Internal illnesses. Rheumatism (Sokolsky-Buyo disease) (differential diagnosis, treatment, prognosis, prevention) (most important)

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Internal illnesses. Rheumatism (Sokolsky-Buyo disease) (differential diagnosis, treatment, prognosis, prevention) (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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10. RHEUMATISM (SOKOLSKY-BUYO DISEASE) (DIFFERENTIAL DIAGNOSIS, TREATMENT, PROGNOSIS, PREVENTION)

Differential diagnosis. Infectious myocarditis develops at the height of the infection, it is not characterized by progression, signs of valvulitis.

Of the connective tissue diseases, it is necessary to take into account periarteritis nodosa, systemic lupus erythematosus, scleroderma.

With neurocircular dystonia of the cardiac type, there are diverse complaints, there are no objective signs of the disease.

In the syndrome of primary tuberculosis, there are no radiographic symptoms of the primary complex, antistreptococcal antibodies. Mantoux and Pirquet tests are carried out, tuberculosis mycobacteria in sputum are examined.

Treatment. With active rheumatism, mandatory hospitalization is carried out up to 40-60 days or more.

An appropriate regimen is assigned: in the absence of carditis - half-bed for 7-10 days, then free; in the presence of carditis - strict bed rest for 2-3 weeks, then semi-bed and free.

From nutrition, table No. 10 is prescribed with a protein content of at least 1 g / kg, limiting salt to 6 g / day.

Mandatory early prescription of antibiotics is carried out: benzylpenicillin 1,5-4 million units per day (depending on the degree of activity) for 2 weeks. Then they switch to a prolonged form: bicillin-5, 1,5 million units every 2 weeks for 2 months. After this, antibiotic therapy is carried out every 3 weeks every month for at least 3 years in patients without a history of carditis and for at least 5 years in patients with a history of carditis. If you are allergic to penicillin, antibacterial drugs of other groups are used - macrolides, oral cephalosporins.

Glucocorticoid drugs are prescribed only for severe carditis, acute (less often subacute) course of the disease: prednisolone 20-30 mg / day for 2-3 weeks, then the dose is reduced until the drug is completely discontinued, the course of treatment is 1,5-2 months.

Of the metabolic drugs, phosphalene, a polarizing mixture and antiarrhythmic drugs (for arrhythmias) are used.

With the development of circulatory failure, saluretics are used: hypothiazide, furosemide, uregit, ACE antagonists in a short course.

Flow. If the duration of the disease is up to 6 months, it is considered as acute, more than 6 months - chronic.

Forecast. Determined by the condition of the heart. The absence of signs of clinical formation of defects within 6 months is a good prognostic indicator. The formation of a defect within 6 months is considered to be an unfavorable prognostic sign.

Prevention. Primary prevention includes hardening children from the first months of life, nutritious nutrition, physical education and sports, improving living conditions, timely treatment and sanitation of foci of streptococcal infection.

Secondary prevention in patients who have had the first rheumatic attack without carditis is more effective until the age of 18, in patients with carditis with the first attack of rheumatism it is more effective until the age of 25.

In patients with valvular disease, bicillinoprophylaxis can be carried out throughout life.

Author: Myshkina A.K.

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