For secondary prevention of rheumatism, it is administered. Prevention of Rheumatism – Primary and Secondary Prevention

Primary prevention of rheumatism

Systematic general strengthening measures are recommended: hardening the body, physical education and sports, water procedures, adherence to work and rest regimes, balanced diet, stay on fresh air, giving up bad habits (alcohol, smoking), reducing, if possible, contact with patients with streptococcal infection, timely and correct treatment acute and chronic streptococcal infections.

Early diagnosis of streptococcal diseases is often difficult, as it is associated with the need for additional bacteriological and serological studies. It must be taken into account that the typical picture of streptococcal diseases is found in no more than a quarter of patients. In other cases, erased, sometimes asymptomatic forms. A high probability of a streptococcal nature of a nasopharyngeal infection is indicated by sore throat, hyperemia of the pharynx with a reaction of regional lymph nodes, leukocytosis, detection of streptococcus in a throat smear, streptococcal antigen in the blood, increase in titers of streptococcal antibodies in the 2-3rd week from the onset of infection.

Due to the fact that rheumatism most often develops following an acute streptococcal infection (tonsillitis, pharyngitis, scarlet fever), its timely diagnosis and vigorous antibiotic therapy. Timely and correct treatment of acute respiratory viral infections with mixed infection (virus and streptococcus) is also important.

Patients with acute nasopharyngeal streptococcal infection should be isolated if possible. Treatment should be carried out with antibiotics for at least 10 days. The drug of choice is penicillin, which is administered intramuscularly 3-4 times a day. The daily dose of penicillin for adults is 1,500,000-2,000,000 units, for schoolchildren - 600,000-1,500,000 units, for children - at the rate of 20,000-30,000 units kg/weight. Another treatment method can be used: in the first 5-7 days of the disease, penicillin is used intramuscularly in the doses indicated above, and after acute clinical symptoms subside, bicillin-5 is administered intramuscularly at a dose of 1,500,000 units. Bicillin-5 is administered to preschool children at a dose of 750,000 units. If it is not possible to organize outpatient intramuscular injection penicillin, tablet forms of penicillin or semi-synthetic penicillins are used. Oxacillin is prescribed for adults at 3 g/day, for schoolchildren - 2-2 1/2 g, for preschool children - 1 1/2-2 g.

Daily doses of medications are divided into 4-6 doses. The medicine is used 30 minutes before meals. In case of intolerance to penicillin drugs, erythromycin, lincomycin, etc. are prescribed. The daily dose of erythromycin for adults is 1 1/2-2 g/day, for children - 30 mg/kg. When treating streptococcal infection, along with antibiotics, it is necessary to use antirheumatic drugs for 10-14 days - acetylsalicylic acid, analgin, brufen, etc., and in the first 5-7 days in full, and then in half the therapeutic dose.

Discharge to work, school or kindergarten permitted only in the absence of pathology from the internal organs and at normal indicators blood tests. After suffering from a sore throat, the patient should be under the supervision of a general practitioner, pediatrician, and rheumatologist for a month, since the first symptoms of rheumatism usually appear during this period.

Along with the treatment of acute streptococcal infections, an important preventive measure is the treatment of chronic streptococcal infections: tonsillitis, pharyngitis, sinusitis, sinusitis.

Treatment of multiple dental caries and periodontitis should also be carried out. The method of their sanitation is determined by the attending physician together with the otolaryngologist and dentist.

In case of epidemic outbreaks of streptococcal infection (tonsillitis, acute pharyngitis, scarlet fever), acute respiratory viral infections or the simultaneous appearance of several cases of acute rheumatism, especially in closed groups during their formation, along with isolation and active treatment sick, bicillin prophylaxis is indicated for all those in contact with the sick. Bicillin-5 is administered once, 1,500,000 units. Primary prevention must be carried out especially carefully for children, adolescents and young people from families in which there are patients with rheumatism, since these individuals are more at risk from rheumatism than others.

Secondary prevention of rheumatism

Secondary prevention of rheumatism includes a set of measures aimed at preventing exacerbations, relapses and progression of the disease in people with rheumatism. Secondary prevention of rheumatism is carried out by rheumatologists, and in the absence of rheumatology offices - by local therapists under the guidance of department heads.
Due to the fact that rheumatism is a chronic diseases and prone to relapse, complex preventive measures must be carried out for many years. A set of measures to prevent relapses and exacerbations of rheumatism includes:
- intense and long-term treatment patients with primary rheumatism;
- carrying out long-term antirheumatic therapy, if possible until the manifestations of the activity of the rheumatic process are completely eliminated, for patients with chronic variants of the course (protracted, continuously relapsing, latent) with drugs of the quinoline series (delagil, rezoquin, plaquenil), indole derivatives (indomethacin, methindol), brufen ( ibuprofen), voltaren;
- timely and effective treatment acute streptococcal infections of the nasopharynx;
- measures to combat streptococcal reinfection, including long-term bicillin prophylaxis;
- increasing the body's general medical and health regimen, individual complexes of therapeutic exercises, walks in the fresh air, balanced nutrition, hardening water procedures, use of climatic factors, etc.;
- conducting symptomatic therapy patients with heart defects, aimed at improving the functional ability of the heart muscle and maintaining circulatory compensation (cardiac glycosides, diuretics and drugs that improve the metabolism of the heart muscle, potassium preparations).
For secondary prevention of rheumatism, it is recommended, if possible, to carry out year-round bicilinoprophylaxis, since it is much more effective than seasonal. Streptococcus strains are very sensitive to penicillin preparations, in particular bicillin, and do not form resistant forms.

Bicillin prophylaxis is prescribed:
- all patients with rheumatism in the active phase of the disease, and bicillin should be administered in the hospital, immediately after completing the course of antibacterial therapy;
- all patients with newly diagnosed rheumatic heart defects, regardless of the phase of the disease, under the age of 35 years;
- persons who have suffered a significant attack of rheumatism, regardless of the localization of the process and who did not receive bicillin immediately after discharge from the hospital.
Bicillin prophylaxis is not indicated for patients with persistent circulatory failure not associated with the activity of the rheumatic process, and for patients with a tendency to thromboembolic complications.
In the winter and especially spring months, it is advisable to combine these drugs with vitamin therapy, primarily with ascorbic acid up to 0.5-1 g/day.
Patients with chronic variants course of rheumatism, protracted, continuously relapsing and latent, bicillin prophylaxis is carried out against the background of long-term, often many months of taking therapeutic doses of antirheumatic drugs, and for patients with severe decompensation of cardiac activity - against the background of symptomatic therapy with cardiac glycosides, diuretics, potassium preparations.
The duration of bicillin prophylaxis is determined by the characteristics of the disease:
- patients who have had primary rheumatic carditis without signs of valvular damage or chorea without obvious cardiac changes, in the absence or with carefully sanitized foci of chronic infection - 3 years in a row;
- patients who have suffered primary rheumatic carditis with the formation of heart disease - 5 years in a row;
- for patients with recurrent rheumatic carditis, regardless of the presence or absence of heart disease - regularly for at least 5 years in a row from the moment of the last exacerbation of the disease.
The issue of extending the period of bicillin prophylaxis for more than 5 years and its cancellation is decided individually.
Bicillin is administered only intramuscularly. Intravenous administration the drug is strictly prohibited. Before prescribing and each administration of bicillin, it is necessary to collect a detailed allergy history and carefully study medical documentation patient to ensure that he does not have hypersensitivity to penicillin preparations. Before prescribing bicillin, a sublingual test is performed: 100 units are applied under the tongue. bicillin (1 drop) and observe the patient for 3 minutes. If the test is positive, if a burning sensation and swelling of the mucous membrane appears, the remainder of the bicillin is removed with a swab and the mucous membrane is washed saline solution. However, even in these cases severe allergic reaction up to anaphylactic shock.
After injection of bicillin, the patient should be under the supervision of medical personnel who must know clinical manifestations allergies to bicillin and measures emergency care at the same time, and also have a full set of instruments and medications for the treatment of anaphylactic shock and other allergic manifestations.

Systems and organs. 8) Highly effective means prevention rheumatism are systematic hardening and physical exercise... as in the form primary, and in the form of secondary prevention. Primary prevention means preventing diseases...

Bicillins are antibiotic drugs penicillin series, used to treat acute streptococcal tonsillitis (), and some other diseases.

The main feature of bicillins is their very long duration of action. Even after a single injection of the drug active substance remains in the blood plasma in effective concentrations for 4-5 weeks in more than half of the patients. Due to this, the same Bicillin-5 is then prescribed mainly when symptoms appear severe complications- streptococcal shock, heart disease. Such bicillin prophylaxis is especially important after tonsillitis in children - in many cases, untreated disease leads to damage to the heart muscle and the development of lifelong.

Hemolytic streptococcus- the main causative agent of sore throat and related complications

At the same time, due to their specificity, bicillins for sore throats are rarely used - others are more fast acting turn out to be significantly more effective. Bicillin injections after a sore throat are prescribed only if there is a risk of complications. Which ones?

When are bicillins used for angina?

The main indication for the use of bicillin for angina is the suspicion of damage to the heart muscle by the pathogen, the risk of acute rheumatic or other complications - otitis media, laryngeal edema, phlegmon, etc. Bicillin prophylaxis is carried out here to prevent the development of these diseases. In these situations, it continues to suppress and destroy the bacteria that caused the sore throat, but for a long time, preventing the infection from reoccurring.

Heart pain is a common consequence of untreated sore throat.

In this case, bicillin prophylaxis after tonsillitis is prescribed mainly in the absence of clear symptoms of complications. If reactivation of the infection has already occurred and symptoms of complications are obvious, the doctor may replace bicillins with other antibiotics. The prescription of a specific remedy takes into account the specifics of a particular case.

With rheumatic heart disease, various defects can develop. Stenosis mitral valve- one of them.

Bicillins are used much less frequently for the treatment of sore throat, including in children. This is due to the fact that all bicillins are introduced into the body intramuscularly, which is difficult from an organizational point of view and frightens many patients (especially children). At the same time, today there are many antibiotics for oral administration that are not inferior and sometimes even superior to bicillins in digestibility and effectiveness. And the rate of disappearance of pathogens after starting to take bicillins is inferior to that when using other antibiotics.

The main advantage of using bicillins for sore throat is the ability to cure the disease with literally 1-2 injections.

In other words, treating a sore throat is easier and more effective than antibiotics in the form of tablets, and bicillins are used after the illness to prevent the development of complications. However, in some situations bicillins may be necessary:

1. If only a single injection is possible. For example, when the patient’s inability to comply is obvious or the doctor does not have the opportunity to meet with him again;
2. During outbreaks of sore throat in crowded groups - military units, boarding schools;
3. If the patient is unable to take medications independently (for example, if the patient has lost consciousness).

Today, many doctors introduce into their practice a mandatory single injection of bicillins upon completion of the main antibiotic therapy. This approach is completely justified and allows us to reliably protect the patient from complications.

After a bicillin injection, it is forbidden to rub the area with a tampon. This may result in the drug getting into the subcutaneous tissue. Here it is enough to simply apply cotton swab

to the injection site.

If a blood vessel is injured when injecting bicillin, the patient may become very agitated and microembolism may occur. Microembolism - blockage of the peripheral blood vessel

. The picture shows a clot that can cause an embolism; when bicillins are used, the blockage is caused by undissolved antibiotic crystals.

Bicillin-3 more often causes allergic reactions because it contains. General contraindications to taking bicillins is hypersensitivity to them, hay fever

And . If it is necessary to take medications during lactation, breastfeeding should be stopped.

If bicillins are used incorrectly - in too small quantities or for too short a course - the sore throat pathogen may develop resistance to them with the further development of superinfection. This situation is dangerous due to the complexity and high cost of further treatment. Complications of rheumatic attacks include acquired heart defects, joint pathology, nervous system . But is it possible to prevent the development of this disease ? And what to do if the diagnosis of “rheumatism”, albeit in remission, is already in your?

outpatient card

1 Prevention is the basis of health Currently, there is an increasing trend towards preventive treatment in medical work . In outpatient clinics, prevention departments are being expanded and among the healthy population, local service doctors strive for 100% dispensary coverage of people with chronic diseases. But it is much more important when the person himself makes a choice in favor of health and disease prevention. Prevention of diseases is divided into primary - when a person seeks to avoid pathology, as well as secondary - when the disease is in remission, or has been transferred to history, and the patient tries to avoid relapse. What is the prevention of rheumatism?

2 Primary prevention

To answer the question “how to avoid getting rheumatism?”, you should imagine what causes the development of the disease. Rheumatism or acute rheumatic fever is a complication of streptococcal infections. Sore throat not treated with antibiotics, past flu on the legs, frequent purulent sinusitis, lesions chronic infection in the nasopharynx, untreated carious teeth... These are all foci where a streptococcal infection can nest, and with a certain tendency to develop the disease, lead to rheumatic damage to the body.

At risk for rheumatism are girls over 5 years of age, female gender, people with a hereditary predisposition to the disease, as well as patients with chronic foci of infection in the nasopharynx and upper respiratory tract. Primary prevention of rheumatism, which includes the following measures and effective methods, helps reduce the incidence of morbidity:

Primary prevention measures are not complicated; they are aimed at preventing the occurrence of rheumatism. They are necessary and important to observe for all persons who are responsible for their health. And the success of primary prevention depends on the level of consciousness of a person and his attitude towards his own health.

3 Secondary prevention

But what to do if the diagnosis of “rheumatism” is already in your outpatient record? Secondary prevention of rheumatism is recommended for all patients who have suffered a rheumatic attack. It is aimed at preventing the return of the disease or relapses. Secondary prevention of rheumatism is divided into year-round and seasonal. Both forms of secondary prevention include taking long-acting penicillins (bicillin prophylaxis), taking NSAIDs, and treating chronic foci of infection.

Year-round bicillin prophylaxis is prescribed to all patients who have had rheumatism. If the patient has not developed a heart defect, then bicillin prophylaxis is carried out year-round for 3 years, and then seasonal prophylaxis for 2 years. When a defect forms in childhood, year-round prevention is carried out until the age of 21-25 (in Europe - until the age of 40).

Long-acting penicillins:

• bicillin-5 1.5 million units once every 2 weeks,
• extensillin (retarpen) 2.4 million units once every 3 weeks.

Seasonal prevention of rheumatism is carried out with the same drugs for six weeks, 2 times a year. cold season year (spring/autumn), during the outbreak respiratory diseases. In addition, after successful secondary prophylaxis, a patient with a history of rheumatism requires ongoing prophylaxis for life. It includes admission antibacterial drugs with antistreptococcal action (amoxicillin) and NSAIDs for seven days during tooth extraction, minor surgical interventions, during an outbreak infectious diseases. All patients who have suffered from rheumatism are registered with a rheumatologist.

Chapter 4 Prevention of rheumatism

Primary prevention of rheumatism

Systematic general strengthening measures are recommended: hardening the body, physical education and sports, water procedures, adherence to a work and rest regime, balanced nutrition, staying in the fresh air, refusal to bad habits(alcohol, smoking), reducing, if possible, contact with patients with streptococcal infection, timely and correct treatment of acute and chronic streptococcal infections.

Early diagnosis of streptococcal diseases is often difficult, as it is associated with the need for additional bacteriological and serological studies. It must be taken into account that the typical picture of streptococcal diseases is found in no more than a quarter of patients. In other cases, erased, sometimes asymptomatic forms are observed. On high probability The streptococcal nature of a nasopharyngeal infection is indicated by sore throat, hyperemia of the pharynx with a reaction of regional lymph nodes, leukocytosis, detection of streptococcus in a pharynx smear, streptococcal antigen in the blood, an increase in titers of streptococcal antibodies in the 2-3rd week from the onset of infection.

Due to the fact that rheumatism most often develops after an acute streptococcal infection (tonsillitis, pharyngitis, scarlet fever), its timely diagnosis and vigorous antibiotic therapy are important. Timely and correct treatment of acute respiratory viral infections with mixed infection (virus and streptococcus) is also important.

Patients with acute nasopharyngeal streptococcal infection should be isolated if possible. Treatment should be carried out with antibiotics for at least 10 days. The drug of choice is penicillin, which is administered intramuscularly 3-4 times a day. The daily dose of penicillin for adults is 1,500,000-2,000,000 units, for schoolchildren - 600,000-1,500,000 units, for children - at the rate of 20,000-30,000 units kg/weight. Another treatment method can be used: in the first 5–7 days of the disease, penicillin is used intramuscularly in the doses indicated above, and after the acute symptoms subside clinical symptoms bicillin-5 is administered intramuscularly in a single dose of 1,500,000 units. Bicillin-5 is administered to preschoolers at a dose of 750,000 units. If it is impossible to organize intramuscular administration of penicillin on an outpatient basis, tablet forms of penicillin or semi-synthetic penicillins are used. Oxacillin is prescribed for adults at 3 g/day, for schoolchildren - 2-21/2 g, for preschool children - 11/2-2 g.

Daily doses of medications are divided into 4-6 doses. The medicine is taken 30 minutes before meals. In case of intolerance to penicillin drugs, erythromycin, lincomycin, etc. are prescribed. The daily dose of erythromycin for adults is 11/2-2 g/day, for children – 30 mg/kg.

When treating streptococcal infections, along with antibiotics, it is necessary to use antirheumatic drugs - acetylsalicylic acid, analgin, brufen, etc. - for 10-14 days, and in the first 5-7 days in full, and then in half the therapeutic dose.

Discharge to work, school or kindergarten is permitted only if there is no pathology in the internal organs and if blood tests are normal. After suffering from a sore throat, the patient should be under the supervision of a general practitioner, pediatrician, and rheumatologist for a month, since the first symptoms of rheumatism usually appear during this period.

Along with the treatment of acute streptococcal infections, an important preventive measure is the treatment of chronic streptococcal infections: tonsillitis, pharyngitis, sinusitis, sinusitis.

Treatment of multiple dental caries and periodontitis should also be carried out. The method of their sanitation is determined by the attending physician together with the otolaryngologist and dentist.

In case of epidemic outbreaks of streptococcal infection (sore throat, acute pharyngitis, scarlet fever), acute respiratory viral infections or the simultaneous appearance of several cases of acute rheumatism, especially in closed groups during their formation, along with isolation and active treatment of the sick, bicillin prophylaxis is indicated for all those in contact with the sick. Bicillin-5 is administered once, 1,500,000 units. Especially carefully primary prevention it is necessary to carry out for children, adolescents and young people from families in which there are patients with rheumatism, since these individuals are more at risk from rheumatism than others.

Secondary prevention of rheumatism

Secondary prevention of rheumatism includes a set of measures aimed at preventing exacerbations, relapses and progression of the disease in people with rheumatism. Secondary prevention of rheumatism is carried out by rheumatologists, and in the absence of rheumatology offices - by local therapists under the guidance of department heads.

Due to the fact that rheumatism is a chronic disease and is prone to recurrence, a set of preventive measures must be carried out for many years. A set of measures to prevent relapses and exacerbations of rheumatism includes:

– intensive and long-term treatment of patients with primary rheumatism;

– carrying out long-term antirheumatic therapy, if possible until the manifestations of the activity of the rheumatic process are completely eliminated, in patients with chronic variants of the course (protracted, continuously relapsing, latent) with drugs of the quinoline series (delagil, rezoquin, plaquenil), indole derivatives (indomethacin, methindol), brufen ( ibuprofen), voltaren;

– timely and effective treatment of acute streptococcal infections of the nasopharynx;

– measures to combat streptococcal reinfection, including long-term bicillin prophylaxis;

– increasing the body’s resistance – general treatment and health regime, individual complexes therapeutic exercises, walks in the fresh air, balanced nutrition, hardening water treatments, use of climatic factors, etc.;

– carrying out symptomatic therapy for patients with heart defects, aimed at improving the functional ability of the heart muscle and maintaining circulatory compensation (cardiac glycosides, diuretics and drugs that improve the metabolism of the heart muscle, potassium preparations).

For secondary prevention of rheumatism, it is recommended, if possible, to carry out year-round bicillin prophylaxis, since it is much more effective than seasonal. Streptococcus strains are very sensitive to penicillin preparations, in particular bicillin, and do not form resistant forms.

Bicillin prophylaxis is prescribed:

- all patients with rheumatism in the active phase of the disease, and bicillin should be administered in the hospital, immediately after completion of the course antibacterial therapy;

– all patients with newly diagnosed rheumatic heart defects, regardless of the phase of the disease, under the age of 35 years;

- persons who have suffered a significant attack of rheumatism, regardless of the localization of the process and who did not receive bicillin immediately after discharge from the hospital.

Bicillin prophylaxis is not indicated for patients with persistent circulatory failure not associated with the activity of the rheumatic process, and for patients with a tendency to thromboembolic complications.

In the winter and especially spring months, it is advisable to combine these drugs with vitamin therapy, primarily with ascorbic acid up to 1/2-1 g/day.

For patients with chronic variants of the course of rheumatism, protracted, continuously relapsing and latent bicillin prophylaxis is carried out against the background of long-term, often many months of taking therapeutic doses of antirheumatic drugs, and for patients with severe decompensation of cardiac activity - against the background of symptomatic therapy with cardiac glycosides, diuretics, potassium preparations.

The duration of bicillin prophylaxis is determined by the characteristics of the disease:

– patients who have had primary rheumatic carditis without signs of valvular damage or chorea without obvious cardiac changes, in the absence or with carefully sanitized foci of chronic infection – 3 years in a row;

– patients who have suffered primary rheumatic carditis with the formation of heart disease – 5 years in a row;

– for patients with recurrent rheumatic carditis, regardless of the presence or absence of heart disease – regularly for at least 5 years in a row from the moment of the last exacerbation of the disease.

The issue of extending the period of bicillin prophylaxis for more than 5 years and its cancellation is decided individually.

Bicillin is administered only intramuscularly. Intravenous administration of the drug is strictly prohibited. Before prescribing and each administration of bicillin, it is necessary to collect a detailed allergic history and carefully study the patient’s medical documentation to ensure that he does not have hypersensitivity to penicillin drugs. Before prescribing bicillin, a sublingual test is performed: 100 units of bicillin (1 drop) are applied under the tongue and the patient is observed for 3 minutes. At positive test If a burning sensation and swelling of the mucous membrane appears, the remaining bicillin is removed with a swab, and the mucous membrane is washed with saline. However, even in these cases, a severe allergic reaction may develop, including anaphylactic shock.

After the injection of bicillin, the patient should be monitored medical personnel, who must know the clinical manifestations of an allergy to bicillin and emergency measures in this case, as well as have a full set of instruments and medications for the treatment of anaphylactic shock and other allergic manifestations.

Current prevention of rheumatism

In patients with rheumatism, any infectious disease should be treated before full recovery and normalization of blood counts. The cause of exacerbations and relapses of rheumatism is most often streptococcal infections - sore throat, pharyngitis, scarlet fever, as well as acute respiratory infections. viral infections and flu.

In this regard, these individuals need to promptly and vigorously carry out antibiotic therapy, regardless of bicillin prophylaxis.

In case of chronic foci of infection, especially oro-pharyngeal, their sanitation is carried out thoroughly, up to and including radical sanitation. The same measures are carried out for family members with whom the patient is in contact, especially if they have a tonsillar infection.

All surgical interventions in patients with rheumatism - tonsillectomy, tooth extraction, abortion, commissurotomy, etc. - should be performed under the protection of penicillin. So, during tonsillectomy, penicillin is administered 2-3 days before surgery and for 7-10 days after it. daily dose for adults (1,500,000–2,000,000 units). For appendectomy and commissurotomy, the dose and duration of antibiotic therapy are determined individually.

Prevention of relapses of rheumatism in the rheumatology department of the hospital

Great importance should be attached to the prevention of streptococcal reinfection in rheumatology departments of hospitals. To do this, it is necessary to carry out a set of sanitary-hygienic and anti-epidemic measures, including the identification and sanitation of sources of streptococcal infection in both patients and staff, and sanitary and preventive measures aimed at preventing the occurrence of streptococcal infections in patients in rheumatology departments. If carriers of group A streptococcus are identified and to prevent streptococcal nosocomial infection, a preventive course of penicillin therapy (1,500,000 units/day) is carried out for 10 days, and then bicillin-5 injections of 1,500,000 units are prescribed once every two to three weeks, while the patients are in the hospital. If penicillin is intolerant, other antibiotics are used wide range action for at least 10 days.

In the wards where patients with rheumatism are located, it is necessary to carry out regular quartz treatment, as well as use various air purifiers.