Hospital therapy. Clinical picture of rheumatism (the most important)

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Hospital therapy. Clinical picture of rheumatism (the most important)

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2. Clinical picture of rheumatism

All manifestations of the disease can be divided into cardiac and extracardiac. It is possible to describe the clinical picture of the disease from these positions.

Stage I: the connection of the disease with the transferred infection is revealed. In typical cases, 1-2 weeks after a sore throat or acute respiratory illness, body temperature rises, sometimes up to 38-4 ° C, with fluctuations during the day within 1-2 C and strong sweat (usually without chills).

The most common manifestation of rheumatism is heart damage - rheumatic heart disease: simultaneous damage to the myocardium and endocardium. Patients complain of mild pain or discomfort in the region of the heart, slight shortness of breath during exercise, interruptions or palpitations are much less common.

Rheumocarditis in young patients, as a rule, is severe: from the very beginning of the disease, severe shortness of breath during exercise and at rest, constant pain in the heart, and palpitations are noted.

Pericarditis, as well as extracardiac manifestations of rheumatism, is rare. With the development of dry pericarditis, patients note only constant pain in the region of the heart. With exudative pericarditis, characterized by the accumulation of serous-fibrinous exudate in the heart sac, the pain disappears, as the inflamed pericardial layers are separated by the accumulating exudate.

The most characteristic of rheumatism is the defeat of the musculoskeletal system in the form of rheumatic polyarthritis.

Rheumatic lesions of the kidneys are also extremely rare, detected only in the study of urine.

Abdominal syndrome (peritonitis) occurs almost exclusively in children and adolescents with acute primary rheumatism.

At stage II of the diagnostic search, the detection of signs of heart damage is of little importance.

In primary rheumatic heart disease, the heart is usually not enlarged. Auscultation reveals a muffled I tone, sometimes the appearance of a III tone, a soft systolic murmur at the apex. This symptomatology is due to changes in the myocardium.

In case of damage to the aortic valve, a proto-diastolic murmur at the Botkin point may be heard, and the sonority of the II tone may be preserved.

In patients with polyarthritis, joint deformity is noted due to inflammation of the synovial membrane and periarticular tissues, pain on palpation of the joint.

Ring-shaped erythema (a sign that is almost pathognomonic for rheumatism) is extremely rare (in 1-2% of patients).

At the III stage of the diagnostic search, the data of laboratory and instrumental studies allow us to establish the activity of the pathological process and clarify the damage to the heart and other organs.

Acute-phase indicators: neutrophilia with a shift of the leukocyte blood count to the left; an increase in the content of 2-globulins, followed by an increase in the level of globulins; increased fibrinogen content; the appearance of C-reactive protein; ESR increases. Immunological parameters, increased titers of antistreptococcal antibodies (antihyaluronidase and antistreptokinase more than 1:300, anti-O-streptolysin more than 1:250).

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