete).
• The diagnosis of GRL from the Lyme ailment is necessary to identify in the ailments the presence of antibodies in the blood to the spirochete.

About lіkuvannya in klinіtsі and homes, as well as inadvisable help with hospitality rheumatic fever, read below.

lykuvannya

A complex scheme is transmitted to the Licuvanna ORL, which includes:

• etiotropic therapy (usunenia of the cause);
• pathogenetic (correction of impaired functioning of organs, stabilization of communication processes, development of immune response to organism), symptomatic (recovery of symptoms).

Call all patients (especially children) to be accommodated in the hospital for the signs of a suvorogo postal regime for 3 years. Transfers included in the food races of proteins, amalgamated salts.

medication

• Throw down the cause of the ailment - beta-streptococcus disease - vicious antibiotics of the penicillin group (from 14 years of benzylpenicillin in doses of 2 - 4 million OD, children younger than 14 years from 400 to 600 thousand OD). The course is not less than 10 dB. Abo zastosovuєtsya bolsh "penetrate" amoxicilin.
• With penicillin allergy, prescribe drugs from a number of macrolides (Roxithromycin, Clarithromycin) or linkosamide. After completing the course, antibiotics are prescribed in trivial tablets.
• Pathogenetic therapy of ARF polyaga in stasosuvanny hormonal drugsі refinery. In case of severe carditis and serositis not less than 18 - 22 days, prenizolone should be consumed at 20 - 30 mg per day until the severe disease is eliminated. For a complete dose of glucocorticosteroids, it is more common to change (2.5 mg per day).

Usunennya symptoms:

1. With the treatment of rheumatic arthritis, chorea, it is recognized that there is a change in the burning of the slopes, in an additional dose of 100 - 150 mg for a course of 45 - 60 days.
2. Signs of rheumatic heart disease are usually recognized as being useful for stimulating myocardial activity (Digoxin).
3. Hormones are specifically injected into the metabolic processes, that is, from looking at the steps of dystrophic changes in the heart, to take medications:

• Nandrolone in a course of 10 ін'єкцій 100 mg once a day;
• Asparkam 2 tablets 3 times for doba, course of 30 days;
• Inosine trichi for dobu 0.2 - 0.4 g, a course of trivial 1 month.

1. When molding in embankments, it is necessary to apply the rіdini in fabrics, to fill the sechogіnnі in the form of lasix. Vikoristovuyt stimulants of the immune system.

Heart defects, which have been formulated in rheumatic heart disease, are eligible for drugs like arrhythmias, nitrates, and other diseases of the disease. The triviality and the specificity of cardio-therapy lie at the stage of the destruction of the structure of the myocardium, the severity of the symptoms and the stage of the lack of the function of the heart.

hirurgic

When diagnosing HRL, an important defect of the heart is revealed, an operation is performed on the valves, and the possibility of plastics and valve prosthetics is assessed.

physiotherapy

One hour from the vicarious medicines in the treatment of GRL, the transfer of the course of physiotherapy:

• UHF-prog_vannya,
• application of aplication of liquid mud and paraffin,
• іnfrachervone vippromіnuvannya,
• zasosuvannya kisne and radon baths,
• lіkuvalnogo massage (pіslya oduzhannya).

prophylaxis

• For the development of GRL, it is the primary prevention of antibiotics in the early development of infections of the pharynx, which cause streptococcus for the additional antibiotics (amoxicilin, Cefloxacinil).
• In case of repeated infusion of vicoric acid, Amoxicilin with clavulanic acid. As the therapy does not give the result of any allergic reaction, it means Lincomicin, klindomitsin.
• Secondary prophylaxis is necessary to prevent repeated attacks of GRL for team patients, who have also suffered from illness. Antibacterials are meant to be trivial - bicilin (Extensilin and Retarpen), which reduce the rate of recurrence of GRL in 5 - 20 times.
• For quiet patients, who are ill with GRL without carditis, the triviality of antibacterial treatment should be at least 5 years. Iakshko diagnostics carditis, which buv vilіkivaniy without inheritance - not less than 10 years.
• For patients who may have a myocardial defect (including quiet, hto transfer the operation) - for all life.

Decreased hospitality of rheumatic fever

A feverish rheumatic woman can have a successful result, and a sickness can get sick, because the diagnosis was carried out promptly, and the treatment was well-timed and literate. We can accelerate, as we can block the GRL:

• transition of GRL into a chronic form of rheumatic heart disease (CRHD), the formation of myocardial malformation, deformity, atrophy of the valve stools with a hundred damage of their functions, but without it;
• prolapse (in the tenth ailing dermal child) abo (sounding of the atrioventricular opening) of the mitral valve, lack of function of the aortic valve;
• breakdown of the rhythm of a very fast heart with the development of chronic arrhythmia;
• admission of imperceptibility to endocarditis (firing of the inner membrane of the myocardium in case of penetration of high microbes into the external bloodstream, and distal - on the valve).

forecast

Rizik of a fatal result in case of a rheumatic fever during the day (in the region of a rare disease of pancarditis - zagalny zapalennya heart balls - in children). The frequency of development of heart wads due to experienced rheumatic pathology in children is 25%.

Prediction of an anxiety to accumulate from:

• myocardial stance - the manifestation and severity of the heart defect formed during carditis;
• stages of lack of pumping function of the myocardium;
• In addition, as soon as they started to carry out the treatment, some of the risky formulations of the vad would start to move with a dying ear of therapy.

Ailments can come to an end in some cases (temporarily) without the formation of heart and valvular vadas with timely distribution and competent therapy.

A whole video will tell you about HRL and rheumatic heart disease:

The proponent has been given a guide to the epidemiology, clinical pictures of the main rheumatic ailments, the criteria of diagnostics, differential diagnostics, non-basic aid and prevention. visualized happy look on etiology, pathogenesis, classification of the main rheumatic diseases. During the preparation of this initial booklet, the bully vikoristani materials of the remaining scientific and practical conferences and symposiums, as well as standards and recommendations of the Ministry of Health Protection of the Russian Federation, the Russian Organizational Cardiological Association, All-Union A basic guidebook of meanings for interns, residents and patients, who are introduced to the system of additional professional education for specialties: therapy, rheumatology, home medicine practice (family medicine).

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Guidance to the melody fragment of the book Clinic, diagnostics and treatment of the main rheumatic ailments (D. I. Trukhan, 2014) provided by our book partner - LitRes company.

RHEUMATISM. Gostra is rheumatic fever

Viznachennya. Trivial hour before rheumatism all the ailments rose, when they were suffering from the organ of the support-roche apparatus: suglobi, m'yazi, m'yak_ fabricі ін. In the last ten years, the term "rheumatism" has been replaced by the word "rheumatic ailments".

The most important term " rheumatism"- self-inflicted disease, tying with streptococcal infection, with lesions of loam, heart, nervous system and other organs. However, in the current medical literature, the term "rheumatism" in the whole meaning of the term "rheumatic fever" is widely accepted by the whole world.

Gostra is rheumatic fever(GRL) - Postinfectious accelerated tonsillitis (angina) or pharyngitis, viral beta-hemolytic streptococcus of A. heart-vascular system(ССС) (carditis), suglobiv (mild polyarthritis), central nervous system (CNS) (chorea) and shkiri (cyclical erythema, rheumatic vyzliks) and develop in sick people (head) 7 in 15 autoimmune susceptibility to macroorganism on the antigens of group A streptococcus and cross-reactivity of antibodies (AT) with similar autoantigens of human tissue (the phenomenon of molecular microorganism). In ICD-10 it is classified under the headings I00 - I02 "Gostra rheumatic fever".

Chronic rheumatic heart disease(CRHD) - discomfort, which is characterized by lesions of the valves of the heart in the viglyadi of the marginal fibrosis of the valve stools or defect of the heart (deficiency and / or stenosis), which were formulated after the transferred HRL. In ICD-10, the headings I05 - I09 are "Chronic rheumatic heart ailments".

Epidemiology. The incidence of GRL in Russia is 2.7% per 100 yew. Population, CRHD - 9.7% (including rheumatic heart disease - 7.64%). The breadth of the CRBS in children is 45 vypadkiv per 100 yew. Population, and for grown-ups - 260 vipadkiv. Individuals of the cholovic and female statuses are ill at the same frequency, but even in 7-15 years.

The suspicion of those who are still young sleepers of the GRL is to blame for the fact that CRBS is not underestimated by the indices of primary illness. What matters is the greaterness in this category of storage of patients with swollen rheumatic vices of the heart. Until the end of the last ten years of the last century in Russia, it was shorter than 2.5 thousand. A sick person from CRBS is more, lower on the cob of restoration (1994).

Prior to the reasons for producing GRL sleepers, the following should be admitted:

- lack of treatment of ailments with angina and pharyngitis of streptococcal etiology;

- lack of knowledge key symptoms grievous fazy ailments in a zyazyka z tim, so you will be able to see it in a given hour;

- weakening of the alertness of people who are ill;

- not so much the obspezhennya of ailments with an increase in rheumatic fever;

- change of virulence of "rheumatogenic" streptococcus.

Ethiology. Gostra rheumatic fever develops when sick, vicious "rheumatogenic" strains of beta-hemolytic streptococcus (M1, M3, M5, M18, M24), like volodyu high contagion, tropism of pre-nasopharyngeal disease. "Rheumatogeny" streptococci take revenge on epitopes, which overreactly reacts with the growth tissues of the macroorganism-governor: myosin and sarcolemmal membrane, synovia and brain, i.e. these structures, which develop into pathological conditions.

Genetic officials. Seven ailments of GRL and CRHD have a tendency to hyperimmune anti-streptococcal disease and a wide range of concomitant and rheumatic diseases of the heart, less in the foreign population, especially in the middle of the first group.

Pathogenesis. In folding pathogenesis classic manifestations HRL is most significant to be immune to inflammation, immunopathological processes, to take an active part in streptococcal antigens and AT, however, the toxic concept is to make a singular contribution to the intelligence of cob manifestations of HRL. With this rank, the development of GRL is established:

- direct toxic ear myocardium "cardiotropic" enzymes of beta-hemolytic streptococcus group A;

- Immunity advice on arterial hypertension(AH) beta-hemolytic streptococcus of group A, to produce anti-streptococcal antibodies (AT) to the synthesis, overreact with AT of weakness of human tissue (the phenomenon of molecular mimicry).

Pathomorphology. Seeing some stages of the pathological process in the resulting tissue: mucoid swelling, fibroids and other changes, proliferative reactions, sclerosis. Proliferative reactions are supported by rheumatic granulomas (Ashoff - Talalaev).

Classification.

Клінічні forms:

- repeated rheumatic fever.

Vikhodyachi:

- oduzhannya.

without blemish of heart;

with the vice of the heart.

Lack of blood circulation:

- for the classification of M.D. Strazheska and V.Kh. Vasilenka (stage 0, I, IIA, IIB, III);

- for the classification of New York cardiological associations (functional classes 0, I, II, III, IV).

Klinika. To drive rheumatism figuratively, the French lykar E. Sh. Lasegue: "Rheumatism is lighter than the loam, the pleura and the brains of the tunic, the more sore bites the heart." The sensation of affection of the field is in the fact that the reduction of slopes, pleurisy and membrane of the brain wants and can manifest itself even more vividly, but not even more inherited inheritance. Striking the heart, if it might be uncomfortable on the cob of ailments, or to bring to the formation of vad heart - the destruction of the robotic valves, which may seriously slow down and significantly deteriorate the forecast.

Klinichny show GRL:

- main: carditis, arthritis, chorea, cytitis erythema, rheumatic diseases;

- dodatkovі: fever, bіl in the slopes, abdominal syndrome, serosis.

At the debut there is a key picture of becoming ill in the age of children. After 2 - 3 days. when the transferred angina in large children is ill, to recover from the raptus temperature increase to febrile digits, appear symmetrical, running pains in great slopes (most often colony ones) and a sign of carditis (pain in the heart) In the case of children, they are susceptible to monosyndromic stretching of the disease, which is a sign of arthritis or carditis, or rather chorea.

Gostro, by the type of spalah, GRL is developed among schoolchildren of the middle century and soldier-recruits, who suffered an epidemic angina, a beta-hemolytic streptococcus group A.

It is typical for children and young people to act on the cob - for the quiet of the most important manifestations of angina appear subfebrile temperature, Arthralgia in large slopes, or only if there are signs of carditis.

A repeated attack of GRL is provoked by infectious diseases, vicious beta-hemolytic streptococcus of the group A and manifested itself in the development of carditis.

On'єktivno obsozhennya. Temperature reaction varies from subfebrile to fever.

Obstezhennya shkіri. Prior to the main signs of GRL, there are ring-like conditions and pediatric rheumatic universities.

k_lcepod_bna eritema- black-eyed rings (up to 5 - 10 cm in diameter) on the tulips and proximal edges of the pictures, but not on the face, as it is not possible to overshoot, I do not need to be overwhelmed. characteristic, ale ridkisny (4 - 17% of all types of GRL) signs.

Pediatric rheumatic universities- rounded small painless painless other universities, loosening of tendons in places where tendons are attached in the area of ​​colonic, homogeneous feet, liktovye slopes, or polycysts; a characteristic, ale, ridkisny (1 - 3% of all types of GRL) symptom.

Unimportant on the value of a decrease in the frequency of children and rheumatic high schools in children and in fact

Obstezhennya suglobіv. In case of GRL, the following is characteristic of the lumpy syndrome:

- loss to the pathological process of the colony, homiless, promenade, littoid slopes;

- goodness (deformation does not develop), the volatility of clinical manifestations, changeable, often symmetrical formation of loam;

- the form of the lesion is important - oligoarthritis, rіdshe - monoarthritis;

- polyarthralgia (mild in great slopes of a growing intensity) is indicated in 10-15% of cases, not superimposed on intercourse ruffs, ailments with palpation and intense symptoms of inflammation;

- the appearance of the suglobovy syndrome in the presence of non-steroidal anti-fiery arthritis (NPZZ).

Pre-treatment of the heart-vascular system. carditis- provincial GDL syndrome, which occurs in 90 - 95% of cases and because of the severity of the failure and the result. Valvulitis (mainly of the mitral valve, before the aortic valve) is the main component of carditis, which appears as an organic heart murmur, possibly in the presence of myocarditis and pericarditis.

Auscultatory symptoms of rheumatic valvulitis

1. systolic murmur obumovaniyu mіtralnoї regurgіtatsієyu. It is optimal to listen to the top of the heart and to be held in the left groin area. For the character of the trivial dme, dressing in I tone and borrowing a larger part of the systole. Low intensity, especially at the early stages of becoming ill. Chi does not lie in the position of the body and phase of the situation.

2. mesostolic noise(Low-frequency) lingering on the upper heart in the position of the sick person on the front of the body when the response to the vidiha is detected (in case of the presence of a gallant carditis with mitral regurgitation). The noise often follows the III tone or drowns out the tone.

3. protodiastolic murmur in the case of aortic regurgitation, it is repaired at once to the second tone, it is often accompanied by a systolic murmur and a low-frequency dme is regressive in nature. The noise is most clearly heard by the bridle of the left edge of the breastbone for a great vidihu when the sick person is nailed forward.

For HRL, the aortic valve enlargement is not characteristic, without the appearance of the noise of the mitral regurgitation. The dissection of the heart by the type of myocarditis and pericarditis with the appearance of valvulitis is inferior to those with low heart disease and is indicated for carrying out retinal differential diagnostics of carditis of the international ethology (in the first place).

The particularity of valvulitis in the case of the first atats of GRL is positive dynamics in the presence of active antirheumatic therapy. In the overwhelming majority of symptoms on the basis of symptoms, there is a normalization of the frequency of heart rates, an improvement in the sonority of tones, a decrease in the intensity of systolic and distant blood noises, a speed of heart rate

Debilitation of the central nervous system. When you look around you see signs of little chorea(In 6 - 30% of cases): hyperkinesia, hypotension (even to the point of weakness of hypotonia), disruption of statics and coordination, sudden dystonia, mental stability .). Rheumatic chorea (chorea mala, Sydenham's chorea) It is diagnosed in 6 - 30% of sick children and rarely in children. Most often, such strikes are spoken among girls and children. In 5 - 7% of patients, chorea can be diagnosed with only one person with HRL.

Striking the serous membranes In this hour, it is rare, only in case of an important interruption of the first attack, and / or repeated rheumatic fever, and it manifests itself in an important abdominal syndrome of low intensity with a sharp revolting therapy development on the front.

Folding. The result of endocarditis is the formation of rheumatic heart defects. The frequency of the development of the first attack of GRL in children becomes 20 - 25%. Overwhelming the isolated vices, often the mental deficiency. Lack of the aortic valve, mitral stenosis and combinations of mitral and aortic valve defect are more often formed. Approximately 7-10% of children with rheumatic heart disease develop mitral valve prolapse (MVP).

In pidlіtkіv, who underwent the first attack of GRL, wadi heart is diagnosed in 30% of patients. In older children of Denmark, the indicator of reach is 45% of the range.

The maximum frequency of the formation of rheumatic heart defects (75%) is promoted by the first 3 years of illness. Repeated attacks of GRL, as a rule, will increase the turn of the valve pathology of the heart.

Features of overcoming rheumatic fever:

- clinical polymorphism (versatility of forms and options for overrun);

- erasure of clinical and laboratory symptoms (especially in older patients);

- there is often a latent interruption, without a clear clinical manifestation;

- the activity of interrupting the process is rarely indicated, often polyarthralgia, mild polyserositis, rheumatic institutes, and hyperplasia occur;

- revaluation of neuro-rheumatism (chorea);

- reloading of the productive component of the heat;

- more friendly interruption of the first attack of rheumatism (sooner to end the form of heart defect).

Diagnostics. Laboratory Doslidzhennya. Prior to general viscous methods of laboratory follow-up, the following should be applied:

- Zagalny analysis of blood: increased fluidity of blood cells (SHOE) and positive C-reactive block (CRP);

- bacteriological dosage: detection of beta-hemolytic streptococcus of group A in a smear (it can be detected in case of active infection, as well as in case of nasal infection);

- the value of antistreptolysin-O, anti-aluronidase and anti-deoxyribonuclease B: change or move in the dynamic titer.

Adequate methods of advancement can be useful for differential diagnostics and to be found in a specific clinical situation ( rheumatoid factor (RF), anti-nuclear AT - negative ) .

instrumental methods doslіdzhennya. Prior to binding methods, include:

- electrocardiography (EKG) to clarify the nature of the heart rhythm damage and conductivity (in case of concomitant myocarditis);

- Echocardiography (EchoKG) for the diagnosis of pathology of the valves of the heart and the occurrence of pericarditis.

Diagnosis of GRL followed by an allowance in cases of fever, carditis or lump syndrome after 2 - 3 months. writing angina streptococcal etiology. To confirm the diagnosis, it is necessary to carry out:

- Zagalny analysis of blood (Zbilshennya SHOE);

- EKG (subdivided into the interval P - Q);

- EchoKG (signs of urazhennya valves);

- bacteriologic smear detection from the screen (detection of streptococcus) or anti-streptococcal antibodies (titration of anti-streptococcus).

When diagnosing HRL, a syndromic principle is established, formed by a pediatrician A.A. їх day.

The American cardiologist T. D. Jones (1944) introduced the indications to the "great" diagnostic criteria, having seen the "little" clinical and laboratory parameters.

For the diagnosis of ARF, the criteria of Kisel-Jones, which were looked over by the American Association of Cardiologists in 1992 and modified by the Association of Rheumatology in Russia in 2003 (Table 1).

The discovery of two great criteria, for one great and two small criteria from the previous day, to confirm the infection in front of the first, to the test of streptococci from the group A, to find out about the high number of people.

Apply a clinical diagnosis:

- HRL: carditis (mitral valvulitis), mild polyarthritis. Lack of blood circulation (NK) of the I functional class (FC), type I01.1 for MKH-10;

- repeated rheumatic fever: carditis. One-hour mental defect of the heart. NK II A (FC II), type I01.9 for MKH-10;

- CRHD: combinations of mitral-aortic heart disease. NK IIB (FC III), subdivided into headings I08.0 for MKKh-10.

Table 1

Diagnostic criteria for ORF

Activity of the disease. When there is a significant activity, the disease is vicious, the quantity of clinical and laboratory parameters is high.

I stage of activity characterized by monosіndromicity (movable carditis or small chorea). Laboratory indicators show the norms or changes insignificantly.

II stage of activity It is possible for people to experience alarming symptoms of heart disease in the presence of subfebrile temperature, polyarthralgia or mono-, oligoarthritis, chorea may be, SHOE value between 20-40 mm / year. It is evident that there is an abatement of leukocytosis and an increase in the titre of anti-streptococcal antibodies.

III stage activity characterized by feverishness, hospitality Polia rtrit, myocarditis, high titers of antireptococcal antibodies, may pancarditis, serositis, neutrophilic leukocytosis, improvement of SHOE 40 mm / year.

Differential diagnosis. The emergence of only one of the main criteria for HRL (carditis, arthritis, chorea) dictates the need for a disease.

Differential diagnosis of rheumatic carditis. transcript nosological forms To be included in the algorithm for differential diagnosis of rheumatic carditis, to achieve a wide:

- infectious endocarditis (IE);

- non-rheumatic myocarditis;

- idiopathic MVP;

- neurocirculatory dystonia;

- cardiomyopathy;

- myxoma;

- primary antiphospholipid syndrome (AFLS);

– nonspecific aortoarteritis;

- systemic chervonia vovchak (VKV).

Characteristic of rheumatic carditis is:

- chronological link from A-streptococcal infection of the pharynx (pharyngitis, tonsilitis);

- latency period - 2 - 4 times;

- young vik sick;

- it is more important than a gostry or a cob;

- polyarthritis or state arthralgia in the debut of ailments;

- "passive" character of cardial skargs;

- the appearance of valvulitis in the presence of myocarditis or pericarditis;

- temporal rupture of symptoms in carditis;

- correlation of laboratory and clinical signs of ailment activity.

Differential diagnosis of rheumatic polyarthritis. The main points in the differential diagnosis of rheumatic polyarthritis (before the onset of symptoms of carditis) with the short-term and the volatility of the battle of the great and middle locks, in the opposite direction Rheumatic polyarthritis differentiation from the onset of illness:

- reactive arthritis (ReA);

- rheumatoid arthritis (RA) and juvenile RA;

- Still's syndrome;

- ankylosing spondylitis;

- hemorrhagic vasculitis.

(In detail div. Vіdpovіdni razdіli navchіvnogo posіbnik.)

post-streptococcal arthritis It is possible to develop in a person of the middle age, develop a period of an altogether short (2 - 4 days) latent period at the time of transfer of pharyngeal infection with hemolytic streptococcus of group A, persisting for a period of about 2 hours (without optimal conditions). and I will regress without excessive changes.

Differential diagnosis of little chorea. The main difficult differential diagnostics of a small number of chorea associated with situations, if there is a single criterion for GRL. Differential diagnosis is carried out spirally with a doctor-neurologist.

Differential diagnosis of autoimmune neuropsychiatric children, associations with infections, vicious with streptococcus group A. In the end of the XX century. descriptions of a specific syndrome, which is indicated by the PANDAS abbreviation ( P ediatric A utoimmune N europsychiatric D isorders A ssociated with group A S treptococcal infections). On the basis of classical rheumatic chorea for a new characteristic turn of psychiatric disorder - obsessive-compulsive problems (as of today obtrusive thoughts and obtrusive rukhiv), the reduction of neuropsychiatric symptoms only with adequate anti-streptococcal therapy.

Likuvannya. Cycles: remediation of beta-hemolytic streptococcus of group A, suppression of the ignition process, amelioration of rheumatic heart disease in patients with carditis, compensation of heart failure in patients with rheumatic heart disease.

Non-drug therapy Including the post-treatment of the post-regime for a period of 2 - 3 days., Diet, Bagatu with vitamins and Bilk (not less than 1 g per 1 kg of oil), with some salt and carbohydrates.

physiotherapeutic treatment not shown.

Ethiotropic therapy. Antibacterial therapy. Benzylpenicillin should be consumed for a stretch of 10 dB in adults and adults in a dose of 0.5 - 1.0 million OD 4 times / add i / m, in children - in a dose of 100 - 150 thousand. OD 4 times / add in / m. It is necessary to freeze the penitentiaries of the prolonged action in the mode of secondary prevention. In case of intolerance to penicillin, macrolide is shown or linkozamid (in detail div. In pidrozdil. "Prophylaxis").

Pathogenetic therapy. Protisapalnaya therapy. glucocorticosteroids(Corticosteroids) stagnate with HRL, which is against the development of carditis and / or polyserositis. Prednizolone is prescribed for adults and for children at a dose of 20 mg / day, for children - at a dose of 0.7 - 0.8 mg / kg in 1 dose of a day until a therapeutic effect is reached (in the middle stretch of 2 months). Let the dose be reduced step by step (by 2.5 mg of skin for 5 - 7 days) right up to the second time. The triviality of the course becomes 1.5 - 2.0 ms.

Refinery It can be recognized in case of mildly severe valvulitis, rheumatic arthritis without valvulitis, minimal activity process (SHOE - less than 30 mm / year), if there is less high activity and corticosteroids, with repeated ARF on the pores of rheumatic fever.

diclofenac sodium prescribe to adults and toddlers in a dose of 25 - 50 mg 3 times / add, for children - at a dose of 0.7 - 1.0 mg / kg 3 times / add to normalization of indicators of ignition activity (in the middle stretch of 1.5 - 2.0 ms .). If necessary, the course of treatment with diclofenac can be continued up to 3 - 5 ms.

In case of polyarthritis (Polyarthralgii), the refinery is more likely to be designated for a new period. Vibor є 5% cream abo gel ibuprofen, registered in the Russian Federation for trade names Dolgit.

In case of chorea, which occurs without any symptoms of GRL, the use of GCS and NPZP is practically ineffective. It is shown that psychotropic drugs are used: neuroleptics (aminazine 0.01 g / dobu) and tranquilizers from the benzodiazepin group (diazepam - 0.006-0.010 g / dobu). In case of severe hyperkemias, it is possible to take the values ​​of the prothysymal drugs (carbamazepin - 0.6 g / dob).

Likuvannya heart failure. Go to therapy of congestive heart failure in patients with ARF and rheumatic heart defects may have a number of peculiarities. Zokrema, with the development of heart failure as a result of gross valvulitis (more often in children), the intake of cardiotonic drugs is not sufficient, some of them have an obvious therapeutic effect - 40 mg of doses can be reached with 60 mg / day. At the same hour, we have rheumatic heart defects with heart failure and without obvious signs of carditis, the sign of GCS is not true through the improvement of myocardial dystrophy.

The main groups of lykarsky diseases (LZ), which can become stagnant in cases of heart failure in patients with ARF and rheumatic heart defects:

- diuretics: loop (furosemid), thiazidny (hydrochlorothiazide), spore (Indap), kalizberigayuchi (spironolactone, triamterene);

- blockers of large calcium channels from the group of dihydropyridines of the trivalo diy (amlodipin, felodipin);

- beta-blockers (carvedilol, bisoprolol, metoprolol);

- heart glucoside (digoxin).

Doses and schemes of prescribing drugs in analogous doses and schemes for the treatment of congestive heart failure and ethology.

With vibration drugs To become stagnant for the therapy of heart failure in patients with carditis on a few rheumatic heart defects, then they can use anti-festering drugs. Nutrition about the degree of retention of angiotensin-converting enzyme (ACE) in people with rheumatic heart disease on the other

Khirurgichesky lykuvannya. Indications to hіrurgіchnogo lіkuvannya Khvorov revmatichnimi Vadamee sericite - virazhenі klіnіchnі manifest vice sericite abo Yogo uskladnennya (Sertsevy nedostatnіst III - IV FC for klasifіkatsієyu New Yorkskoї kardіologіchnoї asotsіatsії, legeneva gіpertenzіya, sistolіchna disfunktsіya lіvogo shlunochka, stenokardіya, migotliva aritmіya іn i.). The nature of the operative involvement (commissurotomy, prosthetic valves) is based on the morphology of the valve changes and the sick person.

Expertise of preceding. Time-consuming terms of timid hourly inconsistency with HRL without heart attack become 20 - 40 days, with HRL with evidence of carditis, polyarthralgia - up to 30 - 45 days, with HRL with feverishness, deficiency of carditis with heart disease - 60 for lesions of the valve apparatus and the manifestation of chronic heart failure - up to 70 - 80 days. Medical and social examination (MCE) should be carried out.

Forecast. A non-mediated threat to life at the link with the GRL is practically every day (for the childish). The main prognosis lies in the form of the heart-vascular system (the manifestation of the severity of the defect, the turn of the heart failure). Even more important is the term for the cob of therapy, so as when you start to get sick (like when you are on the go), the development of rheumatic diseases of the heart quickly grows.

Prevention. A vaccine is being developed to take revenge on the epitope M-block of "rheumatogenic" strains of beta-hemolytic streptococcus group A, which do not take over-reactions with human antigens.

Significantly, come in, direct to the adjustment of natural immunity and adaptability of the organism to the unfriendly minds of the new middle age. To them are admitted:

- early start-up;

- povnotsinne vіtamіnіzovane food;

- the maximum amount of fresh food;

- rational physical culture and sports;

- zapobіgannya purchases in donkeys, child preschool facilities, schools, colleges, universities, community facilities;

- a complex of sanitary and hygienic visits, to reduce the power of streptococcal infection of collectives, especially children. In this day, the basis of the first preventive measures - antibacterial therapy of the gastrointestinal and chronic recurrent infections of the upper dysfunctional paths (tonsillitis and pharyngitis), antibacterial therapy of anti-hemolytic streptococcus drugs in A.

zasosovat vnutr_shny'yazo one-time. For older adults and children older than 12 years, the dose becomes 2.4 million OD, for children with a weight of 25 kg - 1.2 million OD, for children with a weight of less than 25 kg - 600 yew. OD. Situations, as far as the LZ is recognized:

- the patient's overall adherence to oral intake of antibiotics;

- the presence of GRL in the anamnesis of ailing or closest relatives;

- Unfriendly socially-pobutovі mind;

- Sleepers infectious diseases, viclikanovy beta-hemolytic streptococcus of group A, in preschool institutions, schools, boarding schools, schools, vіyskovy parts.

amoxicilin Priznachayut all the middle with a stretch of 10 dB grows in a dose of 0.5 g 3 times / dobu, for children - at a dose of 0.25 g 3 times / dobu.

Phenoxymethylpenicilin in the middle 1 hour before їzhі stretching 10 dB. For older adults, the dose should be 0.5 g 3 times / dobu, for children with a weight of tila up to 25 kg - 0.125 g 3 times / dobu, for children with a weight of tila ponad 25 kg - 0.25 g 3 times / dobu. I'll look at the obviousness lykarskoy form in viglyadi suspensions, phenoxymethylpenicillin is recommended for children of early age.

- azithromicine vseredin 1 hour before їzhі stretching 5 dB. In older adults, the dose of the drug should be 0.5 g in pershu dobu, sometimes - 0.25 g / day, in children - 12 mg / kg / day.

- іnshі macrolіdі lasting 10 days: clarithromіcin, midecamycin, roxithromіcin, spіramіcin, erithromіcin. Erithromycin is characterized by the most frequent, in particular with other macrolides, development side reactions, Especially on the side of the gastrointestinal tract (SCT).

Reserves preparations (in case of intolerance to beta-lactam and macrolide):

- lincomycin in the middle 1 - 2 years before the day for 10 days, we will grow up in a dose of 0.5 g 3 times / dob, for children in extra dose 30 mg / kg in 3 doses;

- clindamicin is grown in the middle for 10 days in a dose of 0.15 g 4 times / add, for children in an additional dose of 20 mg / kg in 3 times.

Antimicrobial therapy of chronic recurrent tonsillitis (pharyngitis), vicious with beta-hemolytic streptococcus of group A, including the intake of amoxicillin + clavulanic acid (every 10 days to add up to 40 mg / day 3 times / 0.625 ) for cefuroxime (for 10 days we will grow up in a dose of 0.5 g 2 r / dob, for children - at an additional dose of 20 mg / kg in 2 doses).

Secondary prevention. By the method of secondary prophylaxis among the patients who have undergone HRL, they serve to prevent repeated attacks and progress to become ill. Secondary prophylaxis is being repaired in the hospital as soon as the etiotropic antistreptococcal therapy is completed.

The triviality of secondary prophylaxis for the skin patient is established individually and in recognition of the factors in the risk of recurrent attacks by ORF, according to the recommendations of the All-Russian Health Protection Organization (WHO). The following factors are included in the list:

- vik sick;

- the presence of CRBS;

- an hour after the first attack of the GRL;

- number of forward attacks;

- a family history of a severe throat condition or CRHD;

- social, economic and educational status of the sick person;

- alterations of streptococcal infections in the region;

- the profession and the mice of a sick person's robot (school teachers, doctors, individuals who work in the minds of the purchaser).

As a rule, the triviality of secondary prevention is guilty of becoming:

- for individuals who have had GRL without carditis (with arthritis, chorea), - not less than 5 rock times for an last attack, or up to an 18-point vik (based on the principle of "better");

- for individuals who have carditis without forming a heart defect, - not less than 10 times for a last attack, or up to 25 times (according to the principle of "better");

- for ailments with a defect of the heart, including the case of an operative treatment, - most of the time.

Benzathine benzylpenicillin (extensilin)- the main drug, which is used for secondary prevention of GRL. The drug should be used intramuscularly 1 time for 3 times. (21 days) in older adults and children in a dose of 2.4 million OD, in children with a weight less than 25 kg - at a dose of 600,000 OD, in children with a weight of more than 25 kg - at a dose of 1.2 million OD. Pre-treatment, carried out at the Institute of Rheumatology of the Russian Academy of Medical Sciences and the State Scientific Center for Antibiotics, showed that the drug (Extensilin) ​​was shown to have pharmacokinetic changes in terms of blood concentration - trivial In a given hour, Bicillin-5 (sum of 1.2 million OD to benzathine benzylpenicillin and 300 thousand OD to benzylpenicillin procaine), they do not look at pharmacokinetic vimogam, but should be presented before preventive medications for professional use.

Rheumatism, Khvoroba Sokolsky - Buyo

Version: Dovidnik zhvoryuvan MedElement

Gostra rheumatic fever (I00-I02)

Cardiology

General information

Short description

(GRL) - systemically fired up with a lot of tissue in the heart lesions of the heart-vascular system, which develops at the end of the A-streptococcal nasopharyngeal infection in sick children.

Classification

The Danish hour is victorious Classification of the Association of Rheumatology in Russia, Accepted in 2003 roci.

Note.
* For the classification of Strazhesko N. D. і Vasilenko V.Kh. ...

** NYHA functional class.
*** Evidence of postinflammatory marginal fibrosis of the valve stools without regurgitation, which can be specified with the help of EchoKG.
**** In the presence of a previously revealed heart defect, it is necessary, if possible, to include the cause of this form (infectious endocarditis, primary antiphospholipid syndrome, valve calcification in degenerative genesis, etc.).

Ethiology and pathogenesis

ethiological factor- Hemolytic streptococcus of the group A. Zahvoryuvannya grows into a link with a hostile or chronic nasopharyngeal infection. Especially significant is the M-proteine, which can be entered to the storehouse of the streptococcus. There are more than 80 types of M-protein, of which rheumatogenesis is infused with M-5, 6, 14, 18, 19, 24. Necessary washing is also necessary for a decrease in predisposition (DR21, DR4, HLA antibodies); alloantigen B-lymphocyte / 17 ...

In the pathogenesis of rheumatism, it is less important that it is directly or prioritized for the streptococcus on organism: streptolysin O, hyaluronidase, streptokinase may be powerful against the antigen. In the opinion of pervinne nadezhdeniya circulating antigens in the blood organism viroblyaє antigens і zdіysnyu to avoid immunologic reactivity. Development of an allergic camp and damage to immunogenesis Immunogenesis - the process of forming immunity
It is accepted by the head factors in the pathogenesis of rheumatism.
With new infections of streptococcal infections, the accumulation of immune complexes in the growing number of infections appears. The process of circulation in sudinn_y system stench stinks in the microcirculatory bed and ear. Antigens at the same time come from the blood into the resulting tissue and produce up to destruction (allergic reaction of a non-secret type). Allergy is less important in the pathogenesis of rheumatism. For those who are allergic to fix it not before an hour of angina, but after 10-14 days and more.
Autoallergy is also more important in the pathogenesis of rheumatism. The strength of the antigenic budov and streptococcus and the resulting tissue of the heart is to produce up to the level of the envelopes of the heart by immune reactions in them, in which case the establishment of autoantigens and autoantitils (molecular mimicry) is detected. Such autoantigens produce more ruinous diu on the endomyocardium, at least one streptococcal antigen.
As a result of the immunocomplex reaction, it develops chronically in the heart. Krim Porushennya humoral immunity(Antibiotic release), in case of rheumatism, hypertension and cellular immunity. A clone of sensitized lymphocyte-cells is established, which carry antibodies to heart disease and endocarditis and ear (allergic reaction of a controlled type).

Epidemiology

The prevalence of rheumatic fever in the middle of children in the winter regions is 0.3-18.6 per 1000 schoolchildren (according to the data of the VOOZ - 1999). The main number of rheumatic ailments of the heart is to become patients with swollen rheumatic heart defects.
For the last 10 years, the first rate of incidence of rheumatic fever in the warehouse is 0.5-0.9 per 10 yew. Population (0.7 - in the original residence). The Danish indicator is not tendency to decline.

Characteristics of the peculiarity of the day-to-day overrun of the ORL:
- a significant stabilization of the disease in large regions;
- tendencies to the development of sickness in the older age (20-30 years);
- Increase in frequency and drop due to prolonged or latent interruption;
- low-symptom and monoorganism of the lesion;
- Changes in the frequency of heart valves.

Factor i group riziku

- Вік 7-20 rockіv;
- to become a child (women are sick 2.6 times more often, not more than a person);
- slump;
- prematurity;
- congenital anomalies in the resulting tissue, inability to collagen fibers;
- postponed GOST of streptococcus infection and part of nasopharyngeal infection;
- unfriendly minds, for living in a country with an increased vologue, a low temperature of food.

key picture

Symptomy, stretching

Acquisition, as a rule, develops after 2-3 days after the transferred nasopharyngeal infection of streptococcal etiology. Gostrota debut to lay down in a bad way. Children of the young age and schoolchildren have an ear of hospitality, in the middle and older age - deeds.

Main clinical manifestations of GRL:
- polyarthritis;
- carditis;
- chorea;
- k_lcepod_bna eritema Erythema - bounded by hyperemia (increased blood supply) shkiri
;

carditis
Є the main clinical acquaintance of GRL, which is observed in 90-95% of cases.
For the recommendation of the American Cardiological Association (ACA), the main criteria for rheumatic heart disease are valvulitis. It is manifested by organic heart murmur, in the presence of myocarditis and / or pericarditis.
The leading symptom of rheumatic valvulitis is a trivial dimesystolic murmur, banding with I tone and visualization of metral regurgitation Mitral regurgitation - the lack of performance of the mitral valve, which is necessary to bring the flow to the bottom of the lithium in the front of the heart before the systole hour
... The whole noise will occupy a larger part of the systole, it will be better heard in the area of ​​the upper heart and will be held in Lviv region. Noise can increase in intensity (especially at the early stages of illness); There are a lot of changes with a change in the position of the body and with a change not to be spared. Most often the mitral valve, the aortic and the slightly tricuspid valve legendary artery(For the lecture information also div. Pidpunct I01.0, I01.1, I01.2).

rheumatoid arthritis
It is found in 75% of patients with the first atats of GRL.
The main characteristics of arthritis:
- shortness;
- goodness;
- the volatility of the impact on the important findings of the great and middle slopes.
After the regression of the ignition warms in the slopes, it is carried out for a stretch of 2-3 days. With a frequent antiapaline therapy, an hour of regression can speed up to decilkoh years or days (report div. At pidpunktі I00).

Mala chorea
It is a rheumatic lesion of the nervous system. Sponsor more importantly among children (older - among children) in 6-30% of children.
Clinical manifestations (pentad syndromes):

choreichnі gіperkіnezi Hyperkinesi - pathological raptus are detected mimovilny rukhs in different groups of m'yaziv
;
- myazova hypotonia right up to the lethargy of myazov from imitating parallels;
- Stato-coordination damage;
- Sudden dystonia Sudden dystonia - dystonia (pathological changes in tone) of blood-bearing vessels, which appear to be impaired regional blood flow or postal blood circulation
;
- psychopathological manifestations.
The statement of diagnosis of rheumatic chorea during the onset of the other criteria of acute respiratory tract infection is only possible when there are other possible causes of damage to the nervous system: Hettington's chorea, systemic heart disease, etc. (For a report on differential diagnostics, see I02).

Kilcepodibna (annular) eritema
Growth in 4-17% of vypadkiv. Vyavlyayetsya at the viglyadі of the black-horned ring-like visipans, scho warіyuyut at the sizes. Hanging, the head rank, is localized on the tulips and proximal views of the colors (but not on the faces). Erythema is of a transient, rapid character, not superimposed on overwhelmed by induction Induction - infringement on the organ of any part as a result of some pathological process
і blіdnі under the onslaught.

rheumatic universities
They are recorded in 1-3% of vipads. They are rounded, painless, slightly destructive, quickly glimpse and learn about new growths on the root surface of slopes, in the area of ​​spines, tendon achilles, spinous growths, and apical ridges

In children and adolescents with HRL, they can be diagnosed by such symptoms as tachycardia without a connection to increased temperature, abdominal pain, chest pain, lack of breath, anemia. These symptoms can serve as a presuppositional diagnosis, or not as diagnostic criteria, as they are often detected in cases of problems.

diagnostics

In the given hour, it is considered until the recommendations of the WHO for GRL in the capacity of the international ones. Jones Diagnostic Criteria, Looked at by the American Association of Cardiologists in 1992.

Great criteria:
- carditis;
- polyarthritis;
- chorea;
- k_lcepod_bna eritema;
- pediatric rheumatic universities.

Small criteria:
- clinics: arthralgia, feverish woman;
- laboratory: advanced state-phase indicators: SHOE and C-reactive block;
- podovzhennya Interval P-R at the EKG.

Dani, go ahead to the front A- streptococcal infection:
- A-streptococcal culture is positive, it is seen from the beginning or a positive test of a quick test of A-streptococcal antigen;
- to increase the titers of A-streptococcal antibodies.

The discovery of two great criteria, for one great and two small ones, have received the same data, which is documented to confirm the infection with the streptococcus group A beforehand, to inform about the visibility of the ORF.

instrumental methods

1. EHC There are disturbances to the rhythm and conductivity, in the case of a fast-moving AV block of 1-2 steps, extrasystoles Extrasystole - a form of broken heart rhythm, which is characterized by the appearance of extrasystoles
, Zmin of the T wave in the view of the decrease in the amplitude and inversion. All the changes of the EKG are unstable and quick to change in the process of treatment.

2. Phonocardiography zastosovu to clarify the nature of the noise that appears during auscultation. With myocarditis, there is a decrease in the amplitude of the 1st tone, the deformity, pathological III and IV tone, systolic murmur, such as a loan of 1 \ 2 systole.
In the presence of endocarditis, a high-frequency systolic murmur, proto-diastolic abo-presystolic murmur at the upper part of the upper muscle during the formation of mitral stenosis, protodiastolic murmur on the aorta during the formation of insufficiency of the aortic valve, rhomboid systolic stenosis of the aortic murmur on the aortic form.

3. X-ray of the organs of the breast yes, the possibility of manifestation of congestive symptoms in a small amount of blood circulation (signs of heart failure) and cardiomegaly Cardiomegaly is a sign of improvement in heart size for the development of thi hypertrophy and dilatation
.

4. echocardiographyє one of the most popular diagnostic methods.

EchoKG signs of mitral valve lesion:
- the edge of the stool, looseness, "purity" of the valve stool;
- obmezhennya rupture of the back stool;
- the manifestation of the metric regurgitation, the steps that lie in the gravity of the battle;
- small kintseviy prolapse Prolapse is a change down from any body or tissue from a normal body; the reason for such a resentment is to make you feel weakened and weakened.
(2-4 mm) front or back stool.

EchoKG signs of aortic valve lesion:
- sweating, looseness of the moon-signal of the aortic stools, which is well seen in the period from the parasternal position and in the transverse recession;
- the right coronary stool is often rotated;
- aortic regurgitation (right up to the anterior mitral stool);
- high-frequency tripotinnya (flater) of the anterior mitral stool in case of aortic regurgitation.

Laboratory diagnostics

There are no specific laboratory tests that can detect the presence of rheumatism. However, at the presentation of laboratory analyzes, it is possible to assess the activity of a rheumatic process.

The titer of streptococcal antibodies- one of the most important laboratory tests, allowing the confirmation of streptococcal infections. Already at the early stages of the gastrointestinal rheumatism, such antibodies grow. However, the titer of antibodies itself does not show the activity of the rheumatic process.

Nybilsh widely vikoristovuvaniyu test for the value of streptococcal antibodies - the value of antistreptolysin Pro... With a one-time admission, the titer is not less than 250 Todd's units for older adults and 333 units for children older than 5 years.

For diagnostics it is also possible to stagnate seeing streptococcus in group A from the nasopharynx by the way of taking the favors. In terms of values, the level of antibodies, Danish methodє mensh are sensitive.

Nybils often start hematological indicators of gastrointestinal phase and rheumatism- SHOE and C-reactive block. In the case of the ailments on the gostru rheumatic fever, the indicators will be advised, the ailments with the chorea behind the blame.

Like mothers on your mind, all kinds of biochemical indicators of the activity of a rheumatic process are nonspecific and unsuitable for nosological diagnostics. Judging about the activity of the ailment (ale ni about її її) for an additional complex of cich indicators is possible in that case, if the diagnosis of rheumatism by priming with clinical and instrumental data.

Values ​​for diagnostics of biological indicators:
- Rivn fibrinogen plasma visce 4 g / l;
- alpha globulin - 10%;
- gamma globulin - 20%;
- hexosi - vische 1.25 gm;
- seromucoid - 0.16 gm;
- ceruloplasmin - 9.25 gm;
- the appearance of a C-reactive cell in the blood.

A large number of biological indicators of activity are parallel to the values ​​of SHOE.

Differential diagnosis

The main problem with what is necessary to differentiate the gostru rheumatic fever

1. Non-rheumatic myocarditis(Bacterial, virgin).
Types of signs:
- the appearance of a chronological link with the nasopharyngeal (mostly viral) infection;
- short (less than 5-7 days) or the duration of the latent period;
- in the debut of the ailment, symptoms of asthenization, deterioration of thermoregulation are manifested;

Progress in the development of a fall;
- arthritis and arthralgia swelling;
- cardial scars may be active and emotive in nature;

Presence of clinical symptoms, EKG and EKH-symptoms of myocarditis;
- valvulitis vidsutnya;

Dissociation of clinical and laboratory parameters;

There is a lot of dynamism in the flow of antiapal therapy.

2. post-streptococcal arthritis.
It is possible to develop in the middle of the century. A very short latency period (2-4 days) from the moment of postponed GHSA-infection of the pharynx (beta-hemolytic streptococcus of group A) and persistent for more than a trivial hour (about 2 months). I do not get sick with carditis, I do not respond optimally to therapy with anti-inflammatory drugs and I will regress without excessive changes.

3. Endocarditis with systemic cervonia vovchak, rheumatoid arthritis and deyakkikh rheumatic illnesses.
Dani become ill characteristic features extra-heart manifestations. With systemic chervonia, specific immunological phenomena appear - antibodies to DNA and other nuclear substances.

4. Idiopathic mitral valve prolapse.
At the same time, a large number of ailments may have an asthenic type of constitution and phenotypic signs, which can lead to congenital dysplasia in the corresponding tissue (funnel-shaped deformity of the breast tissue, scoliosis breastfeeding ridge, syndrome of hypermobility of slopes and in). Put the correct diagnosis in addition to the retail analysis key features extra-cardiac manifestations of discomfort and data from doppler cardiac imaging. Endocarditis is characterized by a minority of the auscultatory picture.

5. Infectious endocarditis.
Hot syndrome with infectious endocarditis On the basis of GRL, on the other hand, it does not stop at the refinery only, destructive changes of valves quickly progress, and also the symptoms of heart failure grow. When the Echo-KG is carried out, vegetation appears on the valves. Characteristic є vision of a positive blood culture. Yak zbudnikiv are verified by streptococcus, staphylococcus and other gram-negative microorganisms.

6. Klischova Migruyucha Eritema.
Є pathognomonic acquaintance early stage Lyme ailments. On a vidminu view annular eritemi zvychayno maє great roses(6-20 cm in diameter). Children often find themselves in the area of ​​head and face, in opposition to sverbinnyi and palinny, regional lymphadenopathy.

7. PANDAS syndrome.

On the basis of rheumatic chorea for the given syndrome, the types of reversal of psychiatric aspects (the present of obtrusive thoughts and obtrusive collapses), as well as a significant regression of symptoms of therapy on a single disease, is adequate.

accelerating

Decrease in cases of important, prolonged and recurrent interruption without interruption. In the active stage, rapid arrhythmias appear Blinking arrhythmia - arrhythmia, which is characterized by fibrillation (rapid speed) at the front of the heart with generally irregular intervals between heart and heart
and lack of blood circulation. Nadal - myocardiosclerosis (the result of myocarditis) and the formation of valvular vad.

Likuvannya beyond the cordon

It is well known from the international classification of ailments, a rheumatic fever (GRL) is a systemic congestion of the tissue from the important localization process in the heart-judging system, which develops at the same time as a headache. -15 rock_v.

Chronic rheumatic heart disease is a disease of the heart, which is characterized by lesions of the heart valves in the presence of postinflammatory marginal fibrosis of the valvular stools or heart defect (lack of and / or stenosis), which is formed by the heart valve.

Epidemiology

Gostru rheumatic fever is being seen in all lands. Preceded by the other half of the twentieth century. the link was brought between the primary ailments of the GRL and the social and economic development of the country. According to the data of VOOZ (1989), the spread of GRL in the middle of children in the small regions of the world became 0.3-18.6 per 1000 children of the school age. In the last few years, the frequency of GRL in the world is decreasing.

In our country, the expansion of GRL in the last 25 years is clearly changing. In the Danish hour, it will take place between 0.2-0.8 per 1000 children. However, it is unimportant to the hundredth success in the treatment and prevention of HRL, but the problem is still not completely revived and retained its relevance.

According to the data of the Ministry of Health Protection of the Russian Federation, in 1994 (in the period from 1993) the values ​​for the first incidence of GRL from 0.06 ‰ to 0.16 ‰ in the middle of children and from 0.08 ‰ to 0.17 ‰ in the middle of the period. Tse inform about those who are negative social phenomena can be accepted by spas of the GRL.

Rheumatic vices of the heart in the lands, where the light develops, is often the cause of lethal symptoms in cases of heart-and-convulsions in people of up to 35 years, which change the mortality rates of such people who are suffering from

Ethiology and pathogenesis

The development of GRL anterior nasopharyngeal infection, viclican β-hemolytic streptococcus of group A. During the incubation period (2-4 dB), generalizations should be repaired - feverish, self-esteem, headache, angina. For the sake of firing up the upper dickheads, the GRL is developing in a part of the patients. The growth of the peculiarities of the whole streptococcus was found, that the development of the GRL in the course of the infection of the upper branches was tied only with the virulent strains, so that they could be tolerated to the deciduous serotypes of A-streptococcus, that phagocytosis. In the given hour, more than 90 types of M-protein have been identified. It was seen with rheumatogenous pins - M-5, M-6, M-18 and M-24. Smell of such power: the path to nasopharyncy, large hyaluronic capsule, mucoid colonies on blood agar, short lancers in bouillon cultures, induction of type-specific protein antibodies, the viscosity of the congenital structure Besides, the stench of the epitope, it overreacts with the tissues of the organism of the patient: myosin, synovium, the brain, the sarcolemmal membrane.

An important role in the pathogenesis of sickness is to trace genetic schilosity. To tell you the truth, for the A-streptococcal nasopharyngeal infection of GRL, there are no more than 0.3% of individuals in the population and up to 3% - in secluded groups. Genetic features of GRL are clinically confirmed by the highest family aggregation, as well as to genetic markers: associations of GRL with the singing blood groups (A and B), phenotypes of the acidic phosphoric acid system.

For an hour, I have great respect for B-lymphocytic alloanthygens, for the dose of D8 / 17 monoclonal antibodies (D8 / 17 monoclonal antibodies). Authors ruin food about new yak about diagnostics criterion of ORL.

In response to streptococcal infection, a complex of hyperimmune reactions develops in the body due to the production of anti-streptococcal antibodies - antistreptolysin-O, antistreptogialuronidases and those of the circulating, circulating forms of With a whole pathological activity of streptococcus, it can be manifested as a direct injection of microorganism itself, as well as a toxic injection of antibodies, which is produced by microorganisms and overreacting with it with wet tissues (molecular memory). In the development of the main clinical manifestations of GRL, an important role is played not only by immunopathological mechanisms, but rather by such mediators as lymphomonokini, kinini, factor chemotaxis. Tse to bring to the formulation of the judicial-exudative phase of the state of fire, the result of which is a systemic disorganization of the resulting tissue, vasculature, with the result in the reconciliation of fibrosis.

Main patomorfologіchnі dіagnostichna Find our revmokardіta - revmatichna granuloma (Aschoff-Talalaїvska granuloma), scho skladaєtsya of great nepravilnoї FORMS bazofіlnih klіtin gіstіotsitarnoї pohodzhennya, gіgantskih bagatoyadernih klіtin myogenic pohodzhennya of eozinofіlnoї cytoplasm, characteristic of kardіogіstіotsіtov roztashuvannyam chromatin in viglyadі gusenitsі, lіmfoїdnih i plazmatichnih klіtin.

The reasons are strictly specific not, є the strength of the anatomy and physiology of the suglob itself or the factor, which can be produced to the very fiery:

• Zakvoryuvannya spoluchnoi tissue of autoimmune nature - psoriasis, rheumatism, systemic chervonia vovchak.
• destructive exchange living talk- Sugar diabetes.
• Water-salt imbalance - gout.
• ailing extravagant character When such a slope is urazhaetsya suddenly - tuberculosis, syphilis, gonorrhea, sepsis.
• Professional skill, through the need for a static force of a lithograph - accountants, miners, science, writers, engineering, water-farmers, engraving and jewelery, teeth technology. Robot tied with physical practice- Budivniks and forebears of the Silskoy state dignity.
• The inheritance of sports amateur and professional people can be taken up, they can be caused by permanent regular microtraumas - tennis, volleyball, basketball, hockey.
• Insufficient or not diagnosed, the trauma of the slope, which ended in minor cicatrices, ale with damaged tissue physiology, was not diagnosed.
• Contact with an infection from the body by a contact path, when there are critical situations; hematogenous path - with blood, with a septic camp; lymphogenous way - for chronic colds in the worst cases cross-state abo dichnoy systems.
• Navmisna abo pobutova, gosstra or chronic trauma, yaka completed hemarthrosis and secondary inflammations - vivikha, pidvikhi, fractures, ear mucosa and tendon.
• Oncological ill-health of an evil or good-natured character.

cause

In the skin, the causes of the ignition process in the lithic loam can be small, but the most frequent from the beginning:

• heritage of professional activity. Given the ailment to be spared, if the labor of the connection of the people is tied with the overworldly navantazhennym, so that you can get there with a little corner, or if your hands are constantly and it is trivial to be in non-manual position... Butt can serve, for example, such professions, such as music or music;
• injuries. In most cases, the area of ​​\ u200b \ u200bliktya is suffering in case of a frontal blow, or in case of a blow. To help prevent getting sick and getting out of the way. In the midst of all not far away falls and blows often breaks, blows, breaks the rings, blows, vivihs, etc.;
• nadmіrnі navantazhennya to lіktyov region. For a large number of athletes, there is a reason for being passionate about being competitive with athletes, who are constantly engaged in important athleticism, or with strength training on strength simulators;
• Infection. Most often, infection expands in terms of organism from any surface ear and to reach the lymph nodes.

lykuvannya

Provide a diagnosis of ailments only with qualifying drugs. To establish an accurate diagnosis, a patient's blood analysis is taken, X-ray signs On a little bit, if є ridina in a literary sum, then you can also be taken for analysis.

In the skin of the patient, there is an obovazkovy spok_y, the hand was hurt, guilty of being overwhelmed with anxiety. If it is necessary, then for the whole vicorist it is necessary to wear dressings, braids, jguty and dressings.

Drug treatment is usually associated with skin lesions only individually. For the weakening of the infectious process, the ailment is prescribed a course of anti-inflammatory drugs, antibiotics and special physiotherapy (electrophoresis, UHF, heat therapy). The process of taking non-steroidal protivopalny medicines - Ortofen, Movalis. Ale in the folding vipad lykar can vipisati and a hormonal antiapalny drug - Diprospan.

Zovnishnє lіkuvannya is carried out with ointments: Fastum, Rilif, Vishnevsky ointment and іnshі.

In that unacceptable vipad, if the patient is afraid of suppuration in a littovoy slope, then it is surgical operation, During the period when cleaning and emptying of the slope is being carried out. If necessary, put a special drainage for the introduction of the backyard.

Allowed and popularly ignited the litter slope, if the therapy is guilty, it was negotiated with the doctor.

symptoms

In that case, if the patient is repaired by the burning of the litter, the symptoms of this illness may appear of a razor-sharp character. If there is an internal inflammation or bursitis, then the symptoms of a viglyad are of the offensive rank:

• strong character in the area of ​​politics;
• the reason for the scars in the area of ​​pain;
• swelling and swelling of the skin;
• Illumination of the soft gorge in the large part, as it can change its shape with a slight pressure.

With an internal burnt bag of a lithium hillock, a ridin is wobbling, like a hardening of the hand. Lyudina recognizes the lack of roche and the definition of muscularity.

That one is in a bad way, if the patient is suffering zovnishnim zapalnyam(Epicondylitis), then the symptoms of the presence of the disease:

• crunching sounds in the area of ​​litte with yogo rusi;
• bіl nyuchnogo character, yak to adapt with the Russian sounds. As a rule, if there is ailment in the camp and not to destroy it with your hand, then it is not present;
• swelling occurs in the area of ​​the sick person.

Alcoholically, due to the signs of visceralism, people can see nudity, weakness of the body, head b_l, Adjustment of temperature.

Shiny osteochondrosis

Degenerative-dystrophic wines shyny viddilu the ridge should be brought up to more in litters.

The reason is the roughing of the tissue of the mid-spine discs to encircle the nerve, which passes into the hand and the lіktyovy hinge.

In case of osteochondrosis, there is a lack of symptoms, even a symptom may appear at night. Pain syndrome is an intense flexing of the arm or insertion behind the back is problematic. Krym tsyogo wines

Likuvannya are directing to usunennya of the main ailment - receiving refineries, chondroprotectors, muscle relaxants, sudinorosilicidal drugs. Osov'yazkovі physiotherapy and exercise therapy.

physiotherapy

Physiotherapeutic treatment is straightforward for pain syndrome and heat, as well as sponges in myases. After the end of the period of staying stalled:

• Paraffin-ozokerite aplication;
• Ultraphonophoresis hydrocortisone;
• Local cryotherapy;
• Extracorporeal shock-khvilova therapy.

At the hospitals, the period of epokondilita for the sickness and the knowledge of the disease is associated with high-intensity impulse magnetotherapy, infraservone laser viprominuvannya and transcutaneous electroanalgesia with the device "Eliman-401."

Ailment shade or lateral (lateral) epicondylitis of a lithic slope є to frequent ailments of the support-corneal system. The monotonous repetition of some and quiet ruins, with the appearance of such an active crunching of a thin slope, appears seriously on the front of the hand and the brush, flashing in the mind of the latrines of the heart (before the call) Tenisists to price steadily. As a rule, the hand is guarded. Tom, behind the ailment, the name tenisny liktya syndrome was called. However, it won’t be seen in the wicked people.

For the prevention of injuries of this kind in the prophylactic purposes, the kinesiological taping of the tenisist is used.

Areas of frequent fighting:

• People, professional skills of some people on uvazi bagatorazovy vikonannye single rukhiv by hand (malaria, artists, lykari, wake-ups, waters, musicians, cooks tosho);
• People have 40-60 years of age;
• Athletes (tenisists, athletes, wrestlers, boxers).

Reasons for getting sick:

• Abovewith the tension of the muscles of the hand, which leads to regular microtraumas of the joints and the tendon and into the bag until the development of the ignition;
• Vіkovі dystrophic processes in the muscles and tendons;
• Genetic weakness of the sound apparatus;
• Інші zvoryuvannya support-roche apparatus;

Inodі to trample, how the ailment appears without any apparent reason (rapid epіkondilіt) or for a one-time intensive pre-treatment. Often, they become chronically ill, since they are easy to get through and people simply don’t go to the hospital.

Yak likuyut liktoviy bursitis

Bursitis is a problem for professional illnesses of athletes. In case of bursitis, the periarticular capsule is ignited from the trauma or microscopic tissue through the trivial point to the slope.

Bursitis develops yak litter of a lithium in case of manifestation:

• sports injuries abo byproduct nature (blows, stretching, fractures);
• trivial change of hands and hands in one and the same position (pumping a little child, gri on musical instruments);
• mechanical injection on hands;

Dane zapalennya torkatsya such a slope, yak slit-skroneviy. Vono is characteristic of the shoulder itself. Bursitis is not always possible at once to be recognized, some of it can be manifested in a sprinkle with a vigilant naprya. Gradually accumulated in the middle of the synovial origin of the beginning to seize the rukhs. Then there is more temperature, the temperature changes, and the temperature is close to the place.

Serous bursitis і gnіynyi develop due to the shape of the ailments. For vilikovvannya bursitis, it is necessary to undergo a difficult diagnostic procedure at the viglyadi punctuation of the corner. Dumka, bursitis can be done with folk methods, є folk preparations To reduce the swelling and burning, to know the ailing in the battle zone. I will grow up with the help of the old folk, and only with the therapeutic methods, or with the operative way.

Forms of illness and characteristic symptoms

For hostile form bursitis, a rapt cob is characteristic of the ignition process, which manifests itself on the coming day with injuries. In the area of ​​the top of the littoral, there is a small embankment, with a touch of consistency. A sore throat, which manifests itself as a yak when palpating the zone and suffering, so in the camp I am calm. Zapalennya supervodzhutsya zagalny nasty self-sentiment, weakness and temperament. Day after day, stretching one tizhnya to grow, delivering people in perceiving discomfort and hassle in the slope. Such a patient needs to be turned for medical aid and pass the signs of a doctor, a course of treatment, to avoid the transition to a relapsing form, if an insignificant factor is used to lead to a new round of burning out of the blow.

A special chronic form є not a rise, but a step-by-step development of small sizes

Lyudin is not immediately respected for the unwavering camp of the person, who can be enlightened in trivial rock in a trustworthy form. Trivial interruption of the ignition process is negatively infused into the slope itself, viciously in new pathological conditions

Chronic bursitis is not safe for the health of the joint

In the case of consumption in the synovial bursa, the Bula has an infection (most often as a result of a bite or poriz), then the pathogen will start to multiply in the middle of the midgrowths of the midsection, and the cyclones are severely gray, and in the worst case. Vono supervodzhutsya to high temperature adjustments, right up to the cake. Misce is hotter on the dot. Septic, or infectious, bursitis is not safe, due to the development of necrosis of the stems of the suglobovy bag and the infection in the bloodstream.

Purulent bursitis - discharges of septic inflammation of the synovial bursa

In such a rank, the symptoms of bursitis include:

1. Nabryak: call the tse of the persha of the sign, which will respect the ailment. Shkira on the stylish side of the litte can be fluffy, so you may not have a chunk of fluff. In some cases, the build-up of a build-up is clearly visible and can be seen at once. Pukhlina can be a size of a ball for golf on the corner of a litte.
2. Bil: in the world of stretching out of the globular bags, there is a bile in lіkti, especially with zginanny. As a rule, when the growth rate changes, it changes aboard. Ale є the category of people with liktovim bursitis, who do not see pain in principle, just because their hand is bent or straight.
3. Possibility of warming up the warm side of the skin: it can be used for the infectious process.
4. Sensitivity in lіctі and near new.
5. Gniy: in neglected cases of infectious inflammation, the appearance of a very white, thick, cloudy exudate in an infected person is characteristic.

Lіkuvannya fired litter slope

It is more effective than a littovoy slope, perhaps as traditional, as well as folk zasob

It is important to remember that if you are engaged in self-care, you can get your health seriously. Schob uniknuty tsyogo, persh nіzh lіkuvati ailment with classic or folk zasob, slіd inaccurately turn to lіkar, with the first occurrences

Lіkuvannya by traditional ways, with a fallacy of lіktya, it is abundant in what to lie down for, and cause ailments.

The main traditional methods of treating bursitis and epicondylitis:

• winter warm and cold compress;
• tight bandage;
• antibacterial therapy (hot spotting of the bag);
• antibiotic preparations;
• non-steroidal antiapalny drugs;
• compresses, ointments (for traumatic bursitis);
• lykuvannya physiotherapy.

Also, if necessary, there can be stasis: surgical treatment, or internal hormonal angles. Most often, such methods are used to treat with accelerated bursitis, if suppuration occurs in the synovial complex.

Likuvannya bursitis and epikondilita folk ways include:

• kartoplі compressions or cabbage;
• compresses with anti-fiery herbs (calendula, plantain, etc.);
• gorylchany compressions with Vishnevsky's maze;
• lotions from the propolis tincture;
• with infusion of celery.

Filling a lіktyovy slope, lіkuvannya yakogo, innocently innocent state form abo be infectious in nature. In the first place, vikoristovuyut complex therapy.

A trace of memory, how to use folk methods for bursitis, without consulting a doctor and medical diagnosis, is unacceptable. If you get sick, you can speed up and go into a form surgical treatment and drainage.

All the detailed manipulation with your hands is to rob a small, ale-foldable lіktyovy hillock. It is stored from the hillock heads of three cysts in the middle of the bone - the diaphysis of the brachial cyst and the epiphyses of the littoral and promenade, which are chiselled with the synovial capsule. The clientele of the fabric is seen for a special trip, for the smoothing of the rucks in the slopes, and for the shock absorption in the case of the thin ruffs and the raising of important objects.

Fired classification for a number of parameters:

1. By the type of the animal: specific (Koch's stick, gonococcus, treponema) and nonspecific (streptococcal and staphylococcal infection, virus infection).
2. For the type of relocation: gostry, yake in his own house, to be detailed according to the type of exudate, to accumulate in the store of heat: serous, hemorrhagic and gnarly; adolescent and chronic - fibrosis.
3. For localization:
   • arthritis is an enemy of all the elements of the slope without non-vortex snakes;
   • arthrosis - degeneration, partly or outside the ruinous complex;
   • urazhennya of the capsule is called bursitis, from the Latin word "bursa" - a bag;
   • pathological process in the muscles and tendons, which is called epicondylitis.

Cause bursitis і yo lіkuvannya video

Most of the patients successfully recover from bursitis. I brush as a prophylactic є the introduction of a healthy way of living with the help of the new entrants and the stasis of the elders in the world of need.

• Zagvoryuvannya on the letter A
  • avitaminosis
  • angina
  • anemia
  • appendicitis
  • arterial vise
  • arthrosis
• B
  • Graves' ailment
  • bartholinitis
  • warts
  • brucellosis
  • bursitis
• V
  • varicose veins
  • vasculitis
  • vіtryanka
  • vitiligo
  • vovchak
• G
  • gardnerellosis
  • haemorrhoids
  • hidrocephalus
  • hypotonia
  • fungus
• D
  • dermatitis
  • design
  • discirculatory encephalopathy
• F
  • zhovchokam'yana hvoroba
  • wen
• Before
  • candidiasis
  • cough
  • klimax
  • colpit
  • conjunctivitis
  • kropiv'yanka
  • rubella
• L
  • leukoplakia
  • leptospirosis
  • lymphadenitis
  • deprive people
  • lordosis
• M
  • mastopathy
  • melanoma
  • meningit
  • myoma of the uterus
  • calluses
  • thrush
  • mononucleosis
• H
  • undead
  • neurodermatitis
• About
  • oliguria
  • onіміння
  • populations
  • osteopenia
  • blockage of the brain
  • nabryak Kvinke
  • nigryaki nig
• NS
  • gout
  • psoriasis
  • umbilical grizzly
  • p'yatkova spur
• R
  • cancer of the legends
  • breast cancer
  • reflux esophagitis
  • birthmarks
  • rosacea
• Z
  • salmonellosis
  • cifilis
  • scarlet fever
  • scabbard
  • staphylococ
  • stomatitis
  • sudomi
• T
  • tonsilitis
  • tremor
  • trіshchini
  • trichomoniasis
  • tuberculosis of legends
• Have
  • ureaplasmosis
  • urethritis
• F
  • pharyngitis
  • flux on yasny
NS

chlamidiasis

C

cervicitis

• NS
  • bump on the nose
  • noise in the head
• E
  • eczema
  • enterokolit
  • erosion of the cervix

• Blood analysis
• analysis of the section
• Pain, oniminnya, injuries, problems
• The letter a

  allergy

• letter B
• letter G
• letter C
• advancing medicine
• ill eyes
• obhvoryuvannya shlunkovo-intestinal tract
• Zakvoryuvannya sechostatovoy system

  Sechostatev system

• Zahvoryuvannya organ_v dikhannya
• Dentistry
• endocrinology

Ailments and symptoms.

Symptoms are precisely localized in the area of ​​the loam: more specific in nature, embarrassment, deterioration (infiltration), deterioration, deterioration of function in a different range, and deterioration of the range of conditions.

Bursitis.

Bursitis is manifested by small symptoms, fallen into aggression and hostility. It appears to be weakly noticeable to the swelling and easy ailment in case of rash, to a significant increase in the slope, scarring, sharp pulsating pain, and to the civil function of the slope. In case of suppuration, or a sharp, aggravated mobility of the zagalny stun, subfebrile temperature, chills, weakness, headache and loss of appetite. In the case of acute inflammation, є it is not safe for the transition of a lumpy abscess in the phlegmon of the hand, and if the mucous membranes and cysts are without medication, it is myositis and osteomyelitis, with the appearance of fistulas and necrotic melting of tissues. Chronic bursitis, characteristic of tissue degradation, institutionalization of higher education institutions and interdependent functions with physical replacement.

Epicondylitis.

Epicondylitis is biliary and internal, and symptoms will be indicative of localization: breakdown and soreness in case of spread and malignancy. Most often, the battle is asymmetric - it’s a good thing to work with, to be in a post-trivial way. It is also designed: lateral and medial form. Lateral - to be called "the hand of a tenisist", is characteristic of vіku pislya 30 rockіv, winyk when singing, folding-straightened rukhs, dominating tenisists, lisorubs and painters. Media is known as "Liktem Golfer", with active use of rukhiv, start before the start.

Arthritis.

arthritis is characterized by early damage functions, with all the signs zapalennya. Regularly from the stage, all the palate of pain - rizki, rizuchi, dull and niyuchy. The wanness and stiffness of the slope are swirled, to the extent of unruffiness and unhappiness of ruffling with a hand in a litte. Ignited sore contracture of the meazo-zyazkovy apparatus. With suppuration, fluctuations and cyanosis of the swollen cloth are discouraged.

accelerated bursitis

Before bursitis accelerates:

• Secondary infection, as you can develop aspirations or steroids;
• secondary septic (infectious) arthritis;
• sepsis (infection of the blood) and osteomyelitis (necrotic process in the cysts) in the case of an important septic bursitis, especially with an acute diagnosis;
• fistulas (pathological openings in the bed) can develop for spontaneous ripping or surgical drainage of the lateral bags;
• recurrence of bursitis - more imovirny with repeated injuries, as it became the cause of burning.

Chronic bile in the slopes and associated with a decrease in its functionality can be a firing process in case of overbearing bursitis.

Causes of diagnosis and symptoms of development

Poisoning a person can be known for no reason. Tsia ailment is developed in people of different categories, independent of the status of belonging. Factors in the risk of skin can be used.

Causes of the blame

The reasons for the diagnosis of ailments are the following:

• underreported by injuries;
• stretching the links;
• overmіrnі navantazhennya postіy character;
• trivial support on l_kot;
• hypothermia;
• transferring infectious diseases;
• recession.

Main symptoms

Symptoms and symptoms are common in the form of ailments. Todi yak bursitis firing the internal elements of the skin structure (synovial bursa), epicondylitis - firing the external structures of the littoral corner.

The main symptoms of a burnt bag inflamed:

• swelling of the suglobovoy bag (the softness is springy swelling of the rounded form);
• complication of the ruch;
• soreness in the hands;
• crunch at rus;
• locally, but also in some and out-of-the-way temperature adjustments.

The main symptoms of epicondylitis:

• bile when turning before the front, as well as overturned rolls;
• Risky intense pain with palpation;
• bіl is localized in urazhenіy regionі.

Likuvannya yak dyati right

Immobilization and preparations

The scheme of lykuvannya viznachaє lykar. Engage in self-indulgence is not safe. In case of folding injuries, it is recommended to use the fixer overlays. Even in the littovo loam є ignition processes, the ruts also go to make sure they are not. When heated, provoked by bacteria, antibiotic therapy is indicated. strong more views You can take a shot to "Novokainu". And it is also recommended to use the following anti-pyrexia and no-fire pills and daytime:

The drug is usune bіl і znіme zapalennya.

• Voltaren;
• Diclofenac;
• Dolobene;
• "Dolgit";
• "Nimedar";
• "Fastum";
• "Indovazin";
• "Ibuprofen";
• "Analgin".

physiotherapy

Physiotherapeutic treatment of lactic ointments and other fabrics includes such procedures as:

• magnetotherapy;
• laser therapy;
• information management;
• electrophoresis;
• diadynamic therapy;
• heat obgortannya with ozokerite or paraffin;
• phonophoresis;
• shock-khvilova therapy of a lіktyovy hillock;
• cryotherapy.

Lіkuvannya folk methods

Zasib maє anti-fiery power.

1. Take 50 g of propolis and olii.
2. Ingredition to darken in a water bath until the same consistency.
3. Chill.
4. Spread a l_ktyovy hillock, tie it with polyethylene and warm fabric on top.

For the reception in the middle of the middle, take the tincture from the shabelnik, prepared as follows:

1. Take a sprinkle of grown roots of a roselin.
2. Add 0.5 l of the bottle.
3. Napoliagati 21 days.
4. Take 10 ml 3 r. doba.

And also the brown ones from the present from Oman, the measles of the oak or the willow, the birch leaf and the brunoks. Warm baths with needles for additional supplies are recommended essential oils with lavender extract. Slid pam'yatati, scho folk method You can use it as an additional one, or not replace the tradition.