Extra-articular rheumatism. Causes, symptoms and treatment

Detailed description of the study

There are a large number of different joint diseases. Among them are often found: rheumatoid arthritis, gout, post-infectious joint damage. Inflammation in the joints is manifested by swelling, tenderness, redness and a local increase in temperature in the affected area. Patients often experience pain and impaired joint mobility. In the future, their deformation, destruction of cartilage tissue, and narrowing of the joint space may occur. Some diseases, such as rheumatoid arthritis, also have systemic manifestations: a person notices pathological weakness, fatigue, weight loss, and fever.

It can be difficult to make a differential diagnosis of joint diseases due to similar symptoms. Laboratory tests help establish the correct diagnosis.

This study contains two tests necessary to identify the cause of joint inflammation:

1. C-reactive protein;
2. Uric acid.

C-reactive protein (CRP) is one of many molecules involved in immune responses. CRP is detected in the blood of patients during various inflammatory processes and is considered a marker of the acute phase of their course. An increase in CRP levels is observed within the first four hours after tissue damage and reaches a peak after 24–72 hours.

The content of CRP during inflammation can be increased by 20 times or more. The most common joint diseases that are accompanied by increased CRP are:

1. Rheumatoid arthritis;
2. Gout;
3. Reactive arthritis.

CRP is also a marker of disease activity.

It should be noted that determining the level of CRP plays an important role in assessing joint inflammation, but is not a specific marker for this group of diseases. The indicator may reflect inflammation of another localization, including against the background of acute infections, injuries, and others.

Uric acid is one of the main products of protein metabolism in the human body. This substance is mainly excreted in the urine. When there is an excessive level of uric acid in the blood (hyperuricemia), deposition of its salts (urates) is observed with the formation of crystals. The latter are deposited in joints, subcutaneous tissue, and kidneys (where urates can form stones).

Gout is a systemic pathology, which is characterized by the accumulation of monosodium urate crystals in the joints, as well as other organs and tissues. An increase in uric acid levels suggests that joint inflammation is associated with the development of this disease.

Thus, this comprehensive study will help the doctor in differential diagnosis of the causes of joint damage and selection of therapy.

It is necessary to donate venous blood for analysis. Often the complex is prescribed in conjunction with other studies, such as general analysis and blood biochemistry, to check other organs and systems.

A detailed description of the studies and reference values ​​are presented on the pages with descriptions of individual studies.

Rheumatism of the joints - symptoms and treatment

In this article I will tell you about rheumatism of the joints: we will talk about its symptoms and treatment, and discuss some misconceptions associated with this disease.

Very often, upon entering my office, a middle-aged man or woman declares from the threshold: “Doctor, my joints hurt. It's probably rheumatism." As a specialist, such statements always make me smile, because in fact, rheumatism is much less common than people imagine.

In addition, rheumatism is a disease of children and adolescents aged 6 to 15 years. The chance of getting this disease in those over 30 years old is almost zero. And even in the classic age group for rheumatism of children 6-15 years old, only one child in a thousand suffers from it. The question arises: if rheumatism is so rare, why do we hear this term so often? Most likely, the “memory of our ancestors” is taking its toll. In earlier times, rheumatoid arthritis was more common. But over the past 50 years, thanks to the advent of antibiotics and the efforts of medicine, the incidence of rheumatism in our country has decreased several times.

The second reason why rheumatism was mentioned much more often in earlier times relates to the category of literature. Previously, the word “rheumatism” meant any joint diseases - arthrosis and arthritis.

Doctors simply did not need to differentiate different joint diseases - after all, in most cases they were all treated with the same methods, since the choice of healing procedures was small. Fortunately, now the capabilities of medicine have increased significantly. And in our time, not a single competent rheumatologist or arthrologist will confuse the manifestations of true rheumatism with the symptoms of any other disease.

Symptoms of rheumatism

Manifestations of rheumatism are very characteristic. As already mentioned, mainly children and adolescents get sick. The disease usually develops 1-3 weeks after a streptococcal infection of the upper respiratory tract: after pharyngitis (inflammation of the pharynx), tonsillitis or tonsillitis (inflammation of the tonsils).

Streptococcal infection does not always manifest itself clearly. Sometimes it occurs latently and atypically, with minimal fever and mild sore throat, so often in such cases doctors diagnose acute respiratory infections and do not provide antistreptococcal treatment. Meanwhile, an untreated streptococcal infection, especially if it occurs repeatedly and against the background of reduced immunity, can lead to joint rheumatism. And a few days after suffering from a sore throat or pharyngitis, inflammation of any large joints occurs: knees, wrists, ankles, elbows and shoulders (small joints of the fingers or toes are rarely affected by rheumatism).

In this case, the joints become inflamed in turn. Let's say, first the knee joint becomes inflamed. Then, after a few hours or days, this inflammation disappears, but another joint becomes inflamed, then a third, etc. This alternating “flaring” of the joints is the “calling card of rheumatism.” Moreover, inflammation of the joints is in the nature of a short-term attack, the duration of which rarely exceeds 10-12 days. But there are usually several such attacks, and, worst of all, each such attack ultimately hits not so much the joints as the heart.

The consequence of rheumatism not cured in time most often becomes rheumatic heart disease (rheumatic inflammation of the heart). Rheumatic carditis can be mild, moderate and severe. The process involves the heart muscle (myocarditis), the lining of the heart (pericarditis) and the heart valves.

In mild forms of rheumatic carditis, not the entire heart is affected, but only certain areas of the heart muscle. The blood circulation of the heart is not impaired, and external manifestations of the disease are usually absent. This form of the disease is the most common and usually goes unnoticed.

With moderate rheumatic carditis, the heart muscle is more severely affected; the heart moderately hypertrophies (increases in size). Patients note discomfort in the chest and behind the sternum, complain of shortness of breath, increased fatigue when climbing stairs and walking (even slowly), and a feeling of palpitations during normal household activities.

With severe rheumatic carditis, the heart weakens even more; its size increases significantly. Patients, even in complete rest, are bothered by pain in the heart, shortness of breath and palpitations; swelling appears in the legs. A severe form of rheumatic carditis very often leads to the appearance of heart defects, that is, to shrinkage of the heart valves.

In addition to rheumatic carditis, chorea, a rheumatic lesion of the nervous system in children, can be a consequence of rheumatism not cured in time. As a result of chorea, a child or teenager becomes irritable, capricious, absent-minded, and sloppy. His handwriting and gait change, his speech and memory deteriorate, and his sleep is disturbed. In the early period of the illness, parents and teachers tend to attribute such changes in behavior to the child’s capriciousness and indiscipline, and seeking medical attention is postponed. Parents begin to “ring the bells” only when the child develops involuntary twitching of the muscles of the face, torso, arms and legs.

Fortunately, chorea, like rheumatic inflammation of the joints, goes away without a trace over time. And only rheumatic heart disease, if treatment is not started on time, can lead to serious health problems and early disability of the patient. Therefore, it is important to devote all your efforts to treating rheumatism before it has time to strike your heart.

Treatment of rheumatism

The main task facing us in the treatment of rheumatism is to suppress streptococcal infection, which causes the development of the disease and provokes its numerous complications. Currently, of the entire large group of antibacterial agents, penicillin (bicillin) and its analogues are most often used to treat rheumatism. Active therapy with penicillin usually lasts about two weeks, and then for five years, every three weeks the patient is given one injection of bicillin intramuscularly to prevent rheumatic complications of the heart.

tablet forms of “broad-spectrum” have been successfully used in recent years for rheumatism Oxacillin, ampicillin, erythromycin, cephalosporin, and a number of other drugs are very effective for rheumatism.

Along with antibiotics, during the period of joint attack of rheumatism, non-steroidal anti-inflammatory drugs are prescribed to eliminate joint pain, which act almost immediately and completely eliminate pain.

Typically, rheumatism is so well treated with antibiotics and non-steroidal anti-inflammatory drugs that they are usually sufficient to completely defeat the disease. Only in rare cases do antibiotics and non-steroidal anti-inflammatory drugs prove to be ineffective. Then you have to resort to extreme measures - prescribe corticosteroid (anti-inflammatory) hormones, which, in combination with antibiotics, suppress rheumatic inflammation literally in a matter of days.

Prevention of relapses of rheumatism

Treating rheumatism in a timely manner and stopping (stopping) its attack is only half the battle. It is more important to prevent repeated attacks and exacerbations of the disease. To do this, it is necessary to pay attention to restoring the body’s defenses, its immunity, as well as preventing the possibility of repeated infections with streptococcal infection, to which a person who previously suffered from rheumatism is especially sensitive. Therefore, all those suffering from rheumatism must be sent to specialized sanatoriums.

After discharge from the sanatorium, within a year or two from the last rheumatic attack, it is advisable to rest in the summer only in your own climatic zone: at the dacha, in holiday homes or in sanatoriums (since long trips to foreign climatic zones are associated with inevitable acclimatization and the risk of complications). All this time, doctors do not recommend that people who have suffered an attack of rheumatism sunbathe a lot and swim for a long time in cold water - cold rivers, lakes, etc. You can swim and sunbathe only in such a way as to prevent extreme temperature effects on the body weakened by rheumatism.

It is also undesirable to actively engage in sports in the first few years after suffering a rheumatic attack. Great physical activity leads to overexertion of a heart weakened by disease and accelerates its wear and tear. On the other hand, completely stopping physical education and ignoring hardening also does not improve health. Therefore, you still need to toughen up and exercise, but little by little. When doing physical exercise, a person who has suffered from rheumatism must control his pulse and breathing. If you experience shortness of breath and a pulse rate of more than 120 beats per minute, you must take a break and rest, and only after the pulse has normalized, continue the exercises, but at a slower pace.

To conclude this section, I would like to give the basic rules for preventing repeated rheumatic attacks, which are indicated by scientists from the Institute of Rheumatology in the “Book for Patients with Rheumatic Diseases.” These are the rules. You need:

• maintain constant contact with your doctor;
• follow the doctor’s instructions regarding the daily routine, hardening, physical training, treatment, and, if possible, avoid participation in those sports games, competitions, hikes that are not authorized by the doctor;
• in case of any acute illness or deterioration in health, immediately consult a doctor and do not self-medicate;
• treat sore teeth, chronic inflammation of the tonsils or pharynx in a timely manner;
• carry out prescribed preventive antibiotic therapy in a timely manner.

And for parents of children who have had rheumatism, the same reference book reminds that a calm and friendly environment in the family will help strengthen the child’s health. Which I agree with one hundred percent.

Nutrition for rheumatism

diet No. 10 during their illness and for another year or two after the last attack of rheumatism . In addition to following diet No. 10, there are additional nutritional rules for those patients whose rheumatism is in the active phase, that is, at the time of exacerbation or during a rheumatic attack.

Since metabolism is disrupted during a rheumatic attack, especially water-salt and carbohydrate metabolic processes, all dishes are prepared without salt or with a minimum of salt. In addition, you need to limit the use of seasonings containing salt (remember that even soy sauce contains a large amount of sodium salt). It is necessary to exclude from the diet or minimize the consumption of dishes containing extractive substances - strong meat and vegetable broths and soups, especially soups from bags or prepared on the basis of bouillon cubes. It is necessary to temporarily limit the consumption of foods containing easily digestible carbohydrates (sugar, jam, honey, confectionery).

Mushrooms, peas, legumes, sorrel and spinach should be practically excluded from the diet. Grapes and grape juice are not recommended for fruits. Meat and fish are recommended only boiled or lightly stewed, and vegetables should be well cooked.

You need to eat little by little, but often - about 5-6 times a day.

In addition, in the acute phase of rheumatism, we need to replenish the loss of vitamin B caused by increased vascular permeability in this disease. Vitamins C, P, PP, B1, B2, B6, B12 must be added to the diet. You can include drinks made from brewer's and baker's yeast in your diet, since yeast supplies large doses of natural B vitamins.

Strict adherence to the above nutritional rules must be observed throughout the entire acute phase of the disease and plus 3-5 days after its end. After getting out of the crisis, if you feel well, you can loosen the strict dietary restrictions, but in general you still need to more or less adhere to the above nutritional recommendations.

Article by Dr. Evdokimenko© for the book “Arthritis”, published in 2003. Edited in 2011 All rights reserved.

References

1. Rheumatoid arthritis. Clinical recommendations. Association of Rheumatologists of Russia, 2021. - 102 p.
2. Rheumatology: National Guide / ed. E.L. Nasonova, V.A. Nasonova. - M.: GEOTAR-Media, 2008. - 720 p.
3. Kishkun, A.A. Guide to laboratory diagnostic methods. - M.: GEOTAR-Media, 2007. - 800 p.
4. Internal diseases in 2 volumes: textbook / ed. ON THE. Mukhina, V.S. Moiseeva, A.I. Martynova, 2010. - 1264 p.
5. Kasper, D., Fauci, A., Hauseret, S. Harrison`s Principles of Internal Medicine 19/E (Vol.1). McGraw-Hill Education, 2015.