Prevention of rheumatism

Description:

The preventive actions directed to the prevention of rheumatic defeats of cardiovascular system can be divided on primary and secondary. Primary prevention includes as the measures directed to increase in protective properties of an organism, and an action of the general sanitary and hygienic character.

According to A. I. Nesterov (1964), at primary prevention of rheumatism four organizational and preventive tasks have to be solved: achievement of high level of natural immunity of the population, first of all at children and youth; elimination or decrease in danger of a streptococcal infection by implementation of sanitary and hygienic actions, identifications and treatments of carriers of a streptococcal infection; the organization and performing the planned qualified treatment of already developed streptococcal infection with the allergic reactivity accompanying it; planned performing antistreptococcal and antiallergic prevention.

For the solution of problems of primary prevention of rheumatism it is necessary to carry out:

  1. complex surveys by doctors of various specialties of big collectives for identification of carriers of a streptococcal infection among them or the persons suffering from persistent focal infection with allergic reactivity;
  2. careful inspection of these persons with use of modern biochemical and immunological methods of a research (determination of quantity of leukocytes, a caption of streptococcal antibodies, first of all antistreptolysin-O, etc.);
  3. sanitation of the centers of an infection;
  4. capture of these persons on the dispensary account for planned treatment and observation.

Treatment of acute streptococcal diseases at rheumatism.

Special attention needs to be paid to treatment of the centers of a streptococcal infection.

Treatment of acute streptococcal diseases has to be carried out by antibiotics within 10 days. It is the most reasonable to enter penicillin in a dose of 1200000 PIECES a day for adults (200000 PIECES intramusculary 6 times a day) within 5-7 days. In the subsequent one is recommended - or double introduction of Bicillinum-3 or Bicillinum-1 in a dose of 600000 PIECES of 1 times in 5-7 days.

It is not recommended to apply streptocides and antibiotics like tetracycline as there are convincing data on resistance of a streptococcus to them.

If antibiotics cannot be entered intramusculary, then at treatment of acute streptococcal infections it is possible to appoint them inside within 10 days (phenoxymethylpenicillin — 1000000-1500000 PIECES, erythromycin — 1000000-1500000 PIECES a day). At the same time it is necessary to pay attention to a reception regularity.

After treatment of the patient with an acute streptococcal infection it has to be carefully inspected and can be written out for work only in the absence of symptoms of a disease. It is necessary to consider that in the absence of changes from blood credits of streptococcal antibodies can be raised. In this case they point to the postponed streptococcal infection, but not to an acute disease.

Persons with the centers of a persistent streptococcal infection (tonsillitis, sinusitis, pharyngitis, carious teeth, cholecystitis, a cholangitis and other inflammatory centers) are subject to careful treatment. The method of sanitation of these centers decides by the attending physician (therapist) jointly on specialists (the otolaryngologist, the stomatologist, the gynecologist).

Especially it is necessary to pay attention to the persons threatened on rheumatism i.e. persons at whom along with the centers of a persistent streptococcal infection the constant or periodic subfebrile temperature, arthralgias, increased fatigue, functional changes from cardiovascular system is observed. This patient along with active sanitation of the centers of an infection carries out seasonal bitsillino-medicamentous prevention within 2 - 3 years.

Secondary prevention is carried out by the patient who had rheumatism for the purpose of the prevention of a recurrence in the conditions of dispensary observation.

Dispensary account.

All persons who had rheumatism irrespective of existence of heart disease, undertake on the dispensary account with obligatory inspection 2 times a year (in months, the most dangerous to development of a recurrence, usually in spring and autumn months). At the same time much attention is paid to identification is hidden - or slow forms of rheumatic process which, as a rule, are not shown clinically. For the purpose of identification of such forms in out-patient conditions (in cardiorheumatological offices) the complex of modern biochemical and immunological researches is conducted. At identification of active rheumatic process by the patient, depending on character of a course of a disease, working conditions, antirheumatic treatment in the conditions of a hospital is carried out or it is out-patient.

Bitsillino-medikamentoznaya prevention.

Now all patient who transferred active rheumatic process in the next 5 years carries out bitsillino-medicamentous prevention, irrespective of age and existence of heart disease (more than 5 years preventive treatment is carried out by the patient with prescription of the postponed active rheumatism according to individual indications).

Distinguish year-round, seasonal and current prevention of rheumatism.

Year-round bitsillino-medicamentous prevention — is performed with the help бицилли - on - 5 or Bicillinum-1 (Bicillinum-3 is not applied to year-round prevention).

To adults and children of school age Bicillinum-5 is entered intramusculary in a dose of 1500000 PIECES of 1 times in 4 weeks, to children of preschool age — 1 time in 2-3 weeks in a dose of 750000 PIECES. Bicillinum-1 is entered intramusculary to children of school age and adults in a dose of 1200000 PIECES of 1 times in 3 weeks, to preschool children — 1 time in 2 weeks in a dose of 600000 PIECES.

Besides, 2 times a year (in the spring and in the fall) within 1-1,5 months conduct courses of antirecurrent treatment by drugs of salicylic acid (acetylsalicylic acid — 0,5 g 3 times a day; pyramidon — 0,5 g 2-3 times a day; analginum — 0,5 g 3 times a day). Bitsillino-medikamentoznuyu prevention is combined with purpose of vitamins, especially ascorbic acid, and other drugs of fortifying action.

Seasonal Bicillinum - medicamentous prevention is carried out in cold, autumn and spring months of year (for a midland October - November and March - April). Bicillinum-5 is entered intramusculary: to adults and school students in a dose of 1 500 000 PIECES of 1 times in 4 weeks (2 injections on a course).

Along with Bicillinum injections within 1,5 months carry out treatment by antirheumatic drugs in the doses stated above in combination with polyvitamins.

The current prevention of rheumatism is carried out to the persons threatened on rheumatism and all sick rheumatism at acute respiratory diseases, quinsy, an aggravation of an adenoid disease, irrespective of the received bitsillino-prevention, within 10 days.

The current prevention is carried out by sick rheumatism at operative measures (appendectomy, a cholecystectomia, a tonsilectomy, abortion, etc.) as in the presurgical, and postoperative period. At the same time appoint penicillin intramusculary (the adult in a dose of 1500000 PIECES a day), and also antirheumatic drugs.

When performing bitsillino-medikamentoziy prevention it is necessary to remember a possibility of allergic reactions, up to an acute anaphylaxis. Therefore before purpose of Bicillinum patients of drugs of penicillin need to specify portability in the past, to carry out tests on portability (skin or intradermal). At emergence of allergic reactions the massive desensibilizing therapy is carried out (glucocorticoids, Dimedrol, Pipolphenum, Suprastinum, etc.).

To the children and adults who transferred primary rheumatic carditis with a subacute or acute current without formation of defect or a chorea without explicit changes of heart with the debrided centers of a streptococcal infection or at their absence within the first 3 years year-round bitsillino-medicamentous prevention, in the next 2 years — seasonal is carried out.

And also with existence of the centers of a persistent streptococcal infection, in the next 5 years year-round bitsillino-medicamentous prevention is shown to persons (adults and children) who transferred primary rheumatic carditis with symptoms of heart disease, to a trochee with a long sluggish current, a returnable rheumatic carditis with defect or without it. The issue of prevention continuation is resolved over 5 years individually depending on a condition of the patient and character of a course of rheumatic process.

Long continuous (year-round) bitsillino-medicamentous prevention which term depends on the nature of rheumatic process at each patient has to be carried out by the patient who transferred a mitral commissurotomy.

An important role in a complex of preventive actions is played by questions of the correct and rational employment of patients with rheumatism. So, irrespective of existence or absence of heart disease, night shifts, watches, long stay on drafts, sharp fluctuations of temperature during the working day are contraindicated to the persons who had rheumatism. Issues of employment have to be resolved jointly by the attending physician, VKK of policlinic and the trade-union organization of the enterprise.

When determining indications to sanatorium treatment it is necessary to consider not only organic changes of a cardiac muscle, heart valves, but, first of all, function of the last, a blood circulation disturbance stage, and also a functional condition of the central nervous system.