medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2016-9-96-101medsovet-1391Research ArticleРЕВМАТОЛОГИЯRHEUMATOLOGYОстрая ревматическая лихорадка в XXI веке. Проблемы и поиск решенийACUTE RHEUMATIC FEVER IN THE XXI CENTURY: PROBLEMS AND SEARCH FOR SOLUTIONSБЕЛОВБ. С.BELOVB. S.

д.м.н.

MD

КУЗЬМИНАН. Н.KUZMINAN. N.

д.м.н., профессор

MD, Prof.

МЕДЫНЦЕВАЛ. Г.MEDYNTSEVAL. G.

к.м.н.

PhD in medicine

Научно-исследовательский институт ревматологии им. В.А. Насоновой, МоскваРоссияResearch Institute of Rheumatology named after V.A. Nasonova, MoscowRussian Federation2016301220160996101Copyright © БЕЛОВ Б.С., КУЗЬМИНА Н.Н., МЕДЫНЦЕВА Л.Г., 20162016БЕЛОВ Б.С., КУЗЬМИНА Н.Н., МЕДЫНЦЕВА Л.Г.BELOV B.S., KUZMINA N.N., MEDYNTSEVA L.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1391

Проблема острой ревматической лихорадки (ОРЛ) по-прежнему сохраняет свою актуальность. «Глобальное бремя» ОРЛ среди детей 5–14 лет насчитывает 336 тыс. новых случаев ежегодно. Ведущим синдромом ОРЛ является кардит, который определяет тяжесть течения и исход заболевания. Поражение сердца по типу изолированного миокардита при отсутствии вальвулита рассматривается как нехарактерное для ОРЛ. Следует иметь в виду возможность развития постстрептококкового неревматического миокардита. Не менее важной остается проблема неврологических нарушений при ОРЛ, включая синдром PANDAS. Анализ новых (2015) диагностических критериев Джонса показывает, что их применение на территории РФ проблематично вследствие больших межрегиональных различий по частоте ОРЛ. Внесение изменений в существующую Российскую классификацию и номенклатуру ОРЛ представляется преждевременным. Основу качественной первичной профилактики ОРЛ порежнему составляет своевременная диагностика и адекватная антимикробная терапии БГСА- тонзиллита/фарингита.

Acute rheumatic fever (ARF) remains a healthcare challenge. The global burden of ARF in children aged 5–14 years totals 336 thousand of new cases annually. The main symptom of ARF is carditis which determines the severity and outcome of the disease. Heart involvement in the form of isolated myocarditis without valvulitis is not regarded as typical of rheumatic fever. It should be borne in mind that post-streptococcal rheumatic myocarditis may also develop. No less important is the problem of neurological disorders in ARF including PANDAS syndrome. Analysis of the updated (2015) diagnostic Jones criteria showed that their application in Russia is problematic due to large inter-regional differences in the frequency of ARF. Amendments to the existing Russian classification and nomenclature of ARF seem untimely. Adequate primary prevention of rheumatic fever is still based on timely diagnosis and rational antimicrobial therapy of GABHS - tonsillitis/pharyngitis.

острая ревматическая лихорадкахроническая ревматическая болезнь сердцадиагностикадиагностические критерииА-стрептококковая инфекция глоткилечениепрофилактикаacute rheumatic feverchronic rheumatic heart diseasediagnosisdiagnostic criteriagroup A streptococcal infectiontreatmentpreventionReferencesOmurzakova NA, Yamano Y, Saatova GM, et al. Rheumatologic services in Central Asian countries: current state of development of rheumatology in Central Asia. Int J Rheum Dis, 2009, 12(4): 288-92.Omurzakova NA, Yamano Y, Saatova GM, et al. Rheumatologic services in Central Asian countries: current state of development of rheumatology in Central Asia. Int J Rheum Dis, 2009, 12(4): 288-92.Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet, 2005, 366(9480): 155-68.Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet, 2005, 366(9480): 155-68.Kumar RK, Tandon R. Rheumatic fever& rheumatic heart disease: the last 50 years. Indian J Med Res, 2013 Apr, 137(4): 643-58.Kumar RK, Tandon R. Rheumatic fever& rheumatic heart disease: the last 50 years. Indian J Med Res, 2013 Apr, 137(4): 643-58.Заболеваемость населения России в 2014 г. Статистические материалы. М., 2015. / Zabolevaemost’ naseleniyaRossii v 2014 g. Statisticheskie materialy. M., 2015.Заболеваемость населения России в 2014 г. Статистические материалы. М., 2015. / Zabolevaemost’ naseleniyaRossii v 2014 g. Statisticheskie materialy. M., 2015.Tandon R. Rheumatic fever pathogenesis: Approach in research needs change. Ann Pediatr Cardiol, 2012, 5(2): 169-78.Tandon R. Rheumatic fever pathogenesis: Approach in research needs change. Ann Pediatr Cardiol, 2012, 5(2): 169-78.deOliveira SK, Pelajo CF. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS): a Controversial Diagnosis. Curr Infect Dis Rep, 2010, 12(2): 103-9.deOliveira SK, Pelajo CF. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS): a Controversial Diagnosis. Curr Infect Dis Rep, 2010, 12(2): 103-9.Esposito S, Bianchini S, Baggi E et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. Eur J Clin Microbiol Infect Dis, 2014, 33(12): 2105-9.Esposito S, Bianchini S, Baggi E et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: an overview. Eur J Clin Microbiol Infect Dis, 2014, 33(12): 2105-9.Macerollo A, Martino D. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): An Evolving Concept. Tremor Other Hyperkinet Mov (NY), 2013 Sep 25, 3.Macerollo A, Martino D. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): An Evolving Concept. Tremor Other Hyperkinet Mov (NY), 2013 Sep 25, 3.Gewitz MH, Baltimore RS, Tani LY et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation, 2015, 131(20): 1806-18.Gewitz MH, Baltimore RS, Tani LY et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation, 2015, 131(20): 1806-18.Белов Б.С., Кузьмина Н.Н., Медынцева Л.Г. и др. К проблеме диагностики острой ревматической лихорадки на современном этапе. Научно-практическая ревматология, 2016, 3: 340-344. / Belov B.S., Kuzmina N.N., Medyntseva L.G. et al. The problem of diagnosis of acute rheumatic fever at the present stage. Nauchno-Prakticheskaya Revmatologiya, 2016, 3: 340-344.Белов Б.С., Кузьмина Н.Н., Медынцева Л.Г. и др. К проблеме диагностики острой ревматической лихорадки на современном этапе. Научно-практическая ревматология, 2016, 3: 340-344. / Belov B.S., Kuzmina N.N., Medyntseva L.G. et al. The problem of diagnosis of acute rheumatic fever at the present stage. Nauchno-Prakticheskaya Revmatologiya, 2016, 3: 340-344.Насонова В.А., Кузьмина Н.Н., Белов Б.С. Классификация и номенклатура ревматической лихорадки. Научно-практическая ревматология, 2004, 2: 48-52. / Nasonova V.A., Kuzmina N.N., Belov B.S. Classification and nomenclature of rheumatic fever. Nauchno-Prakticheskaya Revmatologiya, 2004, 2: 48-52.Насонова В.А., Кузьмина Н.Н., Белов Б.С. Классификация и номенклатура ревматической лихорадки. Научно-практическая ревматология, 2004, 2: 48-52. / Nasonova V.A., Kuzmina N.N., Belov B.S. Classification and nomenclature of rheumatic fever. Nauchno-Prakticheskaya Revmatologiya, 2004, 2: 48-52.Gerber MA, Baltimore RS, Eaton CB et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation, 2009, 119(11): 1541-51.Gerber MA, Baltimore RS, Eaton CB et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation, 2009, 119(11): 1541-51.Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis, 2012, 55(10): e86-102.Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis, 2012, 55(10): e86-102.Logan LK, McAuley JB, Shulman ST. Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic fever. Pediatrics, 2012, 129(3): e798-802.Logan LK, McAuley JB, Shulman ST. Macrolide treatment failure in streptococcal pharyngitis resulting in acute rheumatic fever. Pediatrics, 2012, 129(3): e798-802.Насонова В.А., Белов Б.С., Страчунский Л.С., и др. Антибактериальная терапия стрептококкового тонзиллита и фарингита. Клин. микробиол. антимикроб. тер., 1999, 1: 78-82. / Nasonova V.A., Belov B.S., Strachunsky L.S. et al. Antibiotic treatment of streptococcal tonsillitis and pharyngitis. Klin. Mikrobiol. i Antimikrob. Khemoterapiya, 1999, 1: 78-82.Насонова В.А., Белов Б.С., Страчунский Л.С., и др. Антибактериальная терапия стрептококкового тонзиллита и фарингита. Клин. микробиол. антимикроб. тер., 1999, 1: 78-82. / Nasonova V.A., Belov B.S., Strachunsky L.S. et al. Antibiotic treatment of streptococcal tonsillitis and pharyngitis. Klin. Mikrobiol. i Antimikrob. Khemoterapiya, 1999, 1: 78-82.De Holanda E Silva KG, Barratt G, De Oliveira AG, Do Egito ES. Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments. Expert Opin Drug Deliv, 2012, 9(9): 1099-110.De Holanda E Silva KG, Barratt G, De Oliveira AG, Do Egito ES. Trends in rheumatic fever: clinical aspects and perspectives in prophylactic treatments. Expert Opin Drug Deliv, 2012, 9(9): 1099-110.Gerber MA, Brown HW, Lee G, et al. Physicians’ opinions about critical attributes of a potential group A streptococcal vaccine. Vaccine, 2010, 28(44): 7155-60.Gerber MA, Brown HW, Lee G, et al. Physicians’ opinions about critical attributes of a potential group A streptococcal vaccine. Vaccine, 2010, 28(44): 7155-60.Tandon R. Preventing rheumatic fever: M-protein based vaccine. Indian Heart J, 2014, 66(1): 64-7.Tandon R. Preventing rheumatic fever: M-protein based vaccine. Indian Heart J, 2014, 66(1): 64-7.

The authors declare that there are no conflicts of interest present.