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There are diseases that constantly remind you of themselves. These include rheumatism. This is a group of various pathologies characterized by painful sensations in the musculoskeletal system: muscles, joints, tendons, bones.

The disease worsens the quality of life. People with inflammatory rheumatism are twice as likely to have a stroke. We need to learn how to resist this disease.

What is rheumatism of the joints?

Rheumatism is a reactive disease following infection with group A streptococci (Lancefield classification) . One to three weeks after infection, bacterial inflammation of various organ systems occurs. Components of the streptococcal membrane, some types of M protein, act as an antigen and stimulate the production of antibodies.

However, streptococcal antigens are similar in structure to the body's own proteins. The resulting antibodies react to endogenous structures and cause inflammation.

Development of joint rheumatism after infection with streptococcus

Rheumatism, like syphilis, is a medical “chameleon”. The disease can affect the joints, heart, brain and skin. Adults are prone to developing arthritis, while children and adolescents develop carditis. Rheumatism is not an independent disease. Many musculoskeletal disorders are classified as rheumatic diseases.

Why does rheumatism occur?

Acute rheumatism occurs after a sore throat caused by group A β-hemolytic streptococcus. During illness, the microorganism releases substances into the blood that are recognized by the immune system as antigens, and antibodies are produced against them. Antigens and antibodies form compounds called immune complexes. Normally, they should be eliminated from the body, but in some people they settle in the heart, joints, and other organs. In response to them, an immune reaction occurs again and inflammation develops.

In addition, streptococcal antigens are structurally reminiscent of substances that are part of human connective tissue. The immune system ceases to distinguish between “friends” and “strangers” and attacks everyone. These mechanisms underlie the development of rheumatism.

People who live in unfavorable conditions and have poor nutrition are more prone to rheumatism. A genetic predisposition has also been noted—families are known in which almost everyone is affected.

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Reasons for the development of rheumatism

The main causes of the disease in adults and children are the same:

• malnutrition;
• decreased immunity;
• the presence of streptococcal infection (scarlet fever, pharyngitis, tonsillitis and a number of others);
• hypothermia of the body;
• hereditary predisposition;
• lack of exercise;
• overwork.

The disease affects adolescents aged 7 to 15 years; girls who have had diseases of the ENT organs (sinusitis, sinusitis, frontal sinusitis, tonsillitis) or streptococcal infection are three times more likely to get sick.

Stages of development and types of rheumatism

The disease often worsens in spring and autumn.

There are three stages of the active phase of rheumatism:

• Minimal (grade I) , symptoms can only be seen when diagnosed using ECG and FCT. In studies, the indicators are only slightly deviated from the norm.
• Moderate (II degree) . An elevated temperature is observed, all the symptoms of carditis are revealed, joint pain, weakness, and fatigue appear.
• Maximum (III degree) . There is an acute and subacute phase of the disease, all the symptoms of the disease and possible complications are encountered. A well-designed treatment program prevents the acute form of the disease and complications of cardiosclerosis - and heart disease.

Rheumatism of the knee

Volatile rheumatism

Mostly children from 7 to 15 years old are affected. It is exclusive before 3 years of age and rarely occurs after 30 years of age. The onset of rheumatic fever 2-3 weeks after a sore throat, nasopharyngitis or sinusitis that has not been treated.

Symptoms:

• Great pallor when anemia.
• High temperature, accompanied by severe sweating, body pain, and chills.
• Hot and painful joints.
• Increased joint volume.
• Regression of pain without complications.
• Sometimes Maynet's nodules appear under the skin and in the area of ​​the affected joints.
• The appearance of spots on the skin (maculopapules - slightly noticeable spots).
• Frequent abdominal pain with hepatomegaly (increased liver volume) or rheumatic peritonitis.

Meynette's nodules or rheumatoid nodules

Rheumatism mainly affects the knees, wrists, ankles and is characterized by severe and short-term pain in the joints. Migrating pain moves, after a few days, from one joint to another.

This rheumatism is also characterized by a tendency to develop cardiac complications such as rheumatic heart disease. The mechanism of this infection is often autoimmune. The patient develops antibodies against his own tissue.

Volatile rheumatism is provoked by the following factors:

• Young age.
• Genetic factors.
• Socio-economic factors.
• The emergence of a streptococcal epidemic in crowded places: schools, army.

Treated with antibiotics and corticosteroids as prescribed by a doctor.

Volatile rheumatism

Chronic rheumatism

Rheumatism that persists over time, passes through attacks and periodic exacerbations - is called chronic. Chronic inflammation develops over a long period of time and can be caused by an autoimmune disease in which the immune system attacks the cartilage.

It is treated with treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and anti-rheumatic drugs.

Most often they get sick:

• overweight older people;
• women after menopause;
• athletes who use their joints intensively.

Chronic rheumatism

Inflammation of the tissues around the joint due to injury or excessive stress can cause inflammation of the muscles, tendons, and ligaments around the joint.

Acute rheumatism

The acute phase develops 1-3 weeks after an infectious disease.

Symptoms:

• joint pain;
• increased body temperature;
• headache;
• hyperhidrosis;
• weakness;
• fast fatiguability.

In places of inflammation there appears: swelling, redness, swelling. The pain is symmetrical or fleeting, sometimes in one or the other joint.

Modern methods of treating rheumatism

A patient with an acute form is hospitalized in a hospital. Treatment includes:

• Bed rest for 2-3 weeks.
• A nutritious diet with limited salt.
• Antibacterial therapy - to combat streptococcal infection.
• Nonsteroidal anti-inflammatory drugs, such as diclofenac, to reduce inflammation.
• In severe cases, glucocorticosteroids (drugs of adrenal hormones that suppress the immune system and have a powerful anti-inflammatory effect).
• After discharge, you need to be observed and continue treatment with a rheumatologist at the clinic. Long-term use of anti-inflammatory drugs and antibiotics helps prevent relapse. The doctor may refer you for rehabilitation to a specialized sanatorium.

Rheumatism is a disease that is usually not life-threatening. Its most serious complication is heart disease, which may require surgical treatment.

If you are worried about pain in your heart or joints, and your therapist finds it difficult to establish the correct diagnosis, make an appointment with a rheumatologist at the Medical Center International Clinic Medica24. You can undergo an examination with us and continue treatment on an outpatient basis if you have been discharged from the hospital with a diagnosis of rheumatism. Make an appointment by phone: +7 (495) 230-00-01

The material was prepared by oncologist, traumatologist-orthopedist of the international clinic Medica24 Andemir Olegovich Akhov.

Diagnostics

Diagnosis is made through a routine medical examination, in which the doctor asks the patient questions:

• about the duration of pain;
• about the nature of the pain, which joints are affected;
• How pain manifests itself when examining joints.

Depending on the location of the pain and symptoms, additional tests are performed:

• Blood analysis.
• MRI.
• Ultrasound scanning.
• CT scan.
• Analysis of fluid in the joint for the presence of bacteria or hardened crystals.

During the active phase of rheumatism, the following is observed:

• increased ESR;
• moderate leukocytosis with a shift to the left;
• anemia.

Diagnosis is made based on medical history, physical examination, laboratory tests, and X-rays of the hands and feet.

Which doctor treats rheumatism?

When your joints cause you pain, consult a general practitioner. If necessary, this doctor will refer you to different specialists: a rheumatologist, a physiotherapist or a traumatologist. As the body ages, the body changes, with bone structure and muscle mass changing over the years.

If you experience persistent discomfort and joint pain, consult a rheumatologist. If rheumatism is suspected, treatment should begin immediately, because the disease is dangerous due to serious complications, in particular the development of severe heart disease.

Rheumatism in children and adults is treated by a cardiologist-rheumatologist.

How does rheumatism occur? What's the prognosis?

There are five types of disease progression:

1. Spicy. It begins suddenly and is accompanied by pronounced symptoms.
2. Subacute. Lasts 3–6 months. Symptoms are less pronounced.
3. Lingering. Lasts more than 6 months. All symptoms are mild.
4. Recurrent. Exacerbations alternate with periods of improvement, but organ disturbances increase over time.
5. Latent. There are no symptoms. During the examination, no abnormalities were detected. At one “wonderful” moment, the doctor diagnoses a heart defect and comes to the conclusion that the patient has been suffering from rheumatism all this time.

The longer the disease lasts, the more difficult it is to treat.

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Signs and symptoms of rheumatism

Rheumatism is a general term for diseases that can affect joints, bones, tendons, muscles, connective tissue, and sometimes internal organs.

There are many different forms that differ:

• duration of pain;
• location of pain;
• number of affected joints;
• duration of symptoms;
• other associated symptoms (digestive tract, skin, eyes, etc.).

Psoriatic arthritis affects 5 to 20% of patients with psoriasis. A very debilitating disease. In men, the joints of the spine are more susceptible to the effects; in women, mainly the joints of the limbs are affected.

Main reasons:

• genetic factors;
• infectious diseases (HIV, syphilis, gonorrhea);
• autoimmune diseases (oncological diseases, diabetes mellitus, thyroiditis, lupus erythematosus);
• There are cases when there is no single cause contributing to the disease.

Tactics for managing patients with rheumatism at the outpatient stage

Rheumatic diseases are one of the most common pathologies of the human body, and, despite the successes in the treatment of rheumatism (R) and heart defects, their importance not only in the medical, but also in the social aspect throughout the world cannot be overestimated. According to WHO, more than 1/3 of cases of temporary disability and 10% of total disability are caused by rheumatic diseases.

Almost every 8–10th person over 15 years of age suffers from some kind of rheumatological disease. Moreover, in young people, disability with rheumatism exceeds this indicator with coronary heart disease and hypertension. According to a national study conducted in the United States in the early 1990s, rheumatic diseases rank second among the diseases of the adult population. Every year in Russia, heart valve defects are registered in more than 230 thousand adult patients and 8.3 thousand adolescent and childhood patients. The incidence of diseases of the musculoskeletal system and connective tissue has a steady upward trend. Despite the fact that the disease begins more often in childhood and young adulthood, heart lesions resulting from R are also diagnosed in adulthood. This is due to the fact that rheumatism with a latent course or asymptomatic manifestations of the disease currently dominates.

Rheumatology, which is an integral medical branch, unites a number of areas of medicine: general therapy, cardiology, nephrology, orthopedics and traumatology, rehabilitation. Careful supervision and continuity between various departments in the management of patients with rheumatic processes are the main principles of the organization of medical care for patients with rheumatic diseases. It is quite difficult to recognize the disease at an early stage. This, on the one hand, is associated with a change in the nature of the course towards the predominance of subclinical, so-called minor forms of the disease, and on the other hand, with the loss of doctors’ alertness towards rheumatism.

Currently, there is a scientific debate around the very term “rheumatism” and the need to revise the classification and nomenclature of the nosological form in question. The term “rheumatic fever” seems to be the most justified, since it draws the doctor’s attention to the need to clarify the connection with infection caused by group A β-hemolytic streptococcus (GABHS), and the subsequent prescription of antibiotics to eradicate this infection in the acute period (primary prevention), as well as to prevent recurrences attacks (secondary prevention). Any practicing physician and researcher should take into account the postulate of J. Rotta, according to which “rheumatism will not disappear as long as group A streptococcus circulates, and the human population, for a number of objective reasons, cannot be rid of streptococcus.”

Clinical picture and course of the disease

Rheumatism as a systemic disease is characterized by a polysyndromic clinical picture. At the same time, along with general changes in the condition of patients, there are signs of involvement in the pathological process of the joints, heart, nervous system and (less often) other organs and systems.

In typical cases, the disease develops 1–3 weeks after GABHS or (less commonly) another infection. With repeated attacks, this period may be reduced. In some patients, even primary rheumatism occurs 1–2 days after cooling without any connection with infection.

In case of P, in addition to heart damage, other organs and systems are often involved in the pathological process. Its characteristic manifestations include articular syndrome, which is accompanied by pain in the joints (arthralgia) and swelling of the periarticular tissues. Intensive use of antibiotics, corticosteroids, changes in the virulence of microbial flora, as well as prevention of R in recent years have led to the fact that indolent R (prolonged, with minimal activity) with predominant damage to the heart has become the dominant clinical form. The decrease in acute forms of P contributed to a more favorable course of the disease: the number of patients with pancarditis, pericarditis, and nephritis decreased. The nature of recurrent rheumatic carditis has also changed: today it does not always result in the formation of heart disease.

During P, two phases are distinguished - active and inactive, which is extremely important for the treatment and prevention of disease progression. Clinical manifestations of P depend on the activity of the inflammatory process. Timely detection of minimal process activity and anti-inflammatory therapy can significantly reduce the number of complications and improve the prognosis of the disease. The influence of minimal P activity on the progression of heart disease, worsening heart failure, and an increase in the number of complications of rheumatic heart disease—arrhythmias, thromboembolism, and acute coronary insufficiency—has been proven.

Relapses of the disease often develop after any intercurrent diseases, surgical interventions, or physical overload.

Diagnosis is based on the syndromic principle formed by the domestic pediatrician A. A. Kisel in 1940, who identified the “Big” diagnostic criteria: migratory polyarthritis, carditis, chorea, annular erythema, rheumatic nodules, drawing attention to the diagnostic significance of their combination . In 1944, the American cardiologist T.D. Jones classified the indicated pentad of syndromes as “large” diagnostic criteria, highlighting along with them “small” clinical and laboratory parameters. The diagnosis of P becomes more likely when “major” criteria (absolute Kisel-Jones criteria) are combined with “minor” ones, which include fever, arthralgia, a history of P or the presence of mature valvular heart disease, changes in laboratory parameters: increased ESR, leukocytosis, positive reaction to C-reactive protein, dysproteinemia, increased levels of immunoglobulins, etc. Data from ECG, FCG, EchoCG and X-ray examination are also taken into account. Great importance is attached to data confirming streptococcal infection: elevated titers of streptococcal antibodies, culture of group A streptococcus from the throat and a recent nasopharyngeal infection.

Laboratory monitoring allows you to choose patient management tactics and make timely adjustments to therapy. To monitor the course of the disease and identify the active phase of the process, tests such as determining the concentration in the blood serum of C-reactive protein, rheumatoid factor and antibody titer to streptococcus (ASO titer) are effective. The importance of immunological parameters for the diagnosis of chronic inflammatory process has now been proven. To detect minimal activity of rheumatism, the most sensitive indicators are the neutrophil level. Changes in the values ​​of NBT test indicators indicate the activity of rheumatism.

Establishing a reliable diagnosis of rheumatism, especially at the initial stage, is often a difficult task. Competent differential diagnosis is of great importance in the correct diagnosis and choice of management tactics.

Treatment of rheumatism

The basis of treatment for P is a phasing system, the essence of which is continuous monitoring and treatment of the patient at all stages of the process (hospital - in the acute phase; local sanatorium, clinics - in the subacute phase; resort - in the inactive phase of the disease).

In case of an acute process, treatment begins in a hospital, continues in a cardio-rheumatological sanatorium and then on an outpatient basis.

The therapeutic program for the treatment of patients with rheumatism consists of antimicrobial and anti-inflammatory treatment, measures aimed at restoring immunological homeostasis, organizing a rational balanced diet and adaptation to physical activity, as well as preparation for work load, timely surgical treatment of patients with heart defects.

Pathogenetic therapy of P still remains an important problem in modern medicine. Along with immune disorders, rheumatism develops such complex pathological processes as inflammation, sclerosis, depolymerization of the main components of connective tissue and others, on which the outcome of the disease itself depends. Therefore, it is important that antirheumatic drugs affect the above processes.

In acute polysyndromic course of P or with the development of pancarditis, glucocorticosteroids are indicated - prednisolone or methylprednisolone (metipred, solu-medrol - 0.6-0.8 mg/kg/day) for 10-14 days, less often longer, under clinical and instrumental supervision data, including dynamic echocardiography monitoring. The simultaneous use of corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) (M. A. Yasinovsky) can increase the therapeutic effect, and by reducing the dose of hormonal drugs, reduce the risk of adverse reactions.

Currently, the most pathogenetically substantiated in the treatment of R is the therapy of NSAIDs, which, in addition to anti-inflammatory, analgesic and antipyretic effects, have a certain effect on the body’s immune response.

When treating R in adults, the drug of choice is diclofenac (dicloran, voltaren, diclobene) (orally 100 mg/day, in tablets of 50 and retard capsules of 100 mg, rectally - 100 mg/day, in suppositories of 50 and 100 mg), having high anti-inflammatory activity comparable to that of prednisolone.

The negative effects of NSAIDs on the mucous membrane are associated with the development of minor symptoms from the digestive tract and more serious complications - damage to the mucous membrane of the stomach and duodenum. A new generation of drugs - specific NSAIDs (Ambene, Airtal, Ketonal, Movalis, Nimesil, Nemulide) allows you to avoid the above-mentioned severe complications if you need to take constant, long-term use of NSAIDs. A prominent representative of this class of drugs is Celebrex (200–400 mg), which has a pronounced anti-inflammatory and analgesic effect and does not have a harmful effect primarily on the gastrointestinal tract. Due to the leading role of streptococcal infection in the development of P, the use of antibacterial drugs is of great importance. β-lactam antibiotics remain the drug of choice: penicillins (amoxicillin - 1.5 g in 3 doses; phenoxymethylpenicillin - 1.5 g in 3 doses; benzathine penicillin - 2.4 million units intramuscularly), cephalosporins (cefadroxil - 1 g in 2 doses ); for intolerance to β-lactam antibiotics - macrolides (spiramycin - 6 million units in 2 doses; azithromycin - 0.5 g on the 1st day, then 0.25 g in 1 dose; roxithromycin - 0.3 g in 2 doses; clarithromycin - 0.5 g in 2 doses; midecamycin - 1.2 g in 3 doses); for intolerance to macrolides and β-lactam antibiotics - lincosamines (lincomycin - 1.5 g in 3 doses; clindamycin - 0.6 g in 4 doses). The immunosuppressive effect of penicillin antibiotics reduces the risk of developing R.

Quinoline drugs (Delagil, Plaquenil) have a therapeutic effect in continuously relapsing forms of P and have a weak immunosuppressive effect. For the treatment of P, they are usually used in combination with salicylates. The dose of delagil is 0.25 g, plaquenil is 0.3–0.4 g/day. The course of treatment for a continuously relapsing course ranges from 3 to 6 months, and sometimes 9–12 months.

Cytostatic immunosuppressants - 6-mercaptopurine, imuran (azathioprine), chlorobutine, endoxan - are indicated only for patients with continuously relapsing or protracted course of R, who are resistant to treatment with both classical antirheumatic drugs, including corticosteroids, and quinoline drugs with their long-term, many-month course application. The dose of 6-mercaptopurine, imuran (azothioprine) is 0.1–1.5 mg/1 kg of weight, chlorobutine is 5–10 mg/day.

The connection between rheumatism and heart damage is reflected in the aphorism belonging to the French physician Lasegue: “Rheumatism licks the joints and bites the heart.” Aortic heart defects can be asymptomatic for a long time (sometimes for 20–25 years), and then very quickly decompensation occurs with the development of severe heart failure and cardiac arrhythmias, most often atrial fibrillation. Mitral heart defects have typical clinical symptoms and gradually decompensate, leading to heart failure.

The progression of heart failure is due to the activation of neurohumoral systems, in particular the sympathoadrenal and renin-angiotensin systems. ACE inhibitors and AT1 blockers are currently the drugs of choice for the treatment of any stage of heart failure. The inclusion of ACE inhibitors (captopril, enalapril, quinapril, lisinopril, moexipril, ramipril, cilazapril) in the complex therapy of patients with heart failure due to rheumatic heart defects helps to significantly reduce its size, increase the ejection fraction, and improve performance. The drugs are well tolerated by patients: captopril is prescribed starting with a dose of 6.25 mg 3 times a day, gradually titrating it to 75 mg/day if well tolerated; enalapril - from 1.25 to 10 mg/day. The use of AT1 blockers (Diovan 40 mg once daily) requires caution in the presence of stenoses. Treatment of patients with heart failure should include diuretics (veroshpiron, thiazide, indapamide retard), nitrates (nitroglycerin, isoket, nitromint, olycard retard), β-blockers (atenolol, bisoprolol, metoprolol, sotalol).

At the stage of formed heart disease, rheumatism becomes a surgical problem, and it is very important to make an adequate decision on its surgical correction in a timely manner. Diagnosis and treatment of active P at the preoperative stage are of great importance for obtaining positive long-term results. For reliable diagnosis of chronic inflammatory process, it is important to use immunological markers. All efforts of doctors involved in preparing patients for surgical correction of heart disease (since only surgical intervention can radically help such patients) should be aimed at eliminating the inflammatory process and reducing signs of heart failure.

Despite the successes achieved in the treatment of patients with rheumatic heart disease, in a number of patients the therapeutic effect of traditional therapy remains unsatisfactory, and this forces us to look for new ways to further improve treatment measures. In the treatment of rheumatological patients, along with standard treatment methods, the latest methods and achievements of domestic rheumatology are used. According to indications, the following are carried out: hyperbaric oxygenation, pulse therapy with steroid hormones (metipred, solu-medrol) and cytostatics (6-mercaptopurine, imuran (azothioprine), chlorbutin, endoxan), efferent methods of treatment (hemosorption, plasmapheresis).

The basis of primary prevention of R is timely diagnosis and adequate treatment of GABHS tonsillitis or pharyngitis, for the treatment of which β-lactam antibiotics (penicillins, cephalosparins, carbapenems) are the drug of choice.

Secondary prevention of R is aimed at preventing repeated attacks and progression of the disease and involves regular administration of long-acting penicillin (benzathine penicillin), the use of which in the form of bicillin-5 has significantly (4–12 times) reduced the frequency of repeated rheumatic attacks and, therefore, increased life expectancy patients with rheumatic heart disease. It should be noted that the effectiveness of benzathine benzylpenicillin prophylaxis is currently the subject of debate. Studies conducted at the Institute of Rheumatology of the Russian Academy of Medical Sciences and the State Research Center for Antibiotics have shown that benzathine-benzylpenicillin, prescribed at a dose of 2.4 million units intramuscularly every 3 weeks, is currently a highly effective and safe drug for secondary prevention. When prescribing a preventive course of bicillin, it is necessary to take into account the presence of immunological markers of inflammation and the degree of reactivity of the body, differentially prescribing the drug to each patient.

Clinical observation and preventive treatment play an important role in the management of patients with rheumatic diseases. The objectives of clinical examination include: implementation of therapeutic measures aimed at the final elimination of the active rheumatic process; carrying out symptomatic treatment of circulatory disorders in patients with heart defects; prescribing general health measures, hardening procedures, dosed physical exercises; implementation of secondary prevention of relapse of the disease. At the clinical examination stage, issues related to the ability to work and employment of patients are also resolved, and problems of surgical correction of defects are discussed together with cardiac surgeons. Successful radical correction of the defect, performed in a timely manner, before the development of irreversible pathological changes in the heart and other organs, helps restore the personal and social status of the operated people and provides a certain economic effect.

Spa treatment

Balneotherapy in a resort promotes the restructuring of hemodynamics - an increase in cardiac output with a slight decrease in heart rate, achieving a higher level of functioning of the cardiovascular system, and consequently, preventing the development of circulatory failure, which is the main prerequisite for the widespread use of baths for rheumatic heart lesions. In addition, balneotherapy affects the immunological reactivity of the body, enhancing nonspecific protection and reducing the severity of autoimmune disorders.

During the period when P activity decreases to a minimum, treatment is indicated in local cardiological sanatoriums, where, along with drug treatment and the listed physical factors, climatotherapy using a gentle method and moderate physical activity are used.

Currently, resort treatment of patients with even minimal P activity is considered acceptable against the background of ongoing drug antirheumatic treatment in specialized sanatoriums.

The choice of resort is determined by the specific (influence of chemicals and gases dissolved in water) effect of mineral waters. For the treatment of P, balneotherapeutic resorts with carbon dioxide, sulfide, radon, sodium chloride, iodine-bromine and nitrogen-siliceous waters are indicated. Balneotherapy is contraindicated for heart failure above stage 2A, aortic heart disease with heart failure above stage 1, and severe heart rhythm disturbances.

For the purpose of differentiated treatment of patients with rheumatism, it is necessary to take into account the peculiarities of the action of mineral waters.

Carbon dioxide waters (Borjomi, Matsesta) have a pronounced positive effect on the contractile function of the myocardium, normalize the rhythm of cardiac activity and peripheral hemodynamics. Carbon dioxide baths are effective in patients with stenosis of the left atrioventricular orifice. They can be used for atrial fibrillation (moderately tachysystolic form).

For combined mitral-aortic heart defects, it is preferable to prescribe radon baths, which cause a mild hemodynamic restructuring. Like carbon dioxide, radon baths have a positive effect on abnormal heart rhythm, as well as sedative and analgesic effects, improve tissue trophism and metabolism.

Sodium chloride baths help improve blood circulation, microcirculation and tissue trophism, eliminate blood hypercoagulation and normalize immunological processes.

During the remission phase, mud therapy can also be used in the form of applications to the area of ​​the affected joints.

After mitral commissurotomy, it is recommended to send patients to cardiological sanatoriums at their place of residence (in the inactive phase or in the presence of activity no higher than stage 1, NC no higher than stage 2A). 6–8 months after surgery, in the absence of contraindications, patients can be sent to climatic and balneological resorts. After heart valve replacement, sanatorium treatment is carried out only in cardiological sanatoriums at the place of residence, where patients are prescribed climate therapy using a gentle method and moderate physical training.

Non-drug therapeutic factors make it possible to reduce the level of medication load, provide more rational, comprehensive treatment, and help increase the average life expectancy and improve the quality of life of this group of patients.

Note!

• More than 1/3 of cases of temporary disability and 10% of general disability are caused by rheumatic diseases.
• The disease develops 1–3 weeks after GABHS or (less commonly) another infection.
• In recent years, sluggish rheumatism with predominant damage to the heart has become the dominant clinical form.
• “Major” diagnostic criteria: migratory polyarthritis, carditis, chorea, annular erythema, rheumatic nodules.
• “Minor” diagnostic criteria: fever, arthralgia, history of rheumatism or the presence of formed valvular heart disease, changes in laboratory parameters - increased ESR, leukocytosis, positive reaction to C-reactive protein, dysproteinemia, increased levels of immunoglobulins, etc.
• The basis for the treatment of rheumatism is a phasing system, the essence of which is continuous monitoring and treatment of the patient at all stages of the process (hospital - in the acute phase; local sanatorium, clinic - in the subacute phase; resort - in the inactive phase of the disease).

Clinical example

Patient V.M., born in 1950, is a painter by profession. I went to the clinic about ARVI. She complained of a runny nose, dry cough, weakness, malaise, and palpitations on exertion. There is no typical rheumatic history. Physical examination revealed a systolic murmur at the apex of the heart. Special research methods: electrocardiography with functional load, cardiac fluoroscopy, phonocardiography, analysis of the phase structure of systole, blood flow velocity, minute volume of blood, capillary permeability, oscillography - indicated the presence of stenosis of the left atrioventricular orifice. According to laboratory tests, no active process was identified. In the hospital, the patient received antirheumatic treatment with subsequent observation in a clinic. After 6 months, an increase in the symptoms of cardiovascular failure was noted. Repeated examination revealed progression of stenosis of the left atrioventricular orifice. After a course of preoperative therapy, the patient was referred for surgical treatment and underwent commissurotomy. From the hospital, after a course of primary rehabilitation, the patient was transferred to a cardiological sanatorium to continue rehabilitation treatment.

A. K. Protasova , Doctor of Medical Sciences N. V. Manshina E. V. Maklakova Medical, Moscow

How to treat rheumatism with folk remedies?

Traditional medicine offers a wide range of options for treatment at home:

• For the treatment of gout and rheumatism, compresses made from fresh hemlock leaves are very helpful. Pour boiling water over fresh leaves, apply to the sore spot, and cover with cling film and a bandage to relieve pain.
• Rheumatism is treated with bee stings : the method is to apply a bee to sting the sore spot. On the first day you need 1 bee. A day later there are already 2 bees. The bite is made 4-5 centimeters away from the first place. Every other day they take 3 bees. And so on until five. Then you need to take a two-day break and repeat in the reverse order: 5, 4, 3, 2.1.
• Take 30 grams of yellow acacia leaves, 200 ml of vodka. Leave for 7 days. Take 1 tsp. 3 times a day.
• Take 20 grams of elm, pour a glass of boiling water . Simmer over low heat for 10 minutes. Then leave for 3 hours. The tincture is taken 1 tbsp. l. 4 times a day.
• Take 2 tbsp. l. fresh dandelion flowers, add 2 tbsp. l. sugar _ Leave in a cool, dark place for 8-9 days, then squeeze out the juice. Take 3 times a day, 1 tsp.

Nikolai Maznev about traditional methods of treating rheumatism

Nikolai Maznev in his clinic collected many recipes for getting rid of rheumatism:

• The main therapy for inflammatory rheumatism during remission is a course of thalassotherapy.
• Active exercises in hot water will reduce joint pain.
• Ankylosing spondylitis primarily affects the sacroiliac joint and spine. Gradually, the spine loses flexibility, mainly men suffer. Sea mud is shown.
• Periarthritis most often affects the hip and shoulder joints. Causes stiffness and pain. Restores functions: physical exercise and underwater hydromassage shower.

Treatment of rheumatism in China and Israel

In China, rheumatism is treated with an integrated approach to healing the whole body. The most common methods are: herbal treatment, acupuncture, massage.

Treatment of rheumatism in Israeli clinics is based on the use of gifts from the Dead Sea and homeopathic medicines. However, it is impossible to do without traditional treatment regimens, so Israeli doctors use different combinations of drugs in combination with plasmapheresis and immunomodulators.

Plasmapheresis