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"code": "I00",
"name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
"icd_name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
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3,
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"slug": "i00_revmaticheskaya_lihoradka_bez_upominaniya_o_vovlechenii_serdca",
"lead": "Нарушение здоровья, относящееся к группе острая ревматическая лихорадка",
"description": "Согласно международной классификации болезней, острая ревматическая лихорадка (ОРЛ) — системное заболевание соединительной ткани с преимущественной локализацией процесса в сердечно-сосудистой системе, развивающееся в связи с острой А-стрептококковой инфекцией у предрасположенных к нему лиц, главным образом в возрасте 7–15 лет.",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез. </p>",
"pathogenesis": "<p>В патогенезе условно выделяются два периода: </p>\r\n<p>1. Непосредственное повреждающее и токсическое действие на организм, оказываемое персистирующими стрептококками и их антигенами.</p>\r\n<p>2. Развитие иммунного воспаления в соединительной ткани организма с преимущественным вовлечением в процесс сердца и сосудов в результате запуска механизма синтезааутоантител.</p>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<p>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </p>\r\n<p>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </p>\r\n<p>малая хорея; </p>\r\n<p>ревматические узелки (подкожные узловатые уплотнения); </p>\r\n<p>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </p>\r\n<p>Малые: </p>\r\n<p>клинические: лихорадка, боли в суставах; </p>\r\n<p>лабораторно-инструментальные: </p>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца). </p>",
"treatment": "<p>Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты. <br class=\"SCXW246008330\" /> </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы ревматизма крайне полиморфны и зависят от степени остроты и активности процесса, а также вовлеченности в процесс различных органов. Типичная клиника ревматизма имеет прямую связь с перенесенной стрептококковой инфекцией (тонзиллитом, скарлатиной, фарингитом) и развивается спустя 1-2 недели после нее. Заболевание начинается остро с субфебрильной температуры (38—39 °С), слабости, утомляемости, головных болей, потливости. Одним из ранних проявлений ревматизма служат артралгии - боли в средних или крупных суставах (голеностопных, коленных, локтевых, плечевых, лучезапястных). </p>\r\n<p>При ревматизме артралгии носят множественный, симметричный и летучий (боли исчезают в одних и появляются в других суставах) характер. Отмечается припухлость, отечность, локальное покраснение и повышение температуры, резкое ограничение движений пораженных суставов. Течение ревматического полиартрита обычно доброкачественно: через несколько дней острота явлений стихает, суставы не деформируются, хотя умеренная болезненность может сохраняться в течение длительного времени. </p>\r\n<p>При ревматизме может поражаться центральная нервная система, специфическим признаком при этом служит, так называемая, ревматическая или малая хорея: появляются гиперкинезы – непроизвольные подергивания групп мышц, эмоциональная и мышечная слабость.</p>\r\n<p>Реже встречаются кожные проявления ревматизма: кольцевидная эритема (у 7–10% пациентов) и ревматические узелки. Кольцевидная эритема(аннулярная сыпь) представляет собой кольцевидные, бледно-розовые высыпания на туловище и голенях; ревматические подкожные узелки - плотные, округлые, безболезненные, малоподвижные, единичные или множественные узелки с локализацией в области средних и крупных суставов. </p>\r\n<p> </p>",
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