Rheumatism (sickness of the Sokol Bujo)

Systemic inflammatory disease of connective tissue with a primary lesion of the cardiovascular system. It develops in connection with acute infection (beta-hemolytic streptococcus group A) mainly in children and adolescents (7-15 years). Streptococcal infection, especially massive, has a direct or mediated damaging effect on the tissue by a large number of antigens and toxins. Predisposes to rheumatism, a decrease in immunity to streptococcus, and family-genetic addiction is also noted.
In typical cases, the disease develops 1-3 weeks after the angina, less often another infection. Relapses of rheumatism often occur after any infectious diseases, surgical interventions, physical overload. The most characteristic combination of acute migratory and fully reversible polyarthritis of large joints with moderately severe cardiac damage (carditis). The onset of the disease is usually acute, violent. Rapidly developing polyarthritis, accompanied by an increase in body temperature to 38-40 ± C and a strong sweat, but without chills. Symmetrically large joints, knees, wrists, ankles, elbows are affected symmetrically. They are swollen, the skin over them is hot, the movements in them are sharply painful. Typical is the "volatility" of inflammatory changes, manifested in the rapid (within a few days) reverse development of arthritic phenomena in some joints and their rapid growth in others. Over time, all joint manifestations disappear without a trace. When the heart muscle is damaged (rheumatic myocarditis), patients complain of weak pains or vague unpleasant sensations in the region of the heart, slight dyspnoea with physical exertion, occasionally palpitations, interruptions. The size of the heart is increased, the sonority of its tones changes, a "gentle" noise appears. When the endocardium is damaged (the inner shell of the heart), rheumatic heart defects are formed (see Acquired defects). In addition, there are lesions of the pericardium (see Pericarditis), skin: ring erythema - pink ring-shaped rashes, never itchy, located on the inner surface of the hands, legs, abdomen, neck and torso. In children, the defeat of the central nervous system is manifested by small chorea (muscle weakness, violent pretentious movements of the trunk, limbs and facial muscles). With acute rheumatism, the total number of leukocytes, including neutrophils, increases in the blood, the number of platelets and ESR increases. The content of anti-streptococcal antibodies (anti-streptogialuronidase and antistreptokinase, antistreptolysin) is increased.
Recognition is carried out on the basis of clinical data: carditis, polyarthritis, chorea, ring erythema. Rheumatic nodules in combination with fever not below 38 ± С and laboratory parameters.
Bed rest in an acute period. Glucocorticoid hormones (prednisolone, triamcinolone), voltaren or indomethacin, quinoline preparations (delagil, plakvenil) are used. Outside the period of exacerbation, sanatorium-and-spa treatment is possible. To prevent recurrence of rheumatism preventive treatment with bicillin is carried out, it is necessary to avoid cooling, acute diseases of the upper respiratory tract, treatment of heart failure.
Scleroderma systemic. Chronic disease of the connective tissue system and small vessels with a common skin lesion (sclerosis, fibrosis), connective tissue tissue of internal organs. The reason is unknown. It is provoked by cooling, trauma, infection, vaccination, etc. Family-hepatic predisposition is important. Women are sick 3 times more often than men.
Usually the disease begins with Raynaud's syndrome (see Section 2, Chapter 1), joint pain, weight loss, fever, weakness, fatigue. The most characteristic sign is skin lesions. In the beginning there is a dense widespread swelling, in the future - densification and atrophy of the skin, especially pronounced on the face and extremities. Perhaps the appearance of ulcers and pustules on the coccyx of fingers, long-term non-healing, very painful. Nails are deformed, hair falls out right down to alopecia. Painful compaction and then muscle atrophy is accompanied by gross changes in the tendons: they shorten, which leads to the development of contractures that disrupt the activity of various joints. They cause pain, they are deformed. When X-ray examination reveals destruction - osteolysis of the terminal, and in severe cases and medium phalanges of the hands, less often the legs. In the thickness of the subcutaneous tissue, calcium lumps may be deposited. The disease affects the cardiovascular system. There are pain in the heart, shortness of breath, various disorders of the heart rate and conductivity. With immune inflammation of the vessels, gangrene, thrombophlebitis with trophic ulcers on the feet, shins, etc. can occur. Severe lesions of the internal organs are possible: lungs - pismofibrosis, kidneys - scleroderma kidney, diffuse glomeruloperfrit (see). Especially characterized by a violation of the passage of food through the esophagus, its expansion, revealed by X-ray examination. The defeat of the nervous system is manifested by polyneuritis, vegetative instability (impaired sweating, thermoregulation), emotional (irritability, tearfulness and hypochondria), insomnia. In rare cases, there is encephalitis and psychosis. Isolate acute, subacute and chronic course of the disease. Changes in blood are nonspecific. The level of hemoglobin decreases, the number of leukocytes and ESR can increase.
The diagnosis is confirmed by the detection of specific changes in the immunological status and with skin biopsy.
Apply large doses of glucocorticoid hormones (prednisolone), as well as D-penicillamine, kurrenyl, deligil. For the treatment of Reynaud's syndrome - nifedipine (corinfar, cordafen, foridone). Symptomatic therapy is necessary: ​​lidase, vitamins of group B, vasodilators, physiotherapy (conifers, radon, hydrogen sulphide baths, mud cure, paraffin treatment, etc.), physiotherapy exercises, massage.