Rheumatism in a child: symptoms, treatment, prevention

In this article, we will consider in detail how rheumatism manifests in a child. Symptoms, varieties, peculiarities of treatment, diagnostics and prevention are the main questions on which we will stop.

At once we draw your attention to the fact that rheumatism can develop at any age. This disease is an infectious-allergic nature. The variety of clinical manifestations is due to the fact that rheumatism does not affect any particular organ, but connective tissues that are present in all human organs. Consider the signs of rheumatism in children.

What it is?

Let's start our article from the very concept of "rheumatism". What is this disease? So called inflammatory disease, which affects the entire body at the same time (that is, it is systemic). The origin of rheumatism is infectious-allergic. He has another name: Sokolovsky-Buyo's disease.

The disease is characterized by affection of connective tissue. The connective tissues of the cardiovascular and central nervous system suffer mainly. There is statistical information that indicates that women most often suffer from this disease - three times more than men. However, this difference disappears at a more mature age.

What are the features of rheumatism in children? Symptoms and treatment of the disease in childhood are slightly different. This is due to the fact that children's rheumatism has some characteristics, such as:

• More severe severity of cardiovascular damage;
• Changes in other systems and bodies;
• The possibility of transition of the disease into a chronic form (the probability percentage in childhood is very high);
• Occurrence of relapses.

The chronic form is manifested as follows: after treatment there is a period of rest, but after a while the problem arises again. It should be noted that the recurrence of rheumatism is observed in children very often.

Symptoms of rheumatism in children 2 years or 10 practically do not differ from each other. Children from seven to fifteen years are especially prone to the disease. Children's rheumatism threatens with a number of complications, including heart failure. Often rheumatism begins to develop after infectious diseases. These include scarlet fever, tonsillitis and so on.

Especially often the focus is found in the cardiovascular system. Rheumatism is common all over the world, especially in dysfunctional countries, where the indicators of the disease are very high.

We will take a more detailed look at the symptomatology and diagnosis of the disease in childhood later, but now I want to draw attention to the criteria of Jones. It is important to note that he distinguishes between large and small criteria. If there is at least one sign from the first category, then this is enough to diagnose the disease.

Big criteria	Small criteria
Carditis (observed in 70% of cases), polyarthritis (75%), erythema (up to 10%), chorea (up to 10%), formation of subcutaneous nodules (up to 20%).	Fever, arthralgia, rheumatism in anemia, increased ESR or CRP.

Symptoms

Now we will consider in detail the symptoms of rheumatism in a child. As mentioned earlier, rheumatism can destroy connective tissue in several organs at once. This can explain a large number of various manifestations of the disease. Everything depends on the form and severity of the processes.

The causative agent of rheumatism stimulates the production of a substance called C-reactive protein. It is he that causes inflammation and damage to connective tissue. Again, we draw your attention to the fact that rheumatism does not appear from scratch. The process of its development begins after an infectious disease. There are three forms of the disease, we'll talk about them a little later. The main feature of rheumatism is an acute onset. Symptoms include:

• A sharp increase in body temperature;
• Strong weakness;
• Deterioration of health.

Now the common initial symptoms were listed. In young children (2 years old), symptoms of rheumatism may include:

• irritability;
• Tearfulness;
• Sleep disorders and so on.

Further, other symptoms characterizing one of the forms of rheumatism will gradually join them. Rheumatism in children, the symptoms and treatment of which we consider in the article, can manifest itself in different ways, but in about 85% of cases, the disease threatens complications in the heart.

Classification

There are three forms of the disease:

• Articular;
• Heart;
• Nervous.

We will describe them in detail later.

It is worth noting that the symptoms of streptococcal rheumatism in children do not pass without a trace. The disease always entails consequences in the form of complications, or rheumatism acquires a chronic form.

Symptoms of rheumatism in children 10 years and younger are absolutely no different. An experienced specialist can easily diagnose the disease at any stage of the disease.

Rheumatism has two phases:

• Active;
• Inactive.

What are the criteria for the activity of the disease? These include:

• Severity of manifestations;
• Change laboratory markers.

Proceeding from this, three degrees of rheumatism are distinguished. They are presented in the table below.

First degree	Minimal activity	At this stage, clinical and laboratory signs are very poorly expressed.
Second degree	Moderate activity	The second degree of streptococcal rheumatism in children, whose symptoms are already pronounced, is easily diagnosed. This is due to the fact that clinical, radiological and other signs are already noticeable.
Third degree	Maximum activity	Typical features are: fever, signs of rheumatic carditis, joint syndrome, abrupt changes in laboratory indicators and so on.

The joint form

Now consider the symptoms of rheumatism in a child's articular form. Let's start with a small amount of statistical information. Breast children very rarely fall into this category. In almost 20% of cases, articular rheumatism is manifested at the age of one to five years; And almost 80% - from ten to fifteen years.

Symptoms of joint rheumatism in children can be manifested as follows:

• fever;
• weakness;
• headache;
• Pain in the joints;
• Redness and swelling over the joints and so on.

Despite the fact that cases of diseases are numerous, the causative agent has not yet been determined. Undoubtedly, rheumatic fever is infectious. This infection affects in most cases the lymph nodes located in the nasopharynx. Diseases are associated with previous angina, caries, inflammatory processes.

It should be noted that there are several theories of the onset of the disease. Rheumatism of joints in children, the symptoms and treatment of which we are considering in this article, according to the majority, is of an infectious and allergic nature. This is the most common theory. If you adhere to this opinion, rheumatism is the consequences of an allergic reaction in the human body. Due to the ingress of bacteria into the cells during the incubation period, the organism is re-tuned. Streptococci in this case can cause the above symptoms of rheumatism.

Earlier it was said that the reason for the development of rheumatism is often an earlier transferred any infectious disease (in particular scarlet fever). However, there are other examples:

• Supercooling;
• Overvoltage.

Many symptoms indicate that the CNS (central nervous system) is involved in this process. Such symptoms include:

• chorea;
• Motor disorders;
• Mental illness;
• Nervous diseases and so on.

It is important to note that all of the above diseases are very often accompanied by rheumatism. Studies show that the reactivity of the cerebral cortex is significantly reduced. This can be easily determined by an experienced specialist. Why is this happening? This is usually associated with an increase in the excitability of subcortical centers, which affects the entire body.

Cardiac form

Now we offer a little more detail about the cardiac form of rheumatism in a child, the symptoms of this ailment. At once we draw your attention to the fact that heart problems can begin both simultaneously with the articular form of rheumatism, and to manifest gradually. The severe form of rheumatism is characterized by the fact that the symptoms of cardiac dysfunction are manifested very slowly, that is, the disease develops imperceptibly.

Earlier we said that the distinctive feature of articular rheumatism is an unexpected and violent attack. There are sharp pains, and so on. However, some children may complain of a slight pain in the joints, fatigue. Even in this case, heart disorders can develop. To avoid serious consequences and start treatment in a timely manner, go for a consultation with a specialist even with such complaints.

Rheumatism of the heart in children, whose symptoms and treatment we will consider right now, is usually called rheumatic heart disease. The initial stage practically does not show itself in any way. Symptoms include:

• fatigue;
• Refusal of games;
• Unwillingness to run;
• Shortness of breath;
• cardiopalmus;
• Pallor of the skin.

The heavy form is accompanied by an elevated temperature, usually not exceeding thirty-eight degrees. The general condition of the child worsens daily.

The cardiac form of rheumatism can lead to some heart disorders, presented below in the table.

endocarditis	Violation of the inner shell of the heart
myocarditis	Medium
pericarditis	External
Pancarditis	All three

All this leads to the development of heart disease, that is, the inflammatory process passes to the valves. It is very important to know that timely treatment and compliance with the prescribed regime is the guarantee of a happy future. Many children who suffer from heart defects, lead a normal lifestyle (go to school, walk with friends, visit circles, and so on). If the case is neglected, the disease takes a severe form, which affects your health as follows:

• Presence of a circulatory disorder;
• Swelling of the extremities;
• Strong shortness of breath;
• Enlargement of the liver.

Another distinguishing feature of the severe form of the disease is ring-shaped rash on the skin. At the first symptoms, seek medical help urgently! In time, the treatment started is a chance for a normal life of the child, which should not be missed.

Nervous shape

In this section of the article we will pay attention to the nervous form of rheumatism in children. Symptoms and treatment of the disease - these are the main issues that we will try to highlight in this article.

A distinctive feature of the nervous form of rheumatism in children is chorea, the defeat of certain parts of the brain. Chorea develops gradually, symptoms can be:

• Change of mood;
• irritability;
• Tearfulness;
• Twitching of the muscles (note that this symptom is able to progress, some parents think that the child grimaces and scoffs, even without realizing the true state of affairs);
• Lack of discipline;
• negligence;
• Change of handwriting;
• The appearance of slurred speech;
• Stammered gait.

As for the lack of discipline and negligence, it is worthwhile to make some explanations. In fact, the child is not to blame for this. He really can not accurately lace up his shoes, often drops forks, spoons, pens and other items. Pay attention to these symptoms. Many confuse this with fatigue or negligence. In fact, the child needs your help. These symptoms will manifest for about three months. More pay attention to the behavior and condition of the child, so as not to miss the right moment and start treatment in time.

Good news with this disease: heart damage with a nervous form of rheumatism is extremely rare. If the disease has given any complication to the cardiovascular system, then the disease proceeds very easily. If you notice any changes in the behavior of the child - contact your doctor.

Now, we will pay some attention to hyperkinesis. This condition, which occurs at the height of the disease. During this period a person is always in motion (he can not sit, stand or lie quietly). There are involuntary contractions of the muscles, which can interfere with the child when eating (contractions of the muscles of the tongue, lips and so on). They spread to other muscle groups, the following symptoms may appear:

• Constant flashing;
• Tongue sticking out;
• Grimacing.

Please note that during sleep all symptoms of hyperkinesis disappear. In addition to all of the above symptoms, you can find a lowered muscle tone during the examination. No special examinations are required in severe forms, when visible to the naked eye. A child with a severe form of illness can not keep his head or sit. As a rule, all symptoms last from three weeks to three months. Then they gradually subside. Be sure to note that relapses occur quite often (the time of manifestation is about one year after the last case, sometimes much earlier).

With chorea, body temperature may slightly increase (up to 37.5 degrees). There may be swelling and pain in the joints.

Causes

In this section of the article we will try to disassemble in detail the issue of the causes of rheumatism in children. As stated earlier, even modern medicine can not give an exact answer to this question. There are several theories, and starting from them, we can conclude that many factors can serve as the causes.

Factor	Explanation
The recently transferred infectious diseases	These include ARI, tonsillitis, scarlet fever, tonsillitis and so on. It is important to note that they are caused by group A streptococcus. It is worthwhile to clarify that infection with an infection is not the main condition for the development of rheumatism. This requires a malfunction in the immune system. Only in this case it begins to attack healthy cells. This is manifested in cases when the treatment started untimely (belatedly) or it is simply wrong.
The second factor is hereditary	In a number of studies and interviews it was found that the hereditary factor also plays a role in the development of rheumatism. It was noted that this disease often occurs in members of the same family.
Prolonged carriage of streptococcal infection	As a rule, long-term streptococcus can live in the nasopharynx, as a result of which the immune system malfunctions. The result is the development of rheumatism.
Secondary factors	However strange it may sound, there are other (secondary) factors that can cause the development of rheumatism in childhood. These include: hypothermia, overfatigue, poor nutrition. How does this affect the development of the disease? All is simple, these factors have an adverse effect on the immune system of the child. As a result, the likelihood of rheumatic fever increases several times.

Diagnostics

What is rheumatism in children (symptoms, photos, reasons given in the article), now, hopefully, understandable. We pass to the diagnosis of the disease. To begin with, it must be said that any person, from parents and teachers to the pediatrician or rheumatologist, can suspect the child of the disease.

Clinic of rheumatism in children (clinical manifestations) is diverse. It is important to know the basic criteria:

• Carditis (any form of it);
• Chorea (we paid much attention to this disease earlier);
• Presence of nodules under the skin of a child;
• erythema;
• polyarthritis;
• Recently transferred streptococcal infection;
• Hereditary factor.

If the child has at least one of the listed symptoms, then it is urgent to see a doctor. In addition to these criteria, there are others:

• arthralgia;
• fever;
• Altered blood counts.

To diagnose a little examination and questioning the patient. For accurate diagnosis, it is necessary to conduct a number of laboratory studies, which include chest X-ray, ECG, echocardiography.

X-rays help determine the configuration of the heart, the ECG will show cardiac disturbances (if any), echocardiography determines the presence of heart disease.

Treatment

We examined the diagnosis and symptoms of rheumatism in children. Treatment of the disease is the next question. In this case, an integrated approach is required. Treatment of rheumatism is directed to:

• Relief of symptoms;
• Influence on streptococcal flora.

Rheumatism in children (the symptoms, treatment and photo of which we are considering) is treated in a hospital. Pay attention to the fact that the therapy is carried out even with a suspicion of the disease.

The child needs:

• Bed rest with a gradual increase in activity;
• Proper diet, the diet contains an increased amount of potassium;
• The proper organization of leisure activities.

Medication therapy is based on:

• Antibacterial preparations;
• Hormonal;
• Anti-inflammatory;
• Vitamin complexes;
• Preparations of potassium;
• Immunostimulants.

All these drugs help fight the pathogenic microflora. As a result, the inflammatory process is removed and the symptomatology of the disease is markedly reduced. It is important to note that medication can have some side effects:

• Development of ulcers;
• Gastric bleeding;
• Disturbances in the work of the endocrine glands.

Prevention

This section is devoted to the prevention of rheumatism in children. Allocate primary and secondary prophylaxis. In the first case, attention is paid to the correct development of the child:

• Hardening;
• Proper nutrition;
• sport;
• Fighting infection with group A streptococcus

The secondary focuses on preventing relapses:

• "Bicilin 5" - 1.5 million units once every four weeks to schoolchildren;
• "Bicilin 5" with a dosage of 0.75 million units once every two weeks to preschool children.

Please note that it is recommended to prevent exacerbations every year, every month. The recommended duration is five years.

Forecast

Many mothers were able to cope with this disease by contacting the hospital for medical help on time. If to conduct preventive maintenance of rheumatism, the relapse will not bear a threat to life. We have in detail disassembled a question of rheumatism at children, signs, responses. What are the forecasts?

We note that rheumatic carditis in about 25 percent of cases is accompanied by the development of heart disease. Repeated manifestation does not leave a chance of avoiding valve disruption. As a result, cardiosurgical intervention is necessary. The lethal outcome of heart failure is approximately 0.4%. It is worth noting that the outcome of the disease depends on the correctness and timeliness of treatment.