Rheumatism of the joints - symptoms, treatment and signs in adults

Rheumatism is a terrible disease that attacks adolescents, adults, and children. The key to successful treatment of the disease is timely medical care. Patients should consult a doctor immediately after detecting suspicious symptoms. Patients are concerned about the question: what are the symptoms of rheumatic disease? How to identify the disease?

Rheumatism: what is it?

Rheumatism is a systemic inflammatory disease that is mainly localized in the lining of the heart. At risk are people who have a hereditary predisposition to this disease and are between 7 and 15 years of age. Rheumatism usually affects adolescents and young people, less often elderly and weakened patients.

Rheumatism (synonyms: rheumatic fever, Sokolsky-Buyo disease) is chronic, with a tendency to relapse, exacerbations occur in spring and autumn. Rheumatic lesions of the heart and blood vessels account for up to 80% of acquired heart defects.

The rheumatic process often involves joints, serous membranes, skin, and the central nervous system. The incidence of rheumatism ranges from 0.3% to 3%.

Hereditary predisposition to this disease plays a huge role. In so-called rheumatic families, the incidence is three times higher than in the general population. The disease is inherited in a polygenic manner.

Clinical picture of rheumatism

The trigger for the development of rheumatism is the entry of streptococcus into the body, as a result of which the immune system begins to produce antibodies to fight the infection. However, in the body itself, namely in connective tissues and heart muscle, there are molecules of the same structure. Due to the presence of this factor, the immune system begins to “fight” its cells. As a result, connective tissue is damaged, and this is fraught with heart defects and joint deformation.

Forms of rheumatism

cardiac form (cardiac rheumatism), when all the membranes of the heart are affected (pancarditis), myocardium (myocarditis), endocardium (endocarditis);
articular form (rheumatism of the joints);
cutaneous form;
pulmonary form (pleurisy);
rheumatic chorea (St. Vitus' dance).

Classification

Highlight:

Acute rheumatism

Rheumatism in the acute phase most often manifests itself in young people under 20 years of age. The causative agent is streptococcus. The association of the disease with previous upper respiratory tract infections is the delayed onset of symptoms (14-21 days).

The initial manifestations of rheumatism have much in common with the clinic of colds, but after a short period of time, manifestations of carditis, skin rashes and polyarthritis join the symptoms of a cold.

The total duration of the acute form of the disease is from 3 to 6 months. The acute form of rheumatism can lead to the development of serious complications. In the absence of timely treatment, rheumatic carditis develops into heart defects.

Chronic rheumatism

The chronic form of rheumatism is characterized by frequent relapses of the disease, especially when the body is hypothermic. The heart and joints are most often affected, with typical pain in these organs. The course of the disease can last for several years.

Rheumatism is divided into forms according to the criterion of the affected system or organ:

Rheumatism of the heart. Heart damage during the first rheumatic attack is observed in 90-95% of all patients. In this case, all three walls of the heart can be affected - the endocardium, myocardium and pericardium. In 20-25% of cases, rheumatic carditis ends with a formed heart defect. The main feature of heart damage in rheumatism in children and adults is the extreme paucity of manifestations. Patients complain of discomfort in the heart area, shortness of breath and cough after physical exertion, pain and interruptions in the heart area. As a rule, children remain silent about these complaints, not giving them serious importance. Therefore, heart damage can most often be detected during physical and instrumental examination.
Rheumatism of the joints (rheumatic polyarthritis). Most often, pathological changes affect the elbow, knee and ankle joints. In a person with rheumatic arthritis, body temperature increases to 39 degrees, weakness increases, episodes of nosebleeds may occur, and sweating increases;
Pulmonary form. It appears in combination with damage to the joints and heart, but is extremely rare (about 1-3% of the total number of clinical cases). Develops in the form of pleurisy or bronchitis;
Skin form. It manifests itself as skin rashes or rheumatic nodules. Occurs in no more than 5% of cases;
Rheumatism of the eyes. It is an integral part of the general manifestations of rheumatism in other organs. Characterized by damage to the retina (retinitis) or other parts of the eye (iritis, iridocyclitis, etc.). Complications may include partial or complete loss of vision.

Bacteriological and serological studies have shown that rheumatism is a special allergic reaction to infection with one of the beta hemolytic streptococci of group A.

Classification of rheumatism

Rheumatism is a disease that manifests itself in different forms. The following types are classified according to the frequency of manifestation:

The acute form of rheumatic disease is the primary occurrence of the disease. Typically, the inflammatory process begins approximately 14-20 days after the entry of a streptococcal infection.
Chronic rheumatism – repeated cases. Without proper medical treatment, inflammation becomes chronic. It is much more difficult for medical staff to overcome repeated cases; the risk of heart damage increases with each attack, and the general condition worsens.

Inflammatory processes occur in waves: after painful attacks, periods of imaginary well-being begin. The patient feels absolutely healthy, but the disease is simply waiting in the wings. After a certain period of time, a relapse will definitely occur.

According to the location of the main inflammation, the following are distinguished:

rheumatic carditis (inflammatory process in the heart muscles);
rheumopleuritis (inflammation of the lungs and bronchi);
rheumatic chorea (disruption of the activity of inflamed blood vessels in the brain);
rheumatic erythema (localized on the skin);
rheumopolyarthritis (concentration of inflammation in the articular area).

Attacks of exacerbation are unpredictable. It is difficult to predict the time of re-attack of the disease, the severity of the attack, the features of the manifestation and localization of inflammation in a particular patient. The task of medical staff is to suspect disorders in time, establish an accurate diagnosis, begin treatment as early as possible, stop inflammation, and minimize risks.

First signs

Detection of rheumatism in the early stages, especially if there is a predisposition to this disease, is very important for the effectiveness of its further treatment. However, as a rule, the diagnosis is made in the presence of reliable symptoms indicating the development of rheumatism. It is necessary to pay timely attention to both individual signs and their totality.

Signs to look out for:

In typical cases, the first signs of rheumatism in the form of fever, signs of intoxication (fatigue, weakness, headache), joint pain and other manifestations of the disease are detected 2-3 weeks after a sore throat or pharyngitis.
One of the earliest signs of rheumatism is joint pain, detected in 60-100% of patients (rheumatoid arthritis).
Signs of heart damage are detected in 70-85% of cases. Complaints of a cardiac nature (pain in the heart area, palpitations, shortness of breath) are observed with severe cardiac disorders.
More often, especially at the onset of the disease, various asthenic manifestations (lethargy, malaise, increased fatigue) are observed.

Treatment methods for rheumatic diseases

The doctor can console patients with the possibility of a cure for the disease. The development of rheumatism occurs in attacks, so it is important to start treatment as early as possible. In the treatment process they use:

Bed rest is an important factor in recovery in the acute phase. It is recommended to limit movements for 7-21 days. Patients are often given a referral to a special unit, offering treatment under close medical supervision. Violation of medical recommendations delays the healing process.
Treatment with antibiotics. Medicines that are harmful to streptococci are used. The penicillin series is predominantly used in therapy. For example, Augmentin is suitable for treating childhood seizures, while doctors treat adults with Ampicillin.
Use of antihistamines. Patients are treated with drugs that stop atypical reactions (for example, Suprastin).
Spa treatment is recommended for patients after treatment to maintain health.
Relapse-preventing medical therapy is a must for rheumatic disease. Recovered patients need to carry out year-round bicillin prophylaxis, maintain immunity, monitor their health, and in case of strange symptoms, urgently contact medical professionals, and be examined in a timely manner.

Patients should not rely on herbs and poultices for healing. It is better to use traditional medicine as an effective addition to the main treatment. You must first obtain permission from medical staff.

Rheumatism is a dangerous disease that threatens the joints and heart. Inflammation must be treated quickly and efficiently. Seek help only from trusted medical institutions!

Causes

A rheumatic attack is usually preceded by a streptococcal infection caused by group A β-hemolytic streptococcus:

scarlet fever,
tonsillitis,
puerperal fever,
acute otitis media,
pharyngitis,
erysipelas.

In 97% of patients who have had a streptococcal infection, a persistent immune response is formed. Other individuals do not develop stable immunity, and with repeated infection with β-hemolytic streptococcus, a complex autoimmune inflammatory reaction develops.

Factors contributing to the appearance and development of rheumatism are:

reduced immunity;
crowded groups (boarding schools, schools, dormitories);
young age;
unsatisfactory social and living conditions (food, housing);
prolonged hypothermia;
unfavorable family history.

Causes of rheumatism

The leading cause of negative symptoms is the penetration of streptococcus. Once inside the body, the pathological element actively multiplies, forming entire colonies. The result of the proliferation of streptococcus is the damage to the body by toxic enzyme secretions. The immune response is manifested by a pronounced allergic reaction. Ways of streptococcus entering the patient’s body:

infection with infectious streptococcal diseases from a patient with tonsillitis, scarlet fever through the air (it is enough to ride on a tram with the patient, or pass next to him in a store);
acquisition of streptococcal infection through the use of common objects with the patient (for example, drinking tea from a mug of a patient with tonsillitis);
transfer of streptococcal infection from mother to child during the period of waiting for the baby, during labor.

The presence of streptococcus does not guarantee the development of rheumatism. The disease develops in the absence of proper treatment (for example, symptoms of improvement prompt patients to stop taking antibiotics, go to work, forget to undergo a medical examination after illness).

Important! Initially, rheumatic disease takes an acute form. It is quite easy to cure the disease at this stage. There are practically no negative consequences, patients quickly return to their usual existence. The lack of effective treatment causes the disease to transition to chronic rheumatism, characterized by a long period of treatment and a high risk of complications.

Symptoms of rheumatism in an adult

Rheumatism is a polysymptomatic disease, which, along with general changes in the condition, is characterized by signs of damage to the heart, joints, nervous and respiratory systems, as well as other organic structures. Most often, the disease makes itself felt 1-3 weeks after an infectious disease caused by group A β-hemolytic streptococcus.

The patient develops the following symptoms:

increase in body temperature to high numbers;
tachycardia;
headache;
increased sweating;
weakness;
swelling and tenderness in the joints.

They are very similar to the common cold, but are caused by a streptococcal infection rather than a viral infection. A characteristic difference is pain and swelling of large joints: elbow, ankle, knee, shoulder or wrist.

Typical symptoms of rheumatism are:

high temperature, 38-40 degrees, fluctuations of which during the day are 1-2 C, increased sweating, chills, as a rule, no;
against this background, muscle weakness and increased fatigue appear: pain in the joints;
swelling of soft tissues.

Most often, the disease manifests itself after a few weeks due to previous infectious diseases, for example, after a sore throat and pharyngitis.

As rheumatism progresses, other specific symptoms may appear - not always, on average they are recorded in 10% of cases:

increased fragility of blood vessels - manifests itself in regular nosebleeds that occur suddenly;
Annular rashes appear - they look like a round, small, pink rash with uneven edges;
rheumatic nodes are formed - they are localized in the anatomical locations of the affected joints, have the appearance of subcutaneous dense formations and are absolutely painless;
the abdominal organs are affected - characterized by pain in the right hypochondrium, indicating the need for immediate hospitalization of the patient.
The heart muscle (myocardium) and the inner lining of the heart chambers (endocardium) are affected - as a result, shortness of breath, rapid heartbeat, arrhythmias, chest pain, and heart failure develops.
Rheumatic inflammation of the heart wall (rheumatic carditis) often recurs, and heart defects gradually form.
With rheumatism of the joints, sudden pain appears in one or several joints at once. The joints become red, swollen and hot. Most often the knee, ankle, elbow joints, and wrists are affected. Sometimes the hip, shoulder joints and small joints of the feet and hands are affected.
Simultaneously with the appearance of joint pain, body temperature begins to rise. With rheumatism of the joints, the body temperature either decreases or rises again. Symptoms of rheumatism usually disappear within two weeks.

Causes of development and exacerbation of rheumatism of the joints

Rheumatism of the joints is a disease that does not always occur. For the disease to develop, several factors must be present.

Late or incomplete/incorrect treatment

Sore throat, pharyngitis and other dangerous diseases caused by a special group of streptococci must be treated, and little time is given to doctors and the patient to respond. Otherwise, there is every chance of increasing the risks by developing rheumatism in the hands and feet. An untreated disease in the future threatens with new problems - rheumatism of the knees, legs, arms, etc.

Pathogen (infection) – the disease is provoked by a certain group of streptococci. It is this that lays the foundation for the emergence and development of pathology. The causative agent of joint rheumatism enters the body in different ways, but this dangerous microorganism can cause sore throat and streptoderma, pharyngitis and scarlet fever, and other dangerous ailments.

At risk are people who have virtually no protection against streptococcus. When a pathogen enters the body, it is important to immediately begin adequate treatment, carry it out to completion, and then also make sure that the pathogen is neutralized. Otherwise, you can expect the development of a new disease.

Symptoms of joint rheumatism in adults may not appear immediately, which is the danger of the disease. Detecting and eliminating its negative effects is the main task of the doctor.

The danger of the microorganism is that it releases aggressive toxins that can damage connective tissue, the lining of the heart, and cartilage. But that’s not all - the shell of a dangerous microorganism includes antigens - unique components similar to human cells. This slows down the functioning of the immune system - it malfunctions, attacking not only the enemy, but also its own cells. This causes the development of autoimmune inflammation.

Hereditary factor

Scientists studied patients and identified a risk group. People who have special genes have every chance of getting into it. They are responsible for the reaction to streptococcal infection. It is this gene that causes susceptibility to such dangerous diseases as tonsillitis, etc.

Combined factor

Additional reasons for the development of rheumatism of the joints, arms and legs were:

Unbalanced diet;
Lack of a set daily routine;
Hypothermia;
Adverse habits;
The presence of other diseases of the joints, bones, etc.

Complications

The development of complications of rheumatism is determined by the severity, protracted and continuously relapsing nature of the course. In the active phase of rheumatism, circulatory failure and atrial fibrillation may develop.

If you do not pay proper attention to the symptoms of rheumatism and do not consult a doctor in time, this disease can cause the following complications:

become chronic, treatment of which can take up to several years;
develop heart defects;
cause heart failure;
as a result of malfunctions of the heart, cause disturbances in the functioning of the circulatory system, which in turn can provoke strokes, varicose veins, diseases of the kidneys, liver, respiratory organs, vision organs, etc.
with exacerbation of all of the above symptoms and diseases, lead to death.

Prognosis for rheumatism

Currently, acute rheumatic fever does not pose a direct threat to life. The prognosis is most influenced by the degree of heart damage. And with timely treatment, the primary lesion ends in recovery.

The formation of valvular heart defects, more often with the development of mitral insufficiency, is determined in children in 20-25%, in adolescents in 30%, in adults in 35-49% of cases during the first attack, mainly in severe, protracted or latent course of the disease (acute form progresses to chronic rheumatic fever).

Sources:

1, 2. Steven J Parrillo, DO. Rheumatic Fever in Emergency Medicine. — Medscape, Feb 2019.
Belov B.S. Acute rheumatic fever: current state of the problem. - Russian Medical Journal, No. 6 from 03/26/2004.
Pirinccioglu AG. Measurements of Oxidative Stress Parameters in Children with Acute Rheumatic Fever. — Pediatrics Int., Jul 2019.
Shostak N.A. Acute rheumatic fever: a look at the problem in the 21st century. — Clinician, No. 1, 2010.

Diagnostics

Instrumental research methods include:

ECG (cardiogram rarely reveals heart rhythm disturbances);
Ultrasound of the heart;
X-ray examination (allows us to determine an increase in the size of the heart, a change in its configuration, as well as a decrease in the contractile function of the myocardium);

Laboratory diagnosis of rheumatism:

A general blood test reveals an increase in ESR, a shift in the leukocyte count to the left, and anemia.
In the immunological analysis, ASG titers increase, the number of immunoglobulins of class A, G, M increases, C-reactive protein, anticardiac antibodies and circulating immune complexes are detected.

Rheumatism: diagnosis

A systemic disease of this type is the competence of a rheumatologist. And in order to make a diagnosis and prescribe comprehensive and effective treatment, the treating medical specialist must prescribe a diagnostic examination.

If a rheumatologist suspects rheumatism, a clinical and immunological blood test is recommended. X-rays, echo and electrocardiography may be needed.

General and biochemical blood test

Thanks to the results of a general blood test, the treating rheumatologist can detect infection and some signs of systemic damage to the human body. For rheumatism, diagnostics, or rather a general blood test, will demonstrate an increased erythrocyte sedimentation rate, as well as an increased leukocyte count.

Biochemical laboratory analysis helps detect proteins in the acute phase of the inflammatory process. The brighter the inflammation, the greater the number of proteins will be shown by the result of biochemical analysis. The following proteins are taken into account: haptoglobin, fibrinogen, lactoferrin, ceruloplasmin, as well as A-2 globulin, C-reactive protein and A-1 antitrypsin.

Electrocardiography

This diagnostic procedure is carried out in almost 99% of all cases when it comes to rheumatism. And all because a common complication of this disease is diseases of the heart muscle. Based on the results of electrocardiography, the attending physician can detect pericarditis, myocarditis and valve damage.

Echocardiography

This diagnostic method involves the use of ultrasound waves when examining the heart. Using echocardiography, you can determine not only the structure of the organ, but also the quality of the functions it performs. The results will include the dimensions of the heart walls, chamber volume, and stroke volume. With a pronounced clinical picture of rheumatism, diagnostics of this type can detect: stenosis of the mitral and/or aortic valve, as well as exudative type pericarditis.

Phonocardiography

This diagnostic method is not recommended for patients in all cases, but it allows you to literally listen to how the heart muscle works. The device is equipped with a powerful microphone that detects the tone and sound of the heart. The results of phonocardiography are processed using a computer and displayed graphically on a monitor or paper.

Thanks to this diagnostic technique, the doctor can detect abnormal pericardial friction sounds, as well as systolic and diastolic sounds.

Treatment of rheumatism

Treatment of the disease in question must be carried out under the supervision of a specialist and most often the patient is placed in a medical institution. There are a number of medications that are necessarily prescribed to patients as part of therapy for rheumatism. These include:

Antibacterial drugs (penicillin followed by switching to bicillin5). In case of intolerance to penicillin, erythromycin can be used.
Corticosteroids to provide a pronounced anti-inflammatory effect: Prednisolone. Since the use of corticosteroids affects water-salt metabolism, the patient is additionally prescribed potassium supplements (Asparkam, Panangin).
non-steroidal anti-inflammatory drugs: Indomethacin, Ibuprofen, Xefocam, Revmoxicam, Dicloberl, etc.;
hyposensitizing drugs;
immunosuppressants: Azathioprine, Chlorobutin, Chloroquine, Hydroxychloroquine;
glucocorticosteroids: Triamcinolone, Prednisolone.
Aspirin. For rheumatism, this drug helps to quickly relieve the patient from pain in the joints and relieve swelling of the joints.

Treatment with hormones is now rarely used, and such drugs are prescribed only in some clinical cases.

Treatment of rheumatism is carried out according to a special scheme. It consists of three stages:

Stage 1. Therapy is carried out in a hospital setting and lasts from 4 to 6 weeks. The first stage is treatment of the disease at its peak of activity.
Stage 2. This stage is a recovery stage after intensive therapy. Involves treatment in special sanatoriums or resorts.
Stage 3. This stage is preventative. It involves annual preventive therapy, registration with a rheumatologist and constant monitoring by a doctor.

An acute attack of rheumatism is treated in a hospital. The patient is prescribed bed rest. Drug therapy depends on the clinical manifestations and form of the pathology and includes:

glucocorticoids,
anti-inflammatory drugs,
antibiotics,
drugs that stimulate the body's immune response,
sedative dosage forms.

In the presence of heart damage, cardiac glycosides and diuretics are used.

The prognosis of rheumatism depends on the severity of damage to the tissues of the heart and joints (i.e., the presence and extent of myocardiosclerosis, the nature of damage to the heart valves). If the elimination of a rheumatic attack was started on time, then the disease is quite treatable, and the patient’s life is not in danger. The most unfavorable course is often recurrent rheumatism.

Features of disease therapy

The good news for patients is the prospects for treating the disease. Inflammation of the joints is successfully healed through a set of medical measures:

Prescribing penicillin medications helps expel streptococcus from the body. Elimination of the main cause leads to the remission of the symptoms of the disease, the activation of health restoration, and the increase of the body's defenses.
Prescribing antihistamines helps eliminate the body's allergic reactions to the activity of streptococcus. Patients are prescribed a set of medications based on the specific situation, age, and specifics of the disease.
Nonsteroidal anti-inflammatory drugs help cope with inflammatory processes in the body. Special medications help stop inflammation of the heart tissue and lungs.
Physiological procedures (baths, heating with a lamp, massage) contribute to the effective development of damaged joints, optimizing the well-being of patients.
Exercise therapy exercises serve as an excellent means of restoring the motor functions of patients. Prolonged stay in bed rest causes a gradual entry into sports. Medical staff carefully monitor the physical activity of patients, provide all possible assistance, and develop individual training regimens.
Warming ointments and compresses are prescribed to quickly relieve negative symptoms. With the doctor's permission, it is permissible to use traditional medicine. Self-medication prescriptions are available, cheap, and effective.

The recovery of patients is considered final several years after the end of treatment. This period involves regular prophylactic administration of penicillin drugs to former patients according to a schedule developed by medical staff.

Rheumatism manifests itself in different ways. Symptoms of rheumatism in adults, children, and the elderly are manifested by general signs that allow one to suspect a rheumatic attack. Specific symptoms allow an experienced medical professional to identify a specific type of disease, develop ways of effective treatment, and offer preventive measures to patients, loved ones, and colleagues. Don't miss the onset of the disease!

Folk remedies

It is necessary to use folk remedies for rheumatism only after the consent of the attending physician.

Aconite decoction. Place 10 g of aconite root in a saucepan and pour 500 g of water into it. Cook the product for 2 hours over low heat. Next, cool the product, strain, and rub it on the affected areas 3 times a day.
Lemon. Tincture of citrus fruits stimulates blood circulation and relieves inflammation. Cut 2 large lemons together with the peel, pour 0.4 liters of vodka or diluted alcohol into a glass container, seal it, and leave in a shaded place for three days. The liquid is used externally for rubbing, followed by insulation with woolen fabrics.
Pour 10 g of St. John's wort herb into 1 glass of hot water, boil for 30 minutes over low heat, cool and strain. For rheumatism, take 0.3 cups 3 times a day 30 minutes before meals. Store for no more than 3 days.
Drink 2-3 glasses of corn silk decoction every day. Take a heated teaspoon of raw material into a glass of water and cook over low heat for 10 minutes. Drink for 6–8 weeks. The oldest muscular rheumatism disappears.
Calamus (root) for bath. Pour 2 tablespoons of finely chopped calamus rhizomes into 1 liter of boiling water, boil for 20 minutes, leave for 30 minutes and strain. Take a bath (35-36 °C) during the day or at night for rheumatism and gout. Course of treatment: 10-12 baths.

Rheumatism of the joints, symptoms do not appear immediately

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What is joint rheumatism?

This is an inflammatory lesion of the joints, with characteristic changes inherent in rheumatism. This disease primarily affects large joints such as knees, ankles and elbows.

Gradually, rheumatism moves from one area (joint) to another, that is, such a process is symmetrical. And if the disease is not treated immediately, the result can be damage to all legs or arms, depending on where it all started.

Symptoms

In rheumatism of the joints, symptoms do not appear immediately, and not even the next day, but 2-3 weeks after a sore throat or pharyngitis, which was caused by a streptococcal infection. The pain with this disease can be so extreme that not only is it difficult to move, but even the usual touch of a hand or blanket is quite painful. The temperature of the whole body rises to 40 degrees, but most often 38-39 degrees.

It also happens, of course, that rheumatism of the joints goes unnoticed. Symptoms in such cases are not high fever and moderate body weakness. Patients do not attach importance to such symptoms, but seek help from specialists when more serious problems begin.

With rheumatism, the joints look red and swollen and feel hot to the touch. The pain especially manifests itself if you try to move the part of the body that is painful or with banal pressure, while pain sensations can suddenly arise and disappear just as abruptly. In such cases, the joint does not undergo deformation, that is, this is how benign arthritis usually progresses. If the pain has disappeared or is completely unnoticeable, this does not mean that the disease has passed (cured).

Rheumatism of the joints is generally considered a chronic disease that occurs in waves, and exacerbations occur up to several times a year. This disease must be treated, as it will not disappear on its own. Repeated attacks usually appear after a month, or maybe after years.

Causes

Rheumatism of the joints can occur as a result of a streptococcal infection, which is expressed in the inflammatory process of connective tissue in many organs.

Many studies have been conducted and some of them have shown that rheumatism is a kind of allergic reaction to infection, especially from group A beta-hemolytic streptococci. According to the results of the study, 2.5% of people who have had a streptococcal infection subsequently develop a rheumatism of the joints.

Usually, to get a disease such as rheumatism, you need to have a sore throat, childbed fever, scarlet fever, acute inflammation of the middle ear, chronic pharyngitis or tonsillitis, and erysipelas.

When an infection enters the human body, the immune system begins to fight, as a result of which specific antibodies are produced, which tend to find streptococci by special molecules. These molecules are present in people who are predisposed to rheumatism, resulting in the antibodies acting against their own body.

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This process causes inflammation in the connective tissue of the heart or joint. The body does not develop immunity to infectious diseases, so when re-infected, an attack of joint rheumatism develops again.

Mechanism of disease development

It rarely happens that rheumatism affects only one joint, because, as a rule, after its first manifestation, the disease occurs in another joint, while the pain of the first subsides. Rheumatism seems to jump from one area to another. Patients who immediately began joint treatment suffer from disease in only 2-3 joints. In other cases, rheumatism gradually affects all the joints of the legs and arms, and possibly the spine and jaw, resulting in significant pain that prevents normal eating.

Observant doctors have noticed that rheumatism affects those joints that are most stressed in a person, depending on the nature or profession of his work, as well as his lifestyle. Also, those joints that were previously exposed to pressure, hypothermia or bruises often became ill.

Proper treatment will help the patient get rid of swelling and pain within a week or two weeks, and sometimes even within 2-3 days from the start of treatment.

Treatment of rheumatism

Treatment can be considered successful not only from the correct choice of drug therapy, but also from compliance with simple conditions: general rest, bed rest, ventilation of the room where the patient is.

Methods and means of treatment:

Antibiotics and NSAIDs. This treatment should be followed until the severity and inflammation in the joints disappear;
Immunosuppressants, gamma globulins and glucocorticoids. They are needed to protect the entire body;
Physiotherapeutic procedures include heating with a lamp, electrophoresis, UHF, etc. They begin after acute symptoms have been relieved;
Blood purification. This is required if rheumatism of the joints bothers you and does not go away for a long period of time. The blood is cleansed of various toxins and antibodies.

Bed rest should be maintained until the inflammatory process subsides. The diet often does not change, although some doctors strongly recommend reducing the amount of carbohydrates in food and increasing the protein content accordingly.

Prevention

Measures to prevent rheumatism include:

timely detection of streptococcal infection, sanitation of the infectious focus;
improvement of hygienic, social and living conditions of work and life;
hardening;
preventive use of antimicrobial and anti-inflammatory drugs in the autumn and spring periods.

Secondary prevention of rheumatism includes the following action plan:

If the disease is active, then you should always be under the control of a rheumatic cardiologist. First, visit the doctor every month for 3 months from the onset of the disease, and then once a quarter. A prerequisite is to seek advice from a neurologist, ENT specialist, ophthalmologist, dentist, or gynecologist.
Plasma donation for research should be carried out 6 times a year, and a urine test should be taken up to 4 times a year.
Prevention of rheumatism is based on mandatory diagnostic measures. They should be carried out quarterly.
Blood tests for rheumatic tests are carried out 4 times a year. If there is attenuation of the process and its transition to an inactive phase, then you should visit a rheumatic cardiologist 2–4 times a year.

Drug therapy

How to treat symptoms of rheumatism? One of the main directions is to relieve infection caused by streptococcus bacteria . Other important areas include strengthening the protective functions of the immune system and preventive measures that are aimed at preventing malfunctions of the cardiovascular system. In the acute course of the disease, the following measures and medications are indicated:

bed rest;
non-steroidal anti-inflammatory drugs;
hormonal drugs (Prednisolone) with individual dosage selection. For 10 days, the drug is taken at the initial dose, then the daily volume of the drug is gradually reduced by 2.5 mg every week until complete withdrawal;
antimicrobial drugs with specific action (Bicillin);
antimicrobial drugs for the treatment of streptococcal infections (Amoxicillin, Azithromycin, Cefuroxime, Clarithromycin);
drugs of the quinoline group (prescribed for a long course of 5 months - several years).

If pathological processes in the pharynx area constantly worsen, the doctor may prescribe surgical removal of the tonsils. Procedures to restore the functions of the cardiovascular system are recommended to be carried out in specialized institutions (sanatoriums, rehabilitation centers). In this case, the patient is provided with an integrated approach to solving a medical problem:

antirheumatic therapy;
treatment of existing chronic diseases;
procedures for hardening the body;
special diet;
physiotherapy.

To cure rheumatism, after a course of therapy, you must continue to visit your rheumatologist in order to prevent relapse. At this stage, patients who are interested in what to treat and how to cure the disease must adhere to the following rules:

continue taking penicillin drugs in small doses (once every 2–4 weeks for up to a year);
conduct diagnostic examinations twice a year;
continue procedures to strengthen the immune system;
perform therapeutic exercises;
Twice a year, during the period of possible exacerbations (autumn and spring), conduct a course of treatment with non-steroidal anti-inflammatory drugs (taken for a month).

If the pathology is not accompanied by damage to the heart muscle, therapy with drugs of the penicillin group is indicated for five years after treatment of the disease in an acute form.

According to the phase and activity of the disease

Many specialists in practice continue to use the developments of A. I. Nesterov, classifying rheumatism primarily by the phase of the disease. There are active and inactive forms of the disease. Active usually represents a rheumatic attack, which is often a consequence of streptococcal infection, as an early complication after acute tonsillitis or tonsillitis. Attacks most often occur in children aged 5-13 years, and occur less frequently in adults.

In the active phase, Nesterov’s classification of rheumatism distinguishes three degrees of the disease depending on the severity of the pathological process. With a minimal degree, the symptoms are mild, a low level of rheumatism indicators is determined in the blood, and the increase in temperature is insignificant. The patient feels relatively normal. Moderate pathological activity is characterized by slight changes in blood circulation, an increase in the level of leukocytes and ESR. The degree of greatest activity of rheumatism is inherent in the primary attack with severe symptoms. The clinical picture includes severe rheumatic carditis, hyperthermia and an acute form of joint damage. Laboratory studies and analyzes in this case record high rheumatic results.

Rheumatism in the inactive phase is remission. In this case, symptoms of the disease do not appear for a year or more. The patient's condition is characterized as satisfactory, there are no cases of fever, joint pain, cardiac disturbances, the results of blood tests are within normal limits. If there are no relapses within five years, the patient's chances of a favorable outcome of the disease increase significantly.

Reactive rheumatism appears after infectious diseases of a viral or bacterial nature. The pathology usually develops against the background of painful lesions of the knee or ankle joints, followed by possible involvement of other joints in the process. Depending on the characteristics of the individual organism and immune defense, long periods of illness are possible with the transition of rheumatism to a chronic form.

How does the disease manifest itself?

Rheumatoid disease makes itself felt in the form of diverse manifestations. Rheumatism is most often diagnosed in children aged 7–15 years. Rarely does it affect a child under 3 years of age. The following characteristic symptoms of rheumatism are distinguished:

fever, which is accompanied by fatigue, lethargy, pain in the head;
discomfort in the extremities (rheumatism of the joints), diagnosed in 60–100% of patients;
involvement of certain joints in the inflammatory process (in the knees, elbows);
damage to the heart, accompanied by pain, rapid heartbeats, and shortness of breath.

Rare signs of rheumatism are an anular rash and characteristic nodules.

Anular rash is a rash that is characterized by a pink color. Their shape is a thin ring-shaped rim that does not rise above the surface of the skin. When pressed they simply disappear. Such symptoms of rheumatism can be found at the peak of the disease in 7–10% of patients.

The nodules that arise as a result of the disease are round in shape, they do not cause pain, and they are dense. As a rule, they are localized in the area of large and medium-sized joints, on tendons. Today they are found extremely rarely and are characteristic of a severe form of the disease. In severe cases of rheumatism, the damage strikes other important organs.

Variants of the course of the disease

There are five types of rheumatism, depending on the course of the disease:

latent;
spicy;
subacute;
protracted;
recurrent.

Acute rheumatism is characterized by suddenness and sharp severity of the clinical picture, a high degree of activity of the process, and rapid and effective treatment. In the subacute course, the duration of the disease is from three to six months, the symptoms are less pronounced, the effectiveness of treatment is less, and the activity of the process is moderate.

The protracted version of rheumatism occurs with sluggish dynamics, prolonged rheumatic attack, and low activity of the process. The latent course is characterized by the absence of instrumental and clinical laboratory data; the disease is diagnosed by an already formed heart defect. The continuously relapsing variant of development is determined by severe exacerbations and incomplete remissions, progressive damage to internal organs.

Clinical and anatomical lesions

When classifying rheumatism, the first (1) are the clinical manifestations, the state of the blood circulation and the general clinical and anatomical characteristics of the involvement of the heart or other body systems. In medical practice, a disease is distinguished with the development of heart disease or without it (lesions involving the heart), rheumatic lesions of the lungs, kidneys, neurorheumatism (the involvement of other systems is assessed).

In the WHO classification of rheumatism, clinical manifestations are divided into main and additional. The main ones are arthritis (a common inflammatory disease of the joints), chorea (involuntary movements beyond the control of the patient), carditis (inflammatory damage to the heart), subcutaneous rheumatic nodules (systemic inflammation of connective tissues), ring-shaped erythema (damage to the dermis, manifested by various rashes) . Additional ones include arthralgia (joint pain, which can be either transient or permanent), serositis (inflammation of the serous membrane, for example, the pleura, peritoneum or pericardium) and abdominal pain syndrome.

Which doctor should I contact?

If the temperature rises, swelling and redness of the skin in the area of large joints appears, the patient should consult a rheumatologist. To obtain a more detailed picture of the disease, the patient is prescribed blood tests to identify rheumatic factors, C-reactive protein and other blood parameters. If necessary, the doctor can refer the patient to an otolaryngologist for examination and sanitation of the nasopharynx and oropharynx. To obtain data on the condition of the tissues of the heart and other organs, Echo-CG, ECG and ultrasound are performed, and a consultation with a cardiologist and cardiac surgeon is scheduled.

Rheumatism in adults can begin at a young age and after the onset of symptoms of damage to the cardiovascular system, the patient begins to show signs of damage to joint tissues. If left untreated, the disease can lead to the development of heart failure and atrial fibrillation. And if rheumatism lasts for a long time, then the articular joints are destroyed, which significantly disrupts the normal mobility of the joints.

About rheumatism in the “Pro Health” program:

TV channel “Arkhyz 24”, theme of the “Health” program “Rheumatism: a disease from childhood” (from 3:45 min.):

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Traditional methods

Therapy should begin with water procedures, which relieve inflammation, improve blood circulation and have a general strengthening effect.

Folk remedies for the treatment of rheumatism are varied.

Baths with sea mud or salt or hay husks are very effective. To prepare a hay bath, pour 1 kg of hay husk with 2 liters of water and boil for 30 minutes. The resulting broth is poured into a filled bath. You need to take it for at least 10 minutes.

Treatment of rheumatism with folk remedies is based on the preparation of solutions for rubbing. A good effect can be obtained by using the following recipes:

10 Analgin tablets are ground, added to 10 ml of iodine and mixed with 40 ml of camphor alcohol. 300 ml of alcohol is added to the mixture and shaken. The solution should be left in a dark place for 3 weeks. After that, rubbing is carried out twice a day.
Mustard tincture is good for relieving pain due to rheumatism. You will need 100 ml of vodka, 1 tsp. mustard powder. Mix everything and leave for five days in the refrigerator. Use as needed.
A mixture made from green leaves of indoor ficus gives good results. 100 ml alcohol, 20 g. crushed ficus leaves. Mix the ingredients and leave in the refrigerator for a week. Rub the strained mixture onto the affected areas morning and evening for 7 days.

Types of rheumatism

Rheumatologists have adopted a basic classification that includes two types of rheumatism:

Chronic rheumatism, which is characterized by a frequent relapsing course even with treatment. Its exacerbations occur at different times of the year, mainly in cold seasons (winter and autumn). A similar effect is also typical for patients who live in cold or damp apartments. Exacerbations occur several times a year. The majority of patients (about 85%) are people under forty years of age. The heart and joints are affected. The disease is severe and significantly impairs the quality of life. The patient feels constant pain in the heart and joints. After the relapse (acute phase) passes, the disease can last for several months or even years. Treatment of rheumatism in the active phase is most often carried out in a hospital.
Acute rheumatism. The disease in this phase is predominantly characteristic of young patients (up to twenty years old). Its causative agent is streptococcus. The disease is associated with an infection of the upper tract of the respiratory system suffered by the patient, which consists in a later manifestation of its symptoms (from two to three weeks).

Now we know the symptoms of rheumatism of the joints. We will consider below what treatment is prescribed in each specific case.

Many people are interested in what medications to take. Acute rheumatism is characterized by rapid development. At first, signs of general intoxication appear, like a cold, which makes the disease difficult to identify immediately. Then, after 1-2 days, specific symptoms appear (carditis, polyarthritis, skin rashes, and in rare cases, nodules). The average duration of the acute phase is about three months. It may also last longer - up to six months. The most dangerous in the acute form is carditis, that is, damage to the heart, since in a quarter of all cases it causes a heart defect.

Your doctor will help you choose medications for the treatment of rheumatism.

Kinds

Rheumatism of the joints

The classification of the presented disease involves the following types:

returnable;
pneumonia of rheumatic origin;
rheumatic pulmonary vasculitis;
pleurisy of rheumatic origin;
abdominal syndrome;
rheumatism of the heart;
rheumatic chorea.

Recurrent rheumatic carditis

Such rheumatism in children is accompanied by the emergence of new complications. It occurs in combination with heart defects, resulting in a chronic nature with a labile effect of antirheumatic treatment.

Rheumatic pneumonia

Lung damage in children can provoke acute rheumatic disease in the form of pneumonia or pulmonary vasculitis (damage to small vessels of the organ) of rheumatoid origin. The disease occurs due to the severe symptoms of carditis.

The following symptoms of rheumatism with lung damage are distinguished:

increased shortness of breath;
increase in temperature indicators;
wet rales.

Using X-rays, it is possible to determine local intensification, concentration and pathological changes in the pulmonary pattern with a large number of small foci of compaction.

If a two-way process takes place, then it turns out that the “butterfly wings” picture is typical.

This disease is characterized by dynamic symptoms under the influence of antirheumatic treatment.

Inflammation of small vessels of the lungs of rheumatic origin

This type of disease, which includes the general classification of rheumatism, is characterized by symptoms such as cough, hemoptysis, and shortness of breath. Rheumatism in children of this form, in the absence of certain percussion changes in the lungs, can be detected only through a plurality of sonorous moist rales, and with x-rays a diffuse increase in the pulmonary pattern can be determined. All these manifestations can be eliminated with the help of anti-inflammatory medications.

Pleurisy of rheumatic origin

This type of rheumatism is one of the most common manifestations of rheumatic polyserositis. It most often occurs at the initial stage of the disease along with wandering polyarthritis. This disease is accompanied by the following symptoms:

pain during exhalation or inhalation;
sound produced by friction of the pleura;
increase in temperature indicators.

Pleurisy is very rarely diagnosed today. Under the influence of treatment directed against inflammation, it is possible to achieve a rapid reversal of the changes.

Abdominal syndrome

Abdominal pain syndrome in children

The general classification of rheumatism involves the development of abdominal syndrome. It occurs in childhood if rheumatic disease is acute. This condition manifests itself as the sudden formation of localized painful sensations in the abdomen. These pains can cause nausea, vomiting, constipation, and diarrhea. The pain syndrome is migrating in nature, accompanied by fever, slight tension in the abdominal wall and painful sensations during palpation.

The cause of damage to the abdominal organs is the presence of rheumatic peritonitis. For this reason, it is combined with polyarthritis and serositis of other localizations. Peritoneal manifestations leave the patient after a few days, there are no relapses.

Rheumatic chorea

This disease is the main manifestation of rheumatism. The development of chorea is observed in children and adolescents, and is often diagnosed in pregnant women. Rheumatism in children is manifested by the following symptoms:

development of selfishness;
increased agitation;
passivity;
lack of attention;
fatigue;
aggressiveness.

Against this background, young patients often complain of muscle weakness.

Heart pathology

Rheumatism of the heart is an inflammatory process that affects the membranes of the heart. During the period of relapse, the connective tissue of the organ is disorganized. As a result of this, rheumatic nodules are formed, then scarred and the development of heart disease.

The pathological process can affect various organ membranes. There are cases when all the membranes of the heart fall into its captivity. When the muscles of the organ are affected, the disease is called the myocardium; when the outer membrane is affected, it is called the pericardium.

Rheumatism of the heart

Rheumatism of the heart has the following characteristic symptoms:

heart pain;
uneven beating of the organ, malfunctions;
impaired breathing even when performing physical activity.

During diagnosis, the patient may experience an increase in the boundaries of the heart muscle, the formation of noise during its functioning, as well as changes in the plasma. Against this background, the formation of heart failure is possible.

Cause, mechanisms of occurrence and pathogenesis of rheumatism

The factor that provokes the occurrence of rheumatism is an infection caused by beta-hemolytic streptococcus group A. This pathogen initially causes throat diseases - tonsillitis, scarlet fever, pharyngitis, cervical lymphadenitis, erysipelas, and also releases specific toxins. The body reacts to this by producing antibodies and immune reactions. However, due to individual characteristics, some people's immune systems respond incorrectly. As a result, the pathogen manages to “deceive” it, it begins to destroy the connective tissue of its own body - damage to the joints, heart, and other organs occurs.

Predisposing factors for rheumatism: hypothermia (especially in the autumn-spring period), young age, reduced immunity, large groups (schools, kindergartens, etc.), heredity. A polygenic type of inheritance has been established. The disease is shown to be associated with the inheritance of certain variants of haptoglobin, an alloantigen of B lymphocytes. A relationship with antigens HLA, A11, B35, DRs, DR7 was revealed. With damage to the heart valves, the frequency of carriage of HLA, A3 is increased, and with damage to the aortic valve, B15.

L. I. Benevolenskaya et al. identified a group of risk factors for the development of rheumatism, which is important for its prevention:

the presence of rheumatism or diffuse connective tissue diseases, as well as congenital connective tissue deficiency in first-degree relatives;
female;
age 7-15 years;
previous acute streptococcal infection, frequent nasopharyngeal infections;
carriage of the B-cell marker D8/17 in healthy individuals and, first of all, in relatives of the proband (→ the person with whom the study begins, in this case, the sick person).

Modern science considers the toxic-immunological theory of the pathogenesis of rheumatism. Beta-hemolytic streptococcus produces biologically active substances that have a pronounced cardiotoxic effect and can suppress phagocytosis and damage lysosomal membranes, the main substance of connective tissue. There is a certain immunological relationship between streptococcal antigens and myocardial tissue. Streptococcal toxins cause the development of inflammation of connective tissue and the cardiovascular system; the presence of antigenic commonality between streptococcus and the heart leads to the inclusion of an autoimmune mechanism - the appearance of autoantibodies to the myocardium, antigenic components of connective tissue (structural glycoproteins, proteoglycans), antiphospholipid antibodies, the formation of immune complexes, and aggravation of inflammation.

Analyzes

To diagnose rheumatism, blood is taken from a vein. The doctor may be alerted to indicators such as:

leukocytosis, that is, an increased concentration of leukocytes;
the presence of antibodies to streptococci;
protein defects in blood composition;
detection of antibodies to enzyme substances of streptococci in the body;
increased ESR;
decrease in hemoglobin level;
detection of specific C-reactive protein.

In addition, during the initial examination, the doctor may notice signs of polyarthritis (redness and swelling of the joints, they are hot to the touch). If diagnostic measures are carried out comprehensively, it is possible to accurately diagnose the patient with rheumatism.

To determine the diagnosis, the manifestation of one of the following complex signs is required:

impaired cardiac function (carditis), as well as the release of antibodies from the patient’s blood against streptococcus;
bright external manifestations (articular swelling, etc.) and abnormalities of the heart;
cardiac defects and the existence of two laboratory indicators that indicate rheumatism;
two specific symptoms in the anamnesis (cardiac abnormalities, joint inflammation, skin rashes, rheumatic nodes, minor chorea) and one nonspecific (hyperthermia, cardiac arrhythmias, changes in laboratory test values);
three nonspecific symptoms and one specific.

The treatment of rheumatism and arthritis is largely similar.

Treatment

The main goal when diagnosing rheumatism is to suppress streptococcal infection, which primarily causes the development of the disease and its complications. To treat the disease, a specific technique is used, which varies slightly, based on the individual characteristics of the patient - age, form of the disease, complexity of the course.

Important! It must be remembered that rheumatism of the joints is completely cured if only the mildest form of the disease is present. In other cases, the problem is chronic.

Treatment of rheumatism is carried out comprehensively. During therapy, the use of medications, special dietary nutrition, and adjustment of the physical component of a person’s life are indicated. It is unacceptable to resort to self-medication if the first symptoms of the disease are detected, as this can significantly affect the further quality of life and lead to disability.

In the treatment of rheumatism, the use of the following drugs is indicated:

Bicillin is an antibiotic that is the main one in the fight against the disease. It belongs to the penicillin series of drugs, which allows you to fight directly against the causative agent of the disease, since the drug is more stable and has a longer lasting effect than ordinary penicillin.
Aspirin is used for pain, as it can significantly relieve the inflammatory process and relieve discomfort in the joints. In the first weeks of therapy, the drug can be used in the maximum permissible doses. However, aspirin has a number of contraindications for use by patients who suffer from gastrointestinal disorders - ulcers, gastritis, gastroduodenitis.
Hormonal medications are used for particularly severe forms of the disease, when standard therapy does not have the expected effect. Prescription of medications and their administration are carried out strictly under the strict supervision of the attending physician. Predominantly prednisolone in the maximum dosage.

Diet food

Rheumatism in the active and passive phase suggests the presence of a diet. Nutrition during illness should include as much nutrients, vitamins and minerals as possible, which will allow the body to recover faster and increase its protective properties.

For rheumatism, diet No. 10 is indicated - it does not contain any critical restrictions and is aimed at improving blood circulation processes, normalizing the functions of the heart and liver and kidneys. It must be remembered that meals at the time of exacerbation of the disease should be as light as possible, quickly absorbed by the body and contain a minimum amount of seasonings and salt.

When the disease occurs, the water-salt balance and carbohydrate metabolism are disrupted. Therefore, all dishes should be prepared without adding salt. The patient also needs to remember that saturated and highly concentrated dishes and products are prohibited. This includes rich mushroom, meat and fish broths, sauces, and fruit juices.

The following product names are strictly prohibited:

beans;
mushrooms;
honey;
fresh bread;
fatty poultry and fish;
hard boiled eggs;
chocolate;
flour products;
coffee;
cocoa.

The following products are allowed for consumption:

yesterday's or slightly dried bread;
baked or steamed vegetables;
lean poultry, veal, beef, rabbit;
low-fat sea fish;
vegetarian soups;
weak tea, coffee diluted with milk;
fermented milk products with a low fat content;
ripe fruits, berries;
pasta;
various cereals.

Important! The diet must be followed during the period of exacerbation and for several more days after complete recovery. However, patients who have had the disease must remember that it is better to adhere to a diet of this type throughout their lives, sometimes allowing only some deviations.

Bed rest

Patients with rheumatism are required to adhere to bed rest. With a mild form of the disease, the patient should remain in semi-bed rest for about 10 days. With more complex manifestations of the disease, the period increases to 1 month.

In case of a complex course of the disease, in which all the symptoms and pain are clearly expressed, the doctor obliges the patient to be treated in a hospital setting. The duration of therapy in this case is on average 2 months.

Characteristic symptoms

Symptoms of articular rheumatism are usually acute.

The disease begins with simultaneous damage to several joints at once - both shoulders, elbows, ankles or knees. The pain is sharp, the joints are swollen, red, painful and hot to the touch.

Click on photo to enlarge

Due to severe pain, it is difficult for a person with rheumatic arthritis (inflammation of several joints) to make any movements.

He has a high temperature (up to 40 degrees), sweating, weakness and other signs of general intoxication (poisoning by inflammatory products) appear.

A characteristic sign of articular rheumatism is an increase and decrease in pain and inflammation, first in some joints and then in others.

In 1 or 2% of patients, the disease occurs with skin manifestations - red spots or rings that do not itch and are located on the inner surface of the arms and legs, on the stomach or neck.

Subcutaneous rheumatic nodules in the joint area are very rare.

After 2–4 weeks, the symptoms of rheumatism completely disappear, giving way to other symptoms (heart pain, shortness of breath, rhythm disturbances). After the illness, all joint functions are fully restored.

A very unpleasant, but infrequent manifestation of articular rheumatism is a constantly recurring form. In this case, regular exacerbations are replaced by short and incomplete periods of recovery, and damage to internal organs (heart, lungs) progresses very quickly.

It is the articular form of rheumatism that is rarely complicated. Other complications of the disease are more dangerous:

heart damage (heart disease, rheumatic carditis, myocarditis, cardiosclerosis, endocarditis, pericarditis);
damage to the central nervous system and sensory organs (chorea - increased muscle tension, impaired coordination of movements);
vascular damage (vasculitis);
damage to periarticular tissues (ligaments, tendons, their membranes, inflammation of periarticular bursae).

Rheumatologist: what does this doctor treat and when to contact him

Rheumatology is a branch of medical science that studies problems of connective tissue, heart, joints, muscular system and bones. Common to all rheumatic diseases is the presence of an inflammatory process and malfunctions of the patient’s immune system. A rheumatologist in Moscow has the opportunity to conduct a full range of examinations, which will allow you to effectively treat and monitor the course of the disease.

Contents of the article: Who is it and what does it treat When to see a doctor What examinations are carried out Advice from a doctor

Who is a rheumatologist

A rheumatologist is a medical specialist whose main task is the timely detection of diseases within his area of competence, a comprehensive examination of patients, and the correct treatment of ailments. It should be noted that in some cases he is not always able to cope with diseases on his own alone. For this reason, a rheumatologist works closely with other medical specialists - infectious disease specialists, cardiac surgeons, immunologists, dermatologists.

What ailments does a rheumatologist treat?

What does a rheumatologist treat? A rheumatologist is responsible for a whole list of pathologies:

heart diseases (rheumatism, infective endocarditis, acquired heart defects);
joint diseases (psoriatic arthritis, infectious arthritis, rheumatoid arthritis);
vascular diseases - systemic vasculitis;
connective tissue pathologies – lupus erythematosus, scleroderma.

In the occurrence of rheumatic diseases, the introduction of a pathogenic infectious agent into a susceptible organism and the malfunction of the immune defense system are important.

The immune system is constantly attacked by a variety of aggressive agents (infection, chemicals). Being a reliable guard for your body, immune cells destroy everything harmful that tries to harm it. At some point, it cannot withstand such a load, it malfunctions and ceases to distinguish one from another. From this time on, the cells of one’s own body are perceived as foreign and destroyed – autoimmune inflammation develops.

Who gets sick more often

Rheumatic diseases occur at any age, in people rich and poor, famous and ordinary. Diseases affect men and women equally often. However, some of them (osteoarthritis, osteoporosis) occur more often in mature people.

Some of this list of ailments more often affect representatives of one of the sexes. Thus, men more often suffer from gout, ankylosing spondylitis, and psoriatic arthritis. Women more often develop rheumatoid arthritis, systemic connective tissue lesions, such as lupus erythematosus, scleroderma, and vascular diseases.

What are systemic diseases

What does a rheumatologist treat in adults? The competence of a rheumatologist is diseases of the heart, blood vessels, joints, connective tissue, which are chronic. Their occurrence is facilitated by impaired functioning of the immune system.

Heart diseases

The following ailments are included in this group:

rheumatism;
infective endocarditis;
heart defects that arise during a person’s life.

Rheumatism develops under the influence of streptococcus. In the development of rheumatism, heredity is of great importance (a defect in the immune system in which it is not able to quickly destroy the microbe). After entering the body, streptococcus actively multiplies and simultaneously affects the heart and joints. During rheumatic attacks, the skin over the joints becomes red and swollen. The patient is bothered by constant aching joint pain. However, after treatment, everything returns to its place and the disease does not leave any changes in the joints. A different fate awaits the heart. After each exacerbation, gross changes remain in it, which ultimately leads to the development of various heart defects.

The occurrence of infective endocarditis is promoted by pathogenic microbes - streptococci, staphylococci, E. coli. They rush to the heart valves and begin to destroy them. The patient is concerned about elevated body temperature, which can sometimes rise to life-threatening levels. The sufferer's skin becomes pale and even greyish. He is constantly shivering. Over time, such a patient develops a heart defect.

In a healthy person, blood moves freely through the heart and blood vessels along a strictly defined route. Under the influence of diseases or injuries, such obstacles arise in its path - an acquired heart defect is formed. Our tireless pump (heart) has to work in more difficult conditions - push out blood under high pressure, pump more significant volumes of blood. The heart cannot work for a long time under such conditions. The patient begins to experience shortness of breath, his legs swell, and fluid accumulates in the lungs and abdominal cavity.

Joint diseases

What does a rheumatologist treat from a large list of joint diseases? A rheumatologist treats the following joint diseases:

rheumatoid arthritis;
infectious arthritis;
arthritis caused by metabolic disorders;
joint damage due to psoriasis.

Rheumatoid arthritis develops under the influence of rubella viruses, herpes, and retroviruses. People whose ancestors also suffered from this disease often get sick (heredity matters). Women get sick more often than the stronger half of humanity. Often the disease develops in patients after 45 years of age. The risk of getting sick increases if a woman suffers from some other chronic illness. In rheumatoid arthritis, small joints are affected symmetrically (on both sides). Over time, they become deformed, become immobile, and the muscles atrophy. A person becomes disabled.

With gouty arthritis, the joints are destroyed under crystals of uric acid salts, the metabolism of which is disrupted by the disease. Salts are also deposited in the skin throughout the body, in tendons, and soft tissues (tophi are formed). After some time, they burst, and a white mass flows out, resembling cottage cheese in appearance. Men suffer from this disease more often than women.

Diffuse connective tissue lesions

Connective tissue is present in all organs of the human body. For this reason, damage to connective tissue leads to disruption of the functioning of many organs at the same time. The complaints are so varied that they do not make it possible to immediately make an accurate diagnosis. This group of diseases includes:

lupus erythematosus (SLE);
scleroderma;
dermatomyositis;
Sjögren's syndrome and a number of other ailments.

With all these diseases, damage to the skin, joints, kidneys, lungs, heart, and intestines occurs.

Skin manifestations of systemic connective tissue diseases vary somewhat:

with SLE (lupus erythematosus) – red rash on the face in the form of a butterfly;
with scleroderma - thinning of the skin and the appearance of dense scars of different sizes and shapes;
with dermatomyositis – red rashes on open areas of the skin, the appearance of “spider veins”.

These diseases occur more often in women. Among the possible causes of their occurrence, rheumatologists cite the influence of viruses (measles, rubella, herpes), constant stress, hypothermia, and excessive sunbathing. Rheumatologists attribute a major role to heredity.

Pediatric rheumatologist

What does a pediatric rheumatologist treat? Unfortunately, these types of illnesses also occur in childhood. Their treatment should be entrusted to a pediatric rheumatologist.

A child’s body has a number of features that distinguish it from an adult’s body:

all his organs continue to grow;
organ function is very dependent on the influence of pathogenic agents and harmful environmental factors;
the inflammatory reaction occurs very quickly and with high activity.

Treatment regimens and doses of medications differ - in each case they are calculated depending on the age and weight of the child. A pediatric rheumatologist in Moscow constantly encounters rheumatoid arthritis in childhood, rheumatism, and diffuse connective tissue diseases.

In what situations is it necessary to contact a rheumatologist?

What symptoms should you consult a rheumatologist for? The manifestations of diseases treated by a rheumatologist are different. However, the following symptoms should alert the patient and make him “sound the alarm”:

body temperature is constantly slightly elevated;
chills for a long time;
worries about pain in the joints;
after hypothermia, pain increases significantly;
swelling of the joints appears;
In the morning, movements in the joints are difficult (morning stiffness);
painful nodules appeared under the skin of the joint area;
a vascular pattern appeared on the skin, similar in appearance to a mesh.

If similar complaints appeared after some kind of infectious disease (especially if it was not treated properly), you should not waste time and postpone the visit “for later”. Connective tissue diseases, if not treated by a rheumatologist, lead to irreversible complications and make a person deeply disabled.

What examinations will a rheumatologist perform?

First of all, a rheumatologist will interview the patient and conduct an examination. In addition to complaints, the rheumatologist will be interested in:

after which complaints arose (did the patient suffer from any infectious disease);
in what order new signs of the disease appeared;
whether any of your close relatives had anything similar;
whether the patient has long-term contact with harmful chemicals - at work, living in a contaminated area.

After the examination, the doctor will suggest the following tests:

detailed blood test - to identify signs of an inflammatory reaction in the body;
determination of the activity of the inflammatory process in the blood (so-called rheumatic tests);
Analysis of urine;
biochemical blood parameters;
determination of electrolytes in the blood;
blood test for the presence of pathogenic agents in the body;
detection of slow-onset infections;
scraping from the urethra or cervix for the presence of intracellular infection;
joint puncture and analysis of synovial fluid;
EKG;
Ultrasound of the heart;
Ultrasound of the kidneys;
x-ray of joints;
MRI (if necessary);
computed tomography.

Each patient is examined by a rheumatologist according to an individual plan. First, examinations are carried out, which are mandatory for everyone. Then, the rheumatologist prescribes additional tests based on the results of the first tests.

Advice from a rheumatologist

Every person should remember that it is easier to avoid a disease than to cure it later. Therefore, it becomes very important to protect yourself as much as possible from the adverse influences of the external environment and properly organize your life.

First of all, it is worth analyzing what diseases close relatives and grandparents have suffered or are suffering from. These diseases can be transmitted genetically, so it is urgent to eliminate risk factors for their development:

exclude from the diet foods rich in preservatives and other harmful chemical agents;
enrich the diet with natural products;
do not forget about vitamin-rich vegetables and fruits;
eliminate smoking (active and passive);
drink enough clean water daily (will help maintain healthy joints for a long time);
stay in the fresh air longer;
move to live away from chemical plants, railroads, and major highways (if possible);
avoid hypothermia and stress;
Avoid prolonged exposure to direct sun.

Annual preventive examinations will help to detect the disease in time. They should not be neglected. Only a doctor should treat any disease. Self-medication can lead to the development of severe complications and disability.

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Acute rheumatic fever: what kind of disease is it and what danger does it pose?

Acute rheumatic fever (ARF) is a dangerous disease that mainly affects children or young people under 20 years of age. In Russia, the pathology has been diagnosed extremely rarely lately; it mainly affects Asian residents.

As a result of infection with streptococcal infection, individuals with a hereditary factor develop an acute inflammatory process of connective tissues, which spreads to the heart, joints, nervous system and brain. Without timely treatment, this disease can cause severe complications.

Features of the disease

The disease develops against the background of acute tonsillitis, tonsillitis or scarlet fever caused by aggressive beta-hemolytic streptococci of group A. This type of infection is extremely toxic and dangerous because it provokes the development of an autoimmune process, as a result of which the immune system works against the own cells of the heart and blood vessels. This only happens if the body has a genetic predisposition to rheumatism.

According to statistical data, the pathology is observed mainly in females and is transmitted genetically from first-degree relatives. Acute rheumatic fever is often called a disease of social ill-being. This is due to the fact that predisposing factors are:

living conditions in which a large number of young people live in one room (students);
countries where medical care is low and there is no sanitary culture;
poor nutrition and living conditions, low material standards.

The majority of people, after suffering from an illness caused by streptococcus, develop lasting immunity. And in individuals who are genetically predisposed, there is no immune response and, with secondary infection, a complex autoimmune inflammatory process begins.

Streptococcus antigens, circulating in the bloodstream throughout the body, settle in the tissues and vessels of the cardiovascular system, causing inflammation due to high toxicity. This leads to the development of progressive rheumatism. If treatment is not started at an early stage, then an irreversible process of necrosis of cells and collagen fibers develops, which causes a severe form of sclerosis.

Classification of the disease

ARF is classified according to several indicators:

depending on the phase of the disease;
according to clinical indicators;
according to the degree of involvement of various body systems in the inflammatory process.

Primary and recurrent rheumatic fever

The primary form of the disease begins suddenly, has pronounced symptoms and an active inflammatory process. If timely therapeutic assistance is provided, treatment can be quick and effective.

Repeated infection as a result of hypothermia and stress causes a relapse and progressive course of rheumatism.

Classification according to disease manifestations

The disease can occur with varying degrees of intensity:

acute form - has a sudden onset, active process and polysyndromic lesions;
subacute degree - inflammation develops gradually over several months, has vague symptoms, a moderate process and a low effect of therapy;
protracted form – characterized by a long-term, sluggish inflammatory process;
latent course - has no symptoms, is detected during the diagnosis of heart disease;
recurrent rheumatic fever has an undulating clinical course, with phases of exacerbation and remission; damage to internal organs occurs quite quickly.

Severity of inflammation

The disease has different degrees of damage to internal organs:

heart disease may or may not develop, but the heart is involved in the inflammatory process, which is fraught with myocardiosclerosis and rheumatic carditis;
joints, respiratory organs, kidneys, skin are involved in the inflammatory process; neurorheumatism may develop;
the clinical picture is characterized by polyarthritis, chorea, carditis, subcutaneous nodules and annular erythema;
persistent circulatory disorder causing heart failure.

Serous membranes and internal organs are rarely affected, more often with the repeated development of rheumatism. Mainly the joints and cardiovascular system are affected.

Causes of the disease

There are two main causes of rheumatic fever.

Aggression of beta - hemolytic streptococcus A - type

The main factor causing the disease is the strain of streptococcal infection type A. More often this occurs against the background of previous ENT diseases:

purulent sore throat;
scarlet fever;
pharyngitis.

Hereditary factor

Despite the high pathogenicity of the strain, not everyone is at risk of developing rheumatism. And only those who have a specific antigen in their body, thereby determining a hereditary predisposition to acute rheumatic fever.

Symptoms of acute rheumatic fever

As a rule, the first signs of fever appear 2 weeks after an infectious disease. At first, the patient's condition improves; a period of false recovery may be accompanied by sluggish symptoms in the form of weakness and slightly enlarged lymph nodes. It is at this moment that specific antibodies are synthesized and the disease develops.

The majority of children and adolescents during the acute period of the disease experience the following symptoms:

a sharp increase in body temperature up to 400C;
development of pain in joints of different localization: pain can occur in the knees, elbows and hip joints, constantly moving;
periarticular tissues turn red and swell;
signs of rheumatic carditis appear: pain in the chest, arrhythmia, low blood pressure.

In young children, symptoms are more pronounced, in contrast to adolescents and young children. Their symptoms are moderate:

body temperature does not exceed 38.50C;
pain in the joints is less pronounced, swelling and inflammation do not always accompany pain;
symptoms of rheumatic carditis are vague.

Primary fever manifests itself with striking symptoms:

due to severe pain in the joints, the patient’s mobility is limited;
the pain syndrome is wandering in nature, manifesting itself in different places, but responds well to drug treatment;
the joints have obvious swelling and inflammation, with characteristic redness;
heart rhythm disturbances are observed in 90% of patients;
difficulty breathing and pain in the left side of the chest;
swelling of the lower extremities is accompanied by increased sweating and fatigue;
obvious heart failure due to damage to the heart valves and decreased tone of blood vessels; when listening to the heart, characteristic noises are heard;
Rheumatic nodules are extremely rare, but accurately diagnose rheumatic fever.

Skin rashes in the form of red dense nodules occur only in children, are localized on the chest, back, under the skin in the joint area and disappear within a month.

How is the disease diagnosed?

Due to similar symptoms to other diseases, diagnosing ARF is often difficult. If signs of carditis are observed, the first step to determine the diagnosis is:

An echocardiogram in Doppler mode, which allows you to determine at what speed and in what direction the blood moves in the veins and arteries, as well as the pressure in the vessels. A study of the condition of the coronary vessels and structural changes in the heart gives an idea of the degree of damage to the valves and the inflammatory process of the cardiac membrane.
An electrocardiogram records all pathological changes in heart rhythm, which indicates the condition of the heart muscle.

A laboratory blood test is required, the indicators of which give an idea of the following:

with an increased erythrocyte sedimentation rate (ESR) and an increased amount of reactive protein, which characterizes inflammation in the liver, we can conclude that acute inflammation is developing in the body;
for rheumatic fever, a blood test is performed to check for the presence of antibodies against streptococci (they are elevated).

In addition, a swab is taken from the oral cavity for bacteriological examination for the presence of a hemolytic streptococcal agent. Differential diagnosis is also carried out to exclude other heart diseases. Based on a comprehensive examination of the patient, the doctor prescribes treatment.

Treatment of acute rheumatic fever

The purpose of treatment is as follows:

eliminate the cause of the disease;
normalize metabolic processes in the body and stabilize the functioning of damaged organs, as well as significantly increase immunity;
influence the patient’s condition by eliminating symptoms.

Most patients are subject to hospitalization, especially children. They need strict bed rest for 21 days and a dietary diet. Depending on the patient’s condition, the doctor prescribes medication and physical therapy. In severe cases, surgery may be required.

Medication

For streptococcal infections, only antibiotics are used. These may be penicillin drugs, and in case of individual intolerance they are replaced with macrolides or lincosamides.

For the first 10 days, antibiotics are used as injections, and then tablets are prescribed.

If carditis is diagnosed, hormonal therapy using glucocorticosteroids is used. This is done under the strict supervision of a doctor.

For symptomatic treatment, the following drugs are used:

Diclofenac - to eliminate pain and inflammation in the joints, the course of treatment can last up to 2 months;
Digoxin – as a stimulant to normalize myocardial function;
Asparkam – for dystrophic changes in the heart;
Lasix – as a diuretic for tissue swelling;
Immunostimulants to improve the body's defense reactions.

The duration of treatment and dosage is determined by the doctor. It depends on the condition and age of the patient.

Surgical intervention

Surgical treatment is performed only in cases of severe heart disease. Then the attending physician decides on the need for surgical treatment. The patient may undergo plastic surgery or replacement of heart valves.

Physiotherapy

Physiotherapeutic procedures are carried out in parallel with the main treatment:

paraffin and mud applications;
UHF heating;
treatment with infrared rays;
radon and oxygen baths.

At the recovery stage, a course of therapeutic massage is prescribed, which must be carried out by a specialist.

Nutritional Features

Considering that with this disease allergic reactions are activated due to metabolic disorders, it is necessary to introduce a dietary diet and follow a number of rules:

limit consumption of fast carbohydrates;
exclude fat;
reduce the amount of salt when preparing dishes;
Be sure to eat proteins and vegetable fats;
the diet should be rich in vitamins and minerals;
method of preparing dishes - boiling, stewing, baking, all ingredients must be soft;
diet - fractional, at least 6 times a day, liquid - no more than 1 liter.

What are the consequences of the disease and complications

With timely diagnosis and adequate therapy, the prognosis is usually positive, but some patients may experience serious complications:

development of a chronic form of the disease, heart disease, mitral valve atrophy;
in children, prolapse or stenosis, heart failure occurs in 10% of cases;
arrhythmia, tachycardia;
risk of developing endocarditis.

Death is extremely rare, but the consequences can be serious.

Risk factors

The presented disease occurs due to the activation of bacteria, usually beta-hemolytic streptococcus. It influences the formation of rheumatic disease.

Rheumatism of the legs is an ailment that is not epidemic in nature. Here, swelling of the joints of the legs can affect a number of other small and large vessels. As a rule, the formation of this disease is facilitated by a weakened immune system, which is unable to cope with a streptococcal infection that has entered the human body.

Treatment and prevention of rheumatism

Treatment of rheumatism is a rather complex, lengthy and persistent process.

It must be carried out by a rheumatologist. For the treatment of rheumatism, a three-stage system is used: Stage I - in the active phase of the disease - long-term (4-6 weeks) treatment in a hospital; Stage II - post-hospital sanatorium-resort treatment (resorts of Kislovodsk, Southern coast of Crimea); Stage III - preventive treatment and observation by a rheumatologist at the place of residence.

The main groups of drugs used in the treatment of rheumatism are as follows:

Antibiotics, mainly penicillin and its derivatives;
NSAIDs: diclofenac, ibuprofen, naproxen, etc.;
Glucocorticoids: prednisolone, methylprednisolone, dexamethasone, etc.;
Immunosuppressants (plaquenil, delagil, imuran);
γ-globulins;
Vitamins (mainly C, sometimes B12 and others).

It is necessary to identify and sanitize inflammatory foci (tonsils, carious teeth, sinusitis, etc.).

During the rehabilitation period, chondroprotectors can be used, as well as physiotherapy, ultraviolet radiation, electrophoresis of drugs, heating with a Sollux lamp or infrared ray lamp, UHF, paraffin baths.

In the active phase of the rheumatic process, in order to improve blood circulation and eliminate the consequences of immobility, it is recommended to massage the limbs. Also, the complex of therapeutic measures necessarily includes physical therapy. The specific choice of drugs and procedures, their combinations and dosage are always determined individually by the attending physician. Treatment of rheumatism, in addition to active therapy in the acute period, includes long-term prevention of relapses (dispensary registration, taking NSAIDs, hardening, sanitation of inflammatory foci).