Rheumatism, rheumatic heart disease

Rheumatism (Sokolsky-Buyo disease) is a systemic inflammatory disease of the connective tissue with a predominant lesion of the cardiovascular system. It develops in connection with an acute infection (group A beta-hemolytic streptococcus) mainly in babies and adolescents (7-15 years old).

Streptococcal infection, especially massive, has a direct or indirect damaging effect on tissues with a large number of antigens and toxins. Reduced immunity to streptococcus predisposes to rheumatism, a family genetic tendency is also noted.

Symptoms and course

In typical cases, the disease develops in 1-3 weeks after suffering a sore throat, less often another infection. Relapses of rheumatism often appear as a result of any infectious diseases, surgical interventions, physical overload. The combination of acute migratory and completely reversible polyarthritis of large joints with moderately severe heart damage (carditis) is most characteristic. The onset of the disease is traditionally acute, stormy. Polyarthritis develops rapidly, accompanied by an increase in body temperature up to 38-40C and strong sweat, but without chills. Symmetrically large joints are affected – knee, wrist, ankle, elbow. They are swollen, the skin over them is hot, movements in them are sharply painful. Typical “volatility” of inflammatory changes, manifested in the rapid (over several days) reverse development of arthritic phenomena in some joints and their equally rapid increase in others. Over time, all articular manifestations disappear without a trace. With damage to the heart muscle (rheumatic myocarditis), patients complain of mild pain or vague discomfort in the region of the heart, slight shortness of breath during exercise, occasional palpitations, interruptions. The size of the heart is enlarged, the sonority of its tones changes, a “gentle” noise appears. With damage to the endocardium (the inner lining of the heart), rheumatic heart defects are formed. In addition, there are lesions of the pericardium, skin: annular erythema – pink annular rashes, never itchy, located on the inner plane of the arms, legs, abdomen, neck and trunk. In children, damage to the central nervous system is manifested by minor chorea (muscle weakness, violent fanciful movements of the trunk, limbs and mimic muscles). With acute rheumatism in the blood, the total number of leukocytes, including neutrophils, increases, the number of platelets, ESR increases. The content of antistreptococcal antibodies (antistreptohyaluronidase and antistreptokinase, antistreptolysin) increases.

Recognition is carried out on the basis of clinical data: carditis, polyarthritis, chorea, annular erythema. Rheumatic nodules in combination with fever not lower than 38C and laboratory parameters.


Bed rest in the acute period. Glucocorticoid hormones (prednisolone, triamcinolone), voltaren or indomethacin, quinoline products (delagil, plaquenil) are used. Outside the period of exacerbation, sanatorium treatment is likely. To prevent recurrence of rheumatism, prophylactic treatment with bicillin is carried out, it will be necessary to avoid cooling, acute diseases of the upper respiratory tract, and treatment of heart failure.

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