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REUMATISMUL ARTICULAR ACUT (RAA)REUMATISMUL ARTICULAR ACUT (RAA)

DefniieDefniie este o boal inamatorie, consecina ineciei c! stre"tococeste o boal inamatorie, consecina ineciei c! stre"tococ#r!" A cantonat la ni$el!l arin#el!i%#r!" A cantonat la ni$el!l arin#el!i%

este o mo&alitate "artic!lar &e rs"!ns a or#anism!l!i laeste o mo&alitate "artic!lar &e rs"!ns a or#anism!l!i laa#resi!nea stre"tococic%a#resi!nea stre"tococic%

E"i&emiolo#ieE"i&emiolo#ie RAA este o boal a co"ilriei ('ntre *+ ani)RAA este o boal a co"ilriei ('ntre *+ ani) rar s!b ani -i "este ./ anirar s!b ani -i "este ./ ani nein!enat &e se0nein!enat &e se0 &eterminat &e cantonarea stre"tococ!l!i la ni$el!l arin#el!&eterminat &e cantonarea stre"tococ!l!i la ni$el!l arin#el!

-i n! &e inecia c!tanat-i n! &e inecia c!tanat actori a$ori1ani2 1ona #eo#rafc, !me1eala, con&iiileactori a$ori1ani2 1ona #eo#rafc, !me1eala, con&iiile

socioeconomice, colecti$itisocioeconomice, colecti$iti

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ClinicClinic

Sta&i!l "ro&romalSta&i!l "ro&romal a"are an#ina stre"tococic eritematoas sa!a"are an#ina stre"tococic eritematoas sa!

eritemato"!ltaceeeritemato"!ltacee se maniest clinic c!2 &isa#ie, a&eno"atiese maniest clinic c!2 &isa#ie, a&eno"atie

re#ional, ebrre#ional, ebr

Sta&i!l &e latenSta&i!l &e laten &!rea1 3* 1ile&!rea1 3* 1ile

este asim"tomaticeste asim"tomatic

"ot e0ista semne minore2 s!bebrilitate,"ot e0ista semne minore2 s!bebrilitate,ina"aten, astenie f1ic, e"ista0isina"aten, astenie f1ic, e"ista0is

Sta&i!l clinic maniestSta&i!l clinic maniest a"ar2 a"ar2

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manifestri generalemanifestri generale

ebra &!rea1 s"tm4ni sa! l!niebra &!rea1 s"tm4ni sa! l!ni .5/ 6C.5/ 6C

"re1int ascensi!ni le#ate &e interesrile artic!lare"re1int ascensi!ni le#ate &e interesrile artic!lare cre-terile tem"erat!rii 'n aara "rin&erilor artic!larecre-terile tem"erat!rii 'n aara "rin&erilor artic!lare

"!n "roblema $iscerali1rii (interesare car&iac)"!n "roblema $iscerali1rii (interesare car&iac) "!ls!l"!ls!l

este concor&ant c! ebraeste concor&ant c! ebra

ta7icar&ia "ersistent sa! e0a#erat, &!"ta7icar&ia "ersistent sa! e0a#erat, &!"normali1area tem"erat!rii semnifc interesareanormali1area tem"erat!rii semnifc interesareamiocar&icmiocar&ic

bra&icar&ia semnifc interesarea es!t!l!i &ebra&icar&ia semnifc interesarea es!t!l!i &econ&!cerecon&!cere

trans"iraiile s!nt2trans"iraiile s!nt2

"ro!1e, miros 'ne"tor, acr!, noct!rne -i e"!i1ea1"ro!1e, miros 'ne"tor, acr!, noct!rne -i e"!i1ea1bolna$!l "rin t!lb!rrile 7i&roelectroliticebolna$!l "rin t!lb!rrile 7i&roelectrolitice

risoanele, cealeea, ameelilerisoanele, cealeea, ameelile

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manifestri articularemanifestri articulare

RAA interesea1 artic!laiile mariRAA interesea1 artic!laiile mari a! caracter !#ace, mi#rator, saltanta! caracter !#ace, mi#rator, saltant "re1int caracterele inamaiei ac!te"re1int caracterele inamaiei ac!te n! las sec7elen! las sec7ele "!se!l artic!lar &!rea1 . s"tm4ni"!se!l artic!lar &!rea1 . s"tm4ni

&!rata enomenelor inamatorii la o artic!laie este&!rata enomenelor inamatorii la o artic!laie estesc!rt, &e c4te$a 1ile, e0ist4n& "osibilitatea re$eniriisc!rt, &e c4te$a 1ile, e0ist4n& "osibilitatea re$eniriiinamaiei "e acela- loc 'n ca&r!l acel!ia-i atacinamaiei "e acela- loc 'n ca&r!l acel!ia-i atacre!matismalre!matismal

enomenele inamatorii ma8ore s!nt "re1ente maienomenele inamatorii ma8ore s!nt "re1ente maiales "eriartic!larales "eriartic!lar

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manifestri cardiovascularemanifestri cardiovasculare9 "ancar&ita9 "ancar&ita en&ocar&itaen&ocar&ita

as!r1irea 1#omotelor car&iaceas!r1irea 1#omotelor car&iace #alo"!ri#alo"!ri a"ariia !nor s!!ri 'n ocar!l mitralei -i aorteia"ariia !nor s!!ri 'n ocar!l mitralei -i aortei

miocar&itamiocar&ita accent!area ebreiaccent!area ebrei ta7icar&ie &iscor&ant c! ebrata7icar&ie &iscor&ant c! ebra &imin!area 1#omotelor car&iace&imin!area 1#omotelor car&iace re&!cerea am"lit!&inii -oc!l!i a"e0ianre&!cerea am"lit!&inii -oc!l!i a"e0ian

"ericar&ita"ericar&ita &!rere retrosternal&!rere retrosternal &is"nee&is"nee mrirea matitii car&iacemrirea matitii car&iace

rect!r "ericar&icrect!r "ericar&ic

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manifestri nervoasemanifestri nervoase9 coreea S:&en7am9 coreea S:&en7am mi-cri in$ol!ntare, in!tile, s"asmo&ice, nere#!latemi-cri in$ol!ntare, in!tile, s"asmo&ice, nere#!late #rimase#rimase

t!lb!rri &e scrist!lb!rri &e scris labilitate emoionallabilitate emoional mi-crile s!nt e0acerbate &e stress, emoii -i s!ntmi-crile s!nt e0acerbate &e stress, emoii -i s!nt

re&!se 'n somnre&!se 'n somn

nodulii subcutanainodulii subcutanai9 Me:net9 Me:net a! orm rot!n&, s!nt mobili, ne&!rero-i, ermia! orm rot!n&, s!nt mobili, ne&!rero-i, ermi s!nt &is"!-i 'n a"ro"ierea artic!laiilor (#en!nc7i,s!nt &is"!-i 'n a"ro"ierea artic!laiilor (#en!nc7i,

coate, !meri, occi"!t)coate, !meri, occi"!t) a! e$ol!ie &e *3 s"tm4nia! e$ol!ie &e *3 s"tm4ni

a"ar 'n ca1!rile c! &eterminri car&iacea"ar 'n ca1!rile c! &eterminri car&iace

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eritem marginateritem marginat "lacar& eritematos ne"r!ri#inos, !#ace, locali1at "e"lacar& eritematos ne"r!ri#inos, !#ace, locali1at "e

torace, coa"se, atorace, coa"se, a are "erieria mai ro-ieare "erieria mai ro-ie

eritem nodoseritem nodos este locali1at "e aa anterioar a #ambeieste locali1at "e aa anterioar a #ambei

alte manifestrialte manifestri "le!re1ia -i "ne!monia re!matismal"le!re1ia -i "ne!monia re!matismal &!rerile ab&ominale&!rerile ab&ominale e"ista0is!le"ista0is!l maniestrile renale (7emat!ria macrosco"ic)maniestrile renale (7emat!ria macrosco"ic)

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Examene paracliniceExamene paraclinice Semne de inamaie acutSemne de inamaie acut

;S< cresc!t;S< cresc!t le!cocito1le!cocito1 "roteina C reacti$ "o1iti$"roteina C reacti$ "o1iti$ =3=3#lob!line cresc!te#lob!line cresc!te fbrino#en cresc!tfbrino#en cresc!t

Infecia streptococicInfecia streptococic e0!&at arin#ian "o1iti$ "entr! stre"tococ betae0!&at arin#ian "o1iti$ "entr! stre"tococ beta

7emolitic7emolitic ASL> 9 $alori cresc!teASL> 9 $alori cresc!te

Afectare cardiacAfectare cardiac"e E?@ 9 a"are al!n#irea inter$al!l!i R -i"e E?@ 9 a"are al!n#irea inter$al!l!i R -it!lb!rri &e ritmt!lb!rri &e ritm

Afectare renalAfectare renal "rotein!rie -iBsa! 7emat!rie"rotein!rie -iBsa! 7emat!rie

Afectare hepaticAfectare hepatic T@ $alori cresc!teT@ $alori cresc!te T@> $alori cresc!teT@> $alori cresc!te AS $alori cresc!teAS $alori cresc!te

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Diagnosticul pozitiv Criteriile !ones"Diagnosticul pozitiv Criteriile !ones" #a$ore#a$ore

"oliartrita"oliartrita car&itacar&ita coreeacoreea eritem!l mar#inateritem!l mar#inat no&!lii s!bc!tanaino&!lii s!bc!tanai

#inore#inore ebrebr artral#iiartral#ii al!n#irea inter$al!l!i R (E?@)al!n#irea inter$al!l!i R (E?@) teste inamatorii (;S< cresc!t, "roteina C reacti$teste inamatorii (;S< cresc!t, "roteina C reacti$

"o1iti$, le!cocite cresc!te)"o1iti$, le!cocite cresc!te) e0!&at arin#ian "o1iti$, ASL> $alori cresc!tee0!&at arin#ian "o1iti$, ASL> $alori cresc!te inecii stre"tococice 'n antece&enteinecii stre"tococice 'n antece&ente istoric &e RAA sa! boala car&iac re!matismalistoric &e RAA sa! boala car&iac re!matismal

Dia#nostic!l "o1iti$ se "!ne fe "e &o! criterii ma8ore, fe "eDia#nostic!l "o1iti$ se "!ne fe "e &o! criterii ma8ore, fe "e!n!l!n!l

ma8or -i &o! minore%ma8or -i &o! minore%