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},
"code": "B66.4",
"name": "Парагонимоз",
"icd_name": "Парагонимоз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"7"
],
"periodicity": 3,
"slug": "b66.4_paragonimoz",
"lead": "паразитарное заболевание из группы трематодозов, вызываемое лёгочным сосальщиком",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Парагонимоз — это хронически протекающее инфекционное заболевание, имеющее паразитарную природу. Возбудителями данного патологического процесса являются плоские гельминты, называющиеся легочными сосальщиками. </span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Парагонимоз вызывается легочными сосальщиками, включающими несколько близких видов трематод рода Paragonimus. </span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сложный цикл развития трематод проходит со сменой хозяев: основными являются человек и животные (свиньи, собаки, кошки, ондатры, выдры, крысы), первыми промежуточными служат пресноводные моллюски; дополнительными – пресноводные крабы, раки и креветки. Парагонимоз имеет фекально-оральный механизм передачи. Яйца трематод выделяются из организма основного хозяина в окружающую среду с испражнениями, реже с мокротой и дозревают в воде. Вылупившиеся личинки (мирацидии) активно внедряются в ткани моллюсков и последовательно проходят через стадии спороцисты, редии и церкарии. Церкарии способны активно или пассивно проникать в тела крабов и раков, инцистироваться в мышцах и внутренних органах, развиваясь там до инвазионных метацеркарий.</span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В патогенезе парагонимоза ведущую роль играют токсико-аллергические реакции и механическое воздействие гельминтов и их яиц на ткани. Во время миграции личинок паразитов в легкие через диафрагму и другие органы (печень, поджелудочную железу, почки) в них отмечаются кровоизлияния, а иногда и некрозы. В легких (особенно в нижних долях) помимо кровоизлияний образуются эозинофильные инфильтраты и скопления экссудата. Позднее вокруг паразитов формируются фиброзные кисты размером от 0,1 до 10 см. Они заполнены массой серо-белого, шоколадного или темно-красного цвета, содержат слизь, эозинофилы и другие лейкоциты, кристаллы Шарко-Лейдена, а также одного или нескольких паразитов. Кисты часто сообщаются с разветвлениями бронхов После гибели паразита или выхода его из кисты полость ее зарубцовывается. При нарушении стенки кисты паразиты или их яйца иногда заносятся в головной мозг, мезентериальные лимфатические узлы, предстательную железу, печень, кожу и другие органы и ткани.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В диагностике парагонимоза используются данные эпидемиологического анамнеза, клинической картины, лабораторных (общего анализа крови, микроскопии мокроты, копроовоскопии) и инструментальных исследований (рентгенографии, КТ и МРТ легких, КТ черепа, биопсии кисты, лапароскопии), результаты аллергопробы с антигенами пангонимусов. В острой стадии парагонимоз диагностируется редко, характерным признаком может служить сочетание изменений в легких с неврологической симптоматикой.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз парагонимоза подтверждается обнаружением овальных золотисто-коричневых яиц паразита в мокроте и кале больного. В первые 2-3 месяца после заражения более информативны серологические методы (ИФА), выявляющие специфические антитела к антигенам гельминта. В крови при парагонимозе определяется эозинофилия, лимфоцитоз, гипохромная анемия. На рентгенограмме легких парагонимозные кисты представлены в виде размытых кольцевидных затемнений с ровными гладкими границами в одном или нескольких легочных сегментах. При рентгенографии черепа видны кальцификаты в форме «мыльных пузырей». При лапароскопии в брюшной полости обнаруживается выпот геморрагического, фибринозного или фибринозно-гнойного характера, в котором можно выявить незрелых гельминтов.</span></p>",
"treatment": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В ранней стадии парагонимоза проводится десенсибилизирующая терапия антигистаминными препаратами, при тяжелых органных поражениях – короткий курс кортикостероидов. Специфическое лечение парагонимоза включает прием противогельминтных средств (празиквантел, битионол), принимаемых после стихания острых аллергических реакций. При поражении ЦНС лечение парагонимоза проводится только в стационаре. Применяются противосудорожные, мочегонные препараты. При хроническом парагонимозе показаны общеукрепляющие и сердечно-сосудистые средства. В случае неэффективности консервативной тактики проводится резекция легкого, удаление кист легких и мозга.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика парагонимоза в очагах сводится к исключению из пищи сырого мяса ракообразных, кипячению питьевой воды, охране водоемов от фекального загрязнения.</span></p>\r\n<p><span id=\"docs-internal-guid-0983e3c4-7fff-4080-2d36-512feb6921e6\"> </span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инкубационный период парагонимоза длится 2-3 недели, при массивной инвазии может сокращаться до нескольких дней.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В остром периоде болезни развиваются первые симптомы парагонимоза вследствие тяжелого энтерита, гепатита и доброкачественного асептического перитонита, сопровождающиеся признаками «острого живота». Затем возникают лихорадка, боли в груди, одышка, кашель с гнойной мокротой, имеющей иногда примесь крови. При физикальном и рентгенологическом исследованиях выявляются экссудативные инфильтраты, а иногда и признаки экссудативного плеврита.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Через 2-3 месяца болезнь переходит в хроническую стадию, характеризующуюся периодами ремиссий и обострений, во время которых возникают типичные симптомы парагонимоза: температура повышается до 38-40 °С, усиливаются боли в груди, головные боли, появляются одышка, кашель с выделением ржавой мокроты, в которой содержатся яйца гельминта. Нередко отмечается кровохарканье. При рентгенологическом исследовании легких определяются слабо выраженные округлые тени диаметром от 5 до 40 мм с отходящими от них радиальными линейными затемнениями. По мере формирования фиброзных кист внутри теней просматриваются светлые вакуоли с четкими и гладкими очертаниями величиной 2-4 мм.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Через 2-4 года клинические симптомы парагонимоза постепенно исчезают. После исчезновения симптомов болезни при рентгенологическом исследовании в легких обнаруживаются небольшие изолированные очаги фиброза и единичные или множественные очаги кальцификации диаметром 2-5 мм.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При интенсивной инвазии и многолетнем течении болезни может развиться пневмосклероз и синдром «легочного сердца».</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Попадание парагонимусов в ЦНС вызывает развитие симптомов менингита, повышается внутричерепное давление. Возможно развитие атрофии зрительного нерва, парезов, параличей, нарушений чувствительности, эпилепсии. На рентгенограммах головного мозга у таких больных выявляются кальцинированные округлые образования, содержащие погибших гельминтов.</span></p>",
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},
"code": "M79.3",
"name": "Панникулит неуточненный",
"icd_name": "Панникулит неуточненный",
"gender": 0,
"age_min": 20,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "m79.3_pannikulit_neutochnennyy",
"lead": "нарушение функций работы подкожной жировой клетчатки и ее замещение соединительной тканью, которое имеет воспалительный, разрушающий жировые клетки, характер",
"description": "",
"etiology": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Примерно половина случаев панникулита приходится на спонтанную (идиопатическую) форму заболевания, которая чаще встречается у женщин в возрасте от 20 до 50 лет. Остальные 50% — это случаи вторичного панникулита, развивающегося на фоне системных и кожных заболеваний, иммунологических нарушений, действия различных провоцирующих факторов (холод, некоторые медикаменты). Известно, что в основе развития панникулита лежит нарушение перекисного окисления жиров. Но, несмотря на многочисленные исследования в области этиологии и патогенеза этого заболевания, дерматология до сих пор не имеет четкого представления о механизме его возникновения.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагностику панникулита дерматолог проводит совместно с ревматологом, нефрологом и гастроэнтерологом. Пациенту назначают биохимический анализ крови и мочи, печеночные пробы, исследование панкреатических ферментов, пробу Реберга. Выявление узлов висцерального панникулита осуществляют с помощью УЗИ органов брюшной полости, УЗИ почек. поджелудочной железы и УЗИ печени. Посев крови на стерильность позволяет исключить септический характер заболевания. Для дифференцировки инфильтративного варианта панникулита от абсцесса проводят бактериологическое исследование отделяемого вскрывшегося узла.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Точный диагноз панникулита устанавливают по результатам биопсии узла. При гистологическом исследовании выявляют воспалительную инфильтрацию, некроз жировых клеток и их замещение соединительной тканью.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от его формы и течения. Для лечения узлового панникулита с хроническим течением назначают нестероидные противовоспалительные (напроксен, диклофенак) и антиоксиданты (витамин Е, аскорбиновая кислота), проводят обкалывание единичных узловых образований глюкокортикоидами. Эффективны физиопроцедуры: УВЧ, фонофорез гидрокортизона, магнитотерапия, озокерит, ультразвук, лазеротерапия.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При бляшечной и инфильтративной форме, подостром течении панникулита применяют глюкокортикостероиды (гидрокортизон, преднизолон) и цитостатики (циклофосфан, метотрексат). Для улучшения функции печени целесообразно назначение гепатопротекторов. Лечение вторичных форм панникулита обязательно включает терапию фонового заболевания: панкреатита, СКВ, васкулита, подагры.</span></p>",
"prevention": "",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основным проявлением спонтанного панникулита являются узловые образования, расположенные в подкожно-жировой клетчатке на различной глубине. Чаще всего они появляются на ногах и руках, реже — в области живота, груди или на лице. После разрешения узлов панникулита остаются очаги атрофии жировой клетчатки, которые выглядят как округлые участки западения кожи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Узловой вариант панникулита характеризуется появлением в подкожной клетчатке типичных отдельно расположенных узлов размером от 3-4 мм до 5 см. Кожа над узлами может иметь окраску от обычной до ярко-розовой.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Бляшечный вариант панникулита представляет собой отдельные скопления узлов, которые, срастаясь, образуют бугристые конгломераты. Цвет кожи над такими образованиями бывает розовый, бардовый или бардово-синюшний. В некоторых случаях конгломераты узлов распространяются на всю </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">клетчатку голени, плеча или бедра, сдавливая при этом сосудистые и нервные пучки, что обуславливает выраженную болезненность и отек конечности, приводит к лимфостазу.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфильтративный вариант панникулита протекает с расплавлением узлов или их конгломератов. При этом в области узла или бляшки, как правило, ярко красного или бардового оттенка, появляется флюктуация, типичная для абсцесса или флегмоны. Однако при вскрытии узлов из них выходит не гной, а маслянистая масса желтого цвета. На месте вскрывшегося узла образуется длительно не заживающее изъязвление.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Смешанный вариант панникулита — встречается редко и представляет собой переход узловой формы в бляшечную, а затем в инфильтративную.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Изменения со стороны подкожной жировой клетчатки в случае спонтанного панникулита могут не сопровождаться нарушением общего состояния пациента. Но чаще в начале заболевания наблюдается симптоматика, схожая с проявлениями острых инфекций (ОРВИ, гриппа, кори, краснухи и др): головная боль, общая слабость, повышение температуры, артралгии, боли в мышцах, тошнота.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Висцеральная форма панникулита характеризуется системным поражением жировых клеток по всему организму с развитием панкреатита, гепатита, нефрита, образованием характерных узлов в забрюшинной клетчатке и сальнике.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По своему течению панникулит может быть острым, подострым и рецидивирующим, длиться от 2-3 недель до нескольких лет. Острая форма панникулита характеризуется выраженным изменением общего состояния с высокой температурой, миалгиями, болями в суставах, нарушением функции почек и печени. Несмотря на проводимое лечение, состояние пациента прогрессивно ухудшается, изредка бывают непродолжительные ремиссии, но в течение года заболевание заканчивается летальным исходом.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Подострое течение панникулита более сглаженное. Для него типично нарушение общего состояния, лихорадка, изменения функциональных проб печени, резистентность к проводимому лечению. Наиболее благоприятно рецидивирующее или хроническое течение панникулита. 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"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Панкреатическая стеаторея - это синдром, развивающийся при выделении с калом более 7 г нейтрального жира за сутки из каждых 100 г, принятых с пищей.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Различают патологические варианты синдрома и физиологическую алиментарную форму стеатореи, спровоцированную перееданием жирной пищи. При пищевых причинах расстройства пищеварения появление специфических симптомов обусловлено относительной недостаточностью панкреатических ферментов, которые не успевают расщепить большие количества жира. Намного чаще встречаются патологические формы ПС, в развитии которых играют роль 4 основные причины:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Уменьшение объема панкреатической паренхимы. Главный этиологический фактор стеатореи у взрослых — панкреатиты различного генеза. При хроническом воспалении ткань поджелудочной железы (ПЖ), секретирующая панкреатические ферменты, постепенно подвергается склерозу и фиброзу. Вторая по распространенности причина — сахарный диабет с образованием антител к клеткам ПЖ.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение оттока панкреатического секрета. Такое состояние связано с недостаточностью гормональных веществ, которые стимулируют выделение пищеварительных ферментов в тонкую кишку. Характерно для энтеропатий, болезни Крона, синдрома короткого кишечника. Реже наблюдаются механические препятствия — опухоли или кисты.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диссинхрония пищеварительного процесса. У больных нарушается согласованная эвакуация содержимого желудка и выделение панкреатических ферментов. Наиболее часто диссинхрония возникает в послеоперационном периоде: в 30-50% - при стволовой ваготомии с пилоропластикой, в 50-70% - при ваготомии с антрумэктомией.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врожденные аномалии. Недостаточность внешнесекреторной функции бывает связана с гипоплазией или дисплазией панкреатической железы. Очень редкая причина заболевания — изолированный генетически обусловленный дефицит синтеза панкреатической липазы. Такие формы болезни встречаются у детей и молодых людей.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В норме при попадании кислого химуса желудка в двенадцатиперстную кишку начинают выделяться активные вещества, стимулирующие продукцию панкреатических энзимов. За расщепление жиров отвечает липаза. Сначала жиры эмульгируются под действием желчи, а затем крупные молекулы распадаются до глицерина и жирных кислот. Низкомолекулярные вещества быстро всасываются в кровь.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При панкреатической стеаторее жиры не расщепляются и не могут абсорбироваться в кишечнике, поэтому они выводятся из организма вместе с калом. Непереваренные жиры гидролизуются бактериями толстой кишки и усиливают активность секреторной функции колоноцитов. Выраженные клинические признаки развиваются, если функционирует не более 10% клеток поджелудочной железы.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Первичный метод исследования, рекомендованный при подозрении на панкреатическую недостаточность — копрограмма. В анализе обнаруживают мелкие капли жира, мышечные волокна и другие непереваренные пищевые фрагменты. Такие данные позволяют установить предварительный диагноз стеатореи, после чего врач-гастроэнтеролог назначает детальное обследование больного. Основные методы диагностики:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Зондовые тесты. Наиболее надежным для установления внешнесекреторной панкреатической недостаточности является секретин-панкреозиминовый тест. О патологии свидетельствует снижение уровня липазы в панкреатическом соке после внутривенного введения стимулирующих гормоноподобных веществ. Реже выполняется пищевая проба Лунда.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Беззондовые тесты. Для выявления хронического панкреатита как основной причины стеатореи измеряется концентрация фекальной эластазы в кале. Для установления количества липидов, которые содержатся в каловых массах, используется метод Ван де Камера — диагноз подтверждается при выделении ежесуточно более 5 г жира.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ поджелудочной железы. Ультразвуковой метод применяется для визуализации очагов воспаления или фиброза в паренхиме поджелудочной железы. С помощью эхографии исследуют печень, желчный пузырь и протоки, чтобы исключить билиарные причины стеатореи. При недостаточной информативности сонографии производится КТ органов брюшной полости.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Радиоизотопные методы. Применяют для топической диагностики нарушения переваривания и всасывания жиров. В организм человека вводят меченые липиды, количество которых через определенный промежуток времени измеряется в кале, крови и моче. Для заболевания характерно повышение уровня радиоактивных изотопов в каловых массах.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение стеатореи начинают с подбора специальной диеты. Чтобы улучшить пищеварение, требуется ограничение количества жиров до 40-60 г в день, а при тяжелой секреторной недостаточности — до 30 г. Рекомендуется частое дробное питание, которое предполагает 5 приемов пищи с интервалами 2,5-3 часа. Диетотерапия дополняется медикаментозным лечением, которое включает ряд препаратов:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ферменты. Заместительная терапия проводится при стойких диспепсических жалобах или при потере с испражнениями более 15 г жиров в сутки. Для компенсации пищеварения принимается липаза, при необходимости схему лечения усиливают другими панкреатическими ферментами.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Витамины. Используются при тяжелых гиповитаминозах с клиническими проявлениями. Чаще всего назначается комплекс жирорастворимых витаминов: А, Д, Е. При наличии анемии эффективны цианокобаламин и фолиевая кислота.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вспомогательные лекарства. Препараты желудочного сока показаны при сопутствующих гипоацидных гастритах, которые сопровождаются диссинхронией процессов пищеварения. Для улучшения работы ЖКТ применяют кишечные антисептики и пробиотики.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактические мероприятия включают раннее выявление и лечение гастроэнтерологических болезней, диспансерное наблюдение за страдающими панкреатической стеатореей для предотвращения осложнений.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные признаки ПС — обильный стул (полифекалия) и «жирный» кал. Испражнения приобретают оранжевый или желтоватый цвет, имеют зловонный запах. Характерен сальный блеск кала и трудно смываемые следы на стенках унитаза. Частота дефекации увеличивается до 3-4 раз в течение суток, при этом каждый раз выделяется довольно большая порция кала. Иногда в выделяемых каловых массах можно увидеть непереваренные фрагменты пищи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обострение панкреатической стеатореи наступает после употребления пищи с большим количеством животных жиров. Пациенты жалуются на спастические боли без четкой локализации, урчание в животе. Определяется сильное вздутие живота. Частота стула иногда возрастает до 5-6 раз за сутки. После дефекации урчание и дискомфорт в животе уменьшаются, но полностью не исчезают.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие клинические симптомы присоединяются позже. Они связаны с дефицитом микро- и макронутриентов. Вследствие нехватки железа развиваются глосситы, истончаются и деформируются ногтевые пластины. Дефицит кальция проявляется судорогами икроножных мышц, болями в костях и суставах. Гиповитаминоз жирорастворимого витамина А вызывает ухудшение сумеречного зрения, чрезмерное утолщение и огрубение кожи.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При длительной декомпенсированной панкреатической стеаторее происходит потеря веса вплоть до кахексии. В связи с нехваткой липидов нарушается синтез половых гормонов. У женщин сбои гормонального фона приводят к задержке менструаций или аменорее, у мужчин — к снижению полового влечения, импотенции. При дефиците витамина Е беспокоит слабость в мышцах.</span></p>",
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"name": "Палиндромный ревматизм",
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"lead": "заболевание, характеризующееся короткими приступами артрита, возникающего через нерегулярные промежутки времени и претерпевающего полное обратное развитие после окончания приступа",
"description": "<p><span id=\"docs-internal-guid-29c4ddb7-7fff-dfd2-2bc5-ac1359fdd42b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Палиндромный ревматизм </span></span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">представляет собой редкую доброкачественную форму поражения суставов и периартикулярных тканей, проявляющуюся рецидивирующим через нерегулярные промежутки времени ярко выраженным, но полностью обратимым моноартритом, гораздо реже – олигоартритом.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\"> </span></p>",
"etiology": "<p><span id=\"docs-internal-guid-d4099a1a-7fff-2fa5-92e9-b2cbeec9fbd4\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Врачи установили, что в основе заболевания лежит неспецифический преходящий воспалительный процесс, который развивается в суставной сумке и околосуставных тканях. Но факторы, которые провоцируют повторение приступов, остаются невыясненными. Врачам не удалось установить какие-либо закономерности даже в результате сбора анамнеза и тщательных опросов тысяч пациентов.</span></span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патогенез палиндромного ревматизма не установлен. Патологоанатомической основой поражения синовиальной оболочки и периартикулярных тканей является их неспецифическое воспаление.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Устанавливая диагноз палиндромного ревматизма, ревматолог в первую очередь полагается на типичную клиническую картину заболевания с внезапным возникновением и быстрым разрешением приступов, миграцией поражения от одного сустава к другому и отсутствием каких-либо проявлений в период между атаками. Клинические исследования крови и синовиальной жидкости, обследования пораженного сустава не дают специфических данных. С другой стороны, само отсутствие в них патологических изменений свидетельствует в пользу диагноза палиндромного ревматизма.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В приступный период палиндромного ревматизма в анализе крови возможно умеренное повышение СОЭ, выявление низкого титра РФ. Ускорение СОЭ сохраняющееся в период между приступами может быть признаком развития ревматоидного артрита. Биопсия синовиальной оболочки пораженного сустава в период атаки палиндромного ревматизма выявляет неспецифические воспалительные изменения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При проведении рентгенографии и УЗИ суставов у пациентов с палиндромным ревматизмом не обнаруживают никаких патологических отклонений. В некоторых случаях на рентгенограмме отмечается увеличение тени околосуставных тканей, обусловленное их выраженной отечностью в период приступа.</span></p>",
"treatment": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Терапия пациентов в период атаки палиндромного ревматизма проводится нестероидными противовоспалительными средствами (ибупрофен, диклофенак, нимесулид и др.). Они эффективно облегчают острую симптоматику заболевания, но не препятствуют возникновению новых атак. В лечении палиндромного ревматизма также применяют инъекции солей золота, пeницилламин, сульфасалазин, колхицин, противомалярийные средства.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врачи рекомендуют всем без исключения избегать чрезмерных нагрузок на суставы, переохлаждений организма, а также советуют стараться исключить из жизни травмоопасные ситуации, поддерживать иммунитет на должном уровне, правильно питаться и не злоупотреблять алкогольными напитками.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для заболевания характерно внезапное и острое начало, которое чаще всего возникает во второй половине дня. Заболевание характеризуется развитием быстропрогрессирующего воспалительного поражения, проявляющегося покраснением, припухлостью, повышением местной температуры и появлением болезненности в области пораженного сустава. Патологические признаки в течение нескольких часов нарастают и могут достигать своей максимальной выраженности. Болевой синдром у различных больных варьируется от слабо выраженного до интенсивного и мучительного. На высоте приступа отмечается некоторое ограничение подвижности в суставе, обусловленное его отечностью и болезненностью.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В период атаки заболевания вместе с симптомами артрита отмечается воспалительное изменение периартикулярных тканей, характеризующееся появлением болезненности и припухлости сухожилий в области их крепления к суставу, помимо этого в околосуставной области образуется плотный отек, а также отечность подушечек пальцев и пяток. Примерно в трети всех случаев палиндромного ревматизма отмечается появление подкожных ревматических узелков небольшого размера, которые располагаются по ходу сухожилий на кистях и стопах, а также в области ладонного апоневроза и на разгибательной поверхности предплечий.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пароксизмы заболевания, как правило, протекает с вовлечением в патологический процесс одного, реже — двух суставов. Чаще всего обнаруживается поражение коленного сустава. Возможны воспалительные изменения плечевых, лучезапястных, голеностопных, пястных, проксимальных межфаланговых, височно-нижнечелюстных суставов, а также суставов стопы, шейного отдела позвоночника. Характерным признаком заболевания является миграция воспаления от одного сустава к другому при каждой новой атаке.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Длительность атаки палиндромного ревматизма может варьироваться от нескольких часов, до 3 и более дней. Максимальная зафиксированная длительность атаки – 7 дней. Межприступовый период может занимать от нескольких дней до 3 месяцев. Во время приступа у больного не отмечается появления общих клинических проявлений, таких как лихорадка, недомогание, озноб. Появление общей симптоматики, утренней скованности пораженного сустава либо повторного воспаления одного и того же сустава при последующих атаках свидетельствует о перерождении палиндромного ревматизма в ревматоидный артрит.</span></p>",
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