Rheumatism

Rheumatism - see chapter "Rheumatic diseases.".

Children rheumatism has a significant tendency to acute, severe, recurrent course. Usually affects the cardiovascular system, and with each attack its damage increases. The basis for cardiovascular decompensation in children is always rheumatic activation process (despite the absence of symptoms such as fever, arthritis, increased erythrocyte sedimentation rate, etc.). "Absolute" signs of rheumatic fever in childhood - progressive heart failure, especially in combination with joint disease, chorea, anulyarnoy presence of rash and rheumatic nodules. The latent rheumatism - hard recognizable variant of the disease: the accuracy of the diagnosis is confirmed only by the presence of valvular heart shaped. Along with the existence of primary and secondary has latent-latent rheumatic heart disease: flowing without clinically significant activity, this form also leads to the formation of heart disease, are often combined, and the development of Cardiosclerosis.

Treatment is carried out in a hospital, the duration of 45-60 days. Provide patient treatment regimen depending on the activity of the pathological process and the severity of the heart changes. Meals should be age-appropriate. Drug treatment: one of antirheumatic agents - Amidopyrine or analgin by 0.15-0.2 g per year of life (no more than 2-2.5 g / day); acetylsalicylic acid - 0.2-0.25 g / day per year of life; 0.5 g of sodium salicylate on the year of life in a day 4-6 techniques to process remitting activity when starting to reduce the dose to 2/3 and then to 1/3 but not before 30-35 days from the beginning of an attack. Phenylbutazone appoint 0.05 g three times a day for children of preschool age, 0.08 g for children from 8 to 10 years and 0.1-0.12 g children over 10 years. Often, phenylbutazone and aminopyrine combine or provide their combined forms as tablets reopirin pirabutol and 1/3 tablet for children 6-8 years, 01.02; tablets for children 8-10 years old, and 1 tablet children 12-15 3 times a day. Corticosteroids are generally shown in the earliest period of the active phase of rheumatic fever (to prevent the development of heart disease). The course of treatment for at least 1-1.5 months. In recent years, more highly efficient use such drugs like indomethacin (indomethacin), and Voltaren dose 3.1 mg / (kg day â,¬) alone or in combination with hormonal therapy. With sluggish flow and the low activity of the process instead of glucocorticoids can be used a number of drugs chloroquine -delagil, Plaquenil at 0.5-10 mg / (kg day â,¬).

Prednisolone administered to children 4-7 years 10 to 15 mg / day (1 tablet contains 5 mg of the drug); 8 to 10 years - 15-20 mg / day; 11 -14 years of age or older Ђ- 15-25 mg / day (in young children 1-3 mg / day per 1 kg of body weight) in 3-4 divided doses (morning and afternoon 2/3 of the daily requirement), with a gradual decline ( with an evening reception) to the maintenance dose (usually Houde therapeutic dose), which is given to the disappearance of signs of activity. Assign also triamcinolone (4 mg equivalent of 5 mg of prednisolone and 25 mg cortisone); dexamethasone (0.75 mg equivalent to 4 mg of triamcinolone and the like. d.). To prevent exacerbation of chronic focal infection or during attachment of infectious diseases corticosteroid is administered simultaneously with antibiotics (for? -14 Days).

When arthritis in the affected joints is recommended to dry heat, solljuks, ultraviolet irradiation, UHF. Chorea simultaneously antirheumatic therapy administered vitamin B: Bg vitamin (pyridoxine) 50 mg daily for 10 days, V / m to 1 ml; Vitamin C - 1 ml of a 5% solution in 10-15 mL of 20% glucose / in; 0.5% novocaine solution / in 3 to 10 ml (daily by adding 1 ml); antihistamines. When expressed changes in the cardiovascular system, leading to circulatory failure, cardiac glycosides administered (strofantin - 0.05% solution; digitalis - 0,03-0,075 g 3 times a day saturation -Dose; Korglikon - 0.06% solution) and a diuretic means (eufillin inside, candlelight, and I / O; novurit 2-3 times per week / 0.25-0.5 m - 1 ml candlelight or by 0.25-0.5 g fonurit).

In a hospital a sick child is undergoing treatment for an average of 1.5-2 months, and then at 2-3 months for staged treatment is sent to a sanatorium. When the child enters the sanatorium under the supervision of a pediatrician, cardiologist; the child is put on the account form NS30.

Forecast remains and modern methods of treatment of serious, since even after the first attack, heart defect formed in 10-15% of children. With early treatment and the adequacy of the forecast in most cases favorable.

Prevention. Primary prevention - treatment of acute streptococcal diseases. Secondary prevention - bicillin drug; was carried out for 3 to 5 years round depending on the severity of the disease. Use bicillin 1 (at preschool age 600 000 IU 1 time in 2 weeks, the school - 1 200 000 ME 1 time per month) or bicillin 5 (at preschool age 750 000 IU 1 time in 2 weeks, the school - 1 500 000 ME 1 time per month). In addition, 2 times a year (spring and autumn), was carried out for 6 weeks courses of nonsteroidal anti-inflammatory drugs.

All children who have had rheumatic fever, in case of acute respiratory viral infection, sore throat, sinusitis within 10 days of prescribed antibiotics and anti-inflammatory drugs.