Treatment and prophylaxis of rheumatic fever

Treatment of patients in the active phase of rheumatism out in a hospital. Need bed rest until complete elimination of inflammatory processes; under favorable course and well-being of the patient strict bed rest in 1-2 weeks, you can gradually mitigated. During the first 10 days prescribe antibiotics; in the presence of infections (tonsillitis, sinusitis and others) antibiotics are used throughout the course of treatment. Prescribe penicillin intramuscularly in a dose of 200 000 IU 3 times a day or bicillin 600 000 UNITS 1 once a week. At the same time apply for 3-4 months. and more anti-inflammatory drugs: sodium salicylate on 8-12 grams per day or acetylsalicylic acid 3-5 grams per day. Poor endurance salicylates (nausea, vomiting, dizziness, noise in the ears) designate amidopyrine 1.5-3 g or phenylbutazone of 0.45-0.75 grams per day. Because of the risk of agranulocytosis due to the use of drugs should be made a blood test once a week. Treatment musk or amidopirina combined with corticosteroid hormones. Under the supervision of a physician prescribe prednisone or prednisolone 15 to 20 mg per day and triamcinolone on 12-20 mg or dexamethasone 2-3 mg per day. Treatment with hormones approximately 30-40 days. Initial dose gradually reduce (for example, the dose of prednisone each week reduced to 2.5 mg). At the same time apply potassium chloride 15-20 ml of 10% aqueous solution 3-4 times a day.
Corticosteroid hormones contraindicated in conjunction rheumatism with hypertension, diabetes, active tuberculosis lungs, and especially with peptic ulcer disease because of the risk of gastrointestinal bleeding; gently appoint them in heart failure. If rheumatism disturbance of blood circulation, use of the heart and diuretics. Rheumatic lesions of the Central nervous system with epileptiform seizures shows anti-convulsants: phenobarbital 0.05-0.1 g 2-3 times a day, magnesium sulfate to 5-10 ml of 25% solution intramuscularly 1 per day. Patients in the active phase of rheumatoid arthritis need careful maintenance. The chamber should often be a breeze. Because of excessive sweating patients often need to change clothes, skin, wiping warm water or toilet vinegar. Diet rheumatism should contain a sufficient amount of protein (cheese, egg white omelettes). Necessary vitamins: ascorbic acid up to 1 g / day, vitamins B1 and B6. It is recommended to limit table salt, liquid, carbohydrates, especially with heart failure.

The best results of treatment of rheumatism - with reduction of formation of heart diseases and lesions of the heart muscle is obtained when implementing trejdingovoj treatment system: 1) in-patient treatment of patients in the active phase of the disease; 2) after hospital treatment in suburban sanatorium; 3) the following dispensary observation and treatment.
The principal medical basis of this system is the separation of the disease on the active (acute, subacute, satino-a slow, continuous, intermittent, latent and dormant phase. According to this system, the stationary treatment (preferably repeated during the nearest years after the attacks of rheumatic fever) are subject to all the patients in the active phase of the disease. At this early correct diagnosis is essential therapeutic effect with the least risk of severe rheumatic heart failure.
Inpatient treatment of patients with rheumatism provides: 1) a combination of hospital mode with the mandatory strict bed regime for the whole period of acute and sub-acute manifestations of the disease, increased temperature, expressed pathological laboratory parameters of disease activity; 2) health food; 3) medical physical culture; 4) medical and physiotherapeutic treatment; 5) in some cases, surgery.
The duration of strict bed rest, very important in the treatment of rheumatism, is determined by the General indicators of disease, primarily by the degree and nature of rheumatic heart failure. At the current active treatment methods and favorable for primary rheumatic heart disease duration strict bed rest, on average 6-8 weeks, with recurrent rheumatic heart disease in combination with a heart defect - 2-3 months, when joining circulatory failure is 3-4 months. and more. At the same time, excessive immobilization of the patient is in good health and indisputable reducing the activity of rheumatic heart disease leads to the violation of the immunological reactivity, trophism and adaptation of the cardiovascular system, as well as to dangerous moral and psychic asthenization.
If in the treatment eliminated the main symptoms of rheumatic heart disease, the patient is impractical to take the opportunity to use your toilet, there at the table, to sit in the chair several times a day for 15-20 minutes, it is Advisable to appoint a patient therapeutic physical training - first passive, and then and active. Due to the high sensitivity of patients with rheumatism cooling when expressed their sweating appropriate to support the house-room) temperature in the range of 18-20 degrees and often to change clothes and make wiping Cologne, vodka, aromatic alcohols. As every heart-sick rheumatism needs persistent aeration of his chamber, and in the warmer months - stay on the open veranda. In power-in the acute phase of the disease - it is recommended to reduce the amount of liquid salt and carbohydrates, reinforcing the tendency to allergies, exudative manifestations of disease, and to increase daily protein level till 2-2,5 g of protein per 1 kg of body weight in a well-digested form (cheese, egg white omelettes etc), and the number of vitamins, first of all ascorbic acid (up to 1 g / day), as well as vitamins B1 and B6, improving metabolism in cardiac muscle and the nervous system, contribute to the normalization of the exchange in the system of connective tissue and reduces the permeability of capillaries. In the first ten days, all patients in acute active phase of the disease, and patients with chronic foci of infection throughout the course of treatment recommended antibiotics (penicillin 600 000 IU a day or bicillin 600 000 IU once a week).
For many decades the main curative Antirheumatic means recognized the sodium salicylate. Appointed in high daily doses (8-12 g) and the long-term this drug can ensure a positive anti-inflammatory and analgesic effect. Outstanding domestic clinicians N. D. Strazhesko, N. D. Burman etc. with the help of sodium salicylate these doses and early application received a number of patients abortrule effect. However, such high doses of sodium salicylate assigned a long time, quite often lead to diarrhoea and toxic phenomena (nausea, vomiting, noise in the ears, heartburn, dizziness). Acetylsalicylic acid (aspirin) has a more vigorous anti-inflammatory effect and can be used in smaller doses (3-5 g) and, probably, therefore rarely causes side effects (heartburn, nausea, loss of appetite). Amidopyrine (pyramidonum) and phenylbutazone have no doubt more vivid anti-inflammatory effect and therefore are used in smaller daily doses (amidopirina 1,5-3,0 g, phenylbutazone of 0.45-0.75 g). The dampening effect on the blood with the risk of agranulocytosis causes the necessity of systematic control (at least 1 time per week) over white blood. Phenylbutazone, like other pyrazolone derivatives (reopirin, ilapiry, pyrazolidone, pirabutol and others), also has the capacity to fluid retention in the body.
Recent anti-inflammatory drug therapy is recommended as a normal Antirheumatic drugs (acetylsalicylic acid 3 g, or amidopyrine 1.5-2 g, or phenylbutazone 0.3 g per day) and steroid hormones, prednisone, prednisolone for 15-25 mg, triamcinolone on 12-20 mg dexamethasone 2-3 mg per day. Steroid hormones to gradually reduce the dose of [approximately reduce the daily dose of 2.5 mg (dexamethasone 0.5 mg), during 5-7 days] appointed for the period of acute and sub-acute manifestations of the disease (30-40 days), and acetylsalicylic acid or its substitutes - for the whole course of inpatient treatment and even within one month after discharge.
The specified division is indicative; depending on the form and severity of manifestations of the disease and the response of the body to treatment, daily and course doses should be individualized as well as the duration of the entire course steroide-aspirin therapy. Only the undisputed clinical improvement can reduce the daily dose of medical means and reduce the time of their application.
Good results from the use of specified medical complex are under the conditions of the early proper diagnosis of the disease, early intervention and prolonged hospital treatment. At primary rheumatic heart disease comprehensive treatment provides a relatively quick suppression of the inflammatory process in the heart, first of all in the heart muscle, as well as in other organs (serosity, polyarthritis, chorea and others) and prevent heart disease in many patients. The best results in terms of prevention education rheumatic heart diseases and heavy defeat of the heart muscle received at the beginning of treatment specified steroide-aspirin complex not later than 7-14 days from the occurrence of rheumatic heart disease (L. Century Milaeva).
In recurrent forms of rheumatism remains the same basic scheme of treatment, however, as a rule, with lower daily doses of steroid hormones (10-15 mg of prednisolone) at the same daily dose acetylsalicylic acid (3 g) and, if more limited water-mineral mode. When signs of fluid retention in connection with the appointment of hormones, especially when events decompensation before steroid therapy are recommended even greater restrictions on the amount of liquid and salt and appointment of ordinary heart (digitalis, corglycon, strofantin, Adonis, and others) and diuretics (gipotiazid, novoryt, Favorit and others). The purpose of triamcinolone is possible and desirable, and with circulatory failure, I, IIA and II degrees in patients with recurrent rheumatic heart disease.
In response to emerging decompensated impoverishment of the heart muscle potassium ions, growing under the influence of steroid therapy, it is recommended that during steroid therapy additional introduction of potassium chloride in 2-3-4 g per day under laboratory and ECG monitoring.
Wide experience of treatment of rheumatism using steroide-aspirin complex, which reduced the amount of hormones and duration of their application, confirms not only its efficacy but also a significant reduction of the negative impact of steroid hormones. However, until the appointment of steroid hormones necessary to carefully examine the patient and make sure there are no major contraindications to their use: ulcer and hypertension, diabetes, active tuberculosis lungs, expressed lack of coronary circulation, mental disorders and foci of active infection. Now, when the doctors started to reduce the risk of such complications, as easy compensated early form of hypertension (Dibazol, drugs rauwolfia, ismelin, Ottensen, oktadin and others), a mild form of diabetes (insulin, sulfa drugs), focal infection (antibiotics), pulmonary tuberculosis (various anti-tuberculosis drugs), the main and dangerous complication of steroid therapy should be considered stomach and intestinal bleeding that dictates the mandatory monitoring of patients during steroid therapy (reveal hidden bleeding, dyspeptic symptoms, x-ray examination).
After the inpatient treatment of patients with rheumatism, it is recommended to undergo treatment in a suburban or rheumatic cardiological sanatorium (with the admission of acetylsalicylic acid and gradual expansion of the regime for the physical movement). If it is impossible Spa treatment, the patient is recommended additional treatment in the home.
At the end of stationary and Spa treatment, the patient rheumatism comes under the supervision of the local doctor and the corresponding cardiorheumatological Cabinet.
Patients with low reactivity of the organism, sluggish thrust disease is recommended in the summer months, the rate of climate or treatment at the balneological health resorts of the Crimea, Caucasus, Armenia, Georgia. Patients with heart disease and weakness of the heart muscle through 8 months. after in-patient treatment and in the absence of evidence of active rheumatic carditis may be recommended Spa treatment (Kislovodsk, Matsesta, Tskaltubo, Belokurikha, and others).
As shown by numerous Soviet and foreign authors (A. N. Bakulev, B. C. Petrovsky, A. A. Vishnevsky, P. A. Kupriyanov, and others) and a discussion of the problems of surgical treatment of rheumatic heart diseases at the XIII all-Union conference of therapists with participation of surgeons, pediatricians, pathologists, and radiologists (Moscow, 1963), such treatment, in particular comissurotomy when narrowing of the left venous holes, and the creation of artificial heart valves (B. C. Peter and others) has been recognized in the General system of treatment of rheumatism.
Ability to work in rheumatic heart diseases - see Heart (ability to work in cardiovascular disease).
Therapeutic physical training (LFC). When remitting acute symptoms of rheumatism and a gradual expansion of the mode prescribed physical therapy. Begin physiotherapy exercises in lying position with exercises for small joints of the hands and feet, which are carried out at a slow pace, combined with breathing exercises for 7-10 minutes Then the lessons are conducted in sitting and standing for 10-15 minutes, applied exercises for hands, feet and body. In the future, the amount of exercise therapy depends on the condition of the patient, the presence of heart disease and circulatory failure. After discharge from the hospital, it is recommended to continue treatment in suburban or rheumatic cardiological sanatorium.
Prevention of rheumatic fever include General social and health activities (good nutrition, good living conditions, sanitary-and-hygienic mode of employment, physical culture); measures for the prevention of streptococcal infections (chronic tonsillitis, sinusitis, otitis , and others); clinical supervision and anti-drug treatment. Spring and fall within 6 weeks appoint daily acetylsalicylic acid 1.5-2 g, amidopyrine 1-1,25 g or phenylbutazone 0.3 g and weekly injected intramuscularly in a dose of 600 000 UNITS bicillin. When intolerance bicillin apply penicillin-V 300 000 IU a day or tetracycline 500 000 UNITS in day. In the event of the accession of any infectious disease are the same additional course of baselineprotection. In recent years used bicillin-5, which is injected during the year 1 500 000 IU once a month.

  • The clinical picture of rheumatoid arthritis
  • Diagnosis of rheumatic fever
  • Rheumatic fever in children