Hospital pediatrics. Diagnosis and treatment of rheumatism (most important)

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Hospital pediatrics. Diagnosis and treatment of rheumatism (most important)

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44. Diagnosis and treatment of rheumatism

Diagnostics: based on anamnesis, clinical and laboratory data. In the blood test, neutrophilic leukocytosis with a shift to the left, thrombocytosis, an increase in ESR to 40-60 mm/h. An increase in antistreptococcal antibody titers is characteristic: antistreptohiapuronidase and antistreptokinase more than 1: 300, antistreptolysin more than 1: 250. The height of antistreptococcal antibody titers and their dynamics do not indicate the degree of activity of rheumatism. In a biochemical study, an increase in the level of plasma fibrinogen above 4 g/l, globulins above 10%, seromucoid above 0,16 g/l, and the appearance of C-reactive protein in the blood test. In many cases, biochemical activity indicators parallel the ESR value. There are broad diagnostic criteria for rheumatism: polyarthritis, carditis, ring erythema, chorea, rheumatic nodules. There are minor diagnostic criteria for rheumatism: fever, arthralgia, previous rheumatism, the presence of rheumatic heart disease, increased ESR, a positive reaction to C-reactive protein, prolongation of the P-Q interval on the ECG.

The diagnosis can be considered certain if the patient has two major diagnostic criteria and one minor diagnostic criterion, or one major and two minor diagnostic criteria, but only if both of the following evidence exist simultaneously, it is possible to judge a previous streptococcal infection: scarlet fever (which is an indisputable streptococcal disease); sowing group A streptococcus from the mucous membrane of the pharynx; increased titer of antistreptolysin O or other streptococcal antibodies.

Treatment. Maintain bed rest for 3 weeks or more.

The diet shows the restriction of salt, carbohydrates, sufficient intake of proteins and vitamins. Exclusion of products that cause allergization. Antibacterial therapy of benzylpenicillin, sodium salt is used for 2 weeks, then prolonged action drugs - bicillin-5, with intolerance to penicillins - replacement with cephalosporins, macrolides.

Prescribe vitamin therapy, potassium preparations. Pathogenetic therapy: glucocorticoids, prednisolone. Non-steroidal anti-inflammatory drugs (indomethacin, voltaren). Aminoquinoline preparations (rezokhin, delagil) - with a sluggish, protracted and chronic course. Immunosuppressants are rarely used.

Symptomatic therapy of heart failure is carried out. When indicated, diuretic therapy is prescribed. Treatment in a hospital - 1,5-2 months, then treatment in a local sanatorium for 2-3 months, where chronic foci of infection are treated and dispensary observation is carried out by a local pediatrician and a cardiorheumatologist.

Prevention: primary correct treatment of streptococcal infection, sanitation of foci of chronic infection, rational nutrition. Secondary prevention includes bicillin-drug prophylaxis for all patients, regardless of age and the presence or absence of heart disease, who have undergone a significant rheumatic process. The prognosis is favorable.

Author: Pavlova N.V.

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