Symptoms and treatment of rheumatism. The consequences of rheumatism

In the article, we consider the symptoms and treatment of rheumatism of the joints. What pills to take, we will also tell.

Rheumatism is an inflammatory systemic disease, localized mainly in the heart membrane. The risk group includes people with a hereditary predisposition to this disease, as well as in the age category from seven to fifteen years. Usually rheumatism affects young people and adolescents, in more rare cases, weakened and elderly patients.

Cardiac rheumatic fever is one of the main sources of mortality (about 50,000 people die from this disease in the United States every year). Often, this pathology begins in the cold season, especially in the northern latitudes. It is not included in the number of epidemic diseases, although the streptococcal infection preceding rheumatism can manifest in nature as an epidemic. That is why the disease can begin in a whole group of people - for example, in orphanages, schools, military camps, hospitals, in cramped living conditions and poor families. Serological and bacteriological studies show that rheumatism is a special allergic reaction to infection with any of the beta-hemolytic streptococci included in group A.

Within a month, 2.5% of patients who have had streptococcal infection suffer from rheumatism in acute form. Often, diseases such as scarlet fever, tonsillitis, erysipelas, acute inflammation in the middle ear, maternal fever precede the onset of rheumatism. In this case, the body does not develop immunity to this infection, and an autoimmune attack begins as a response to re-infection. The treatment of rheumatism is described below.

What causes rheumatism?

Rheumatism can cause three main reasons:

• streptococcal infections transferred by the patient (for example, tonsillitis, etc.);
• hereditary predisposition;
• allergic (immune) reaction.

Symptoms of Rheumatism

A disease such as rheumatism is not an isolated one. Often it is accompanied by other diseases due to the fact that harmful substances and antibodies of the immune system secreted by streptococcus affect and damage various systems and organs, and similar symptoms can be considered as rheumatic forms.

The first signs of rheumatism do not allow the diagnosis of pathology. They appear approximately 2–3 weeks after the patient has repeated infections of the upper respiratory tract (tonsillitis, laryngitis, pharyngitis) with an established lesion of streptococcus. Outwardly, the picture resembles a relapse of a cold-related disease. Symptoms of acute rheumatism are fever up to forty degrees, chills, rapid pulse, loss of strength, excessive sweating, painful and swollen joints. Actively working and the largest joints suffer from the disease in the first place. Hand rheumatism is often treated.

Then the inflammation affects the remaining joints, often symmetrically. They redden strongly, swell, hot to the touch, pain is felt when moving and pressing. Most often, the inflammatory process is not the cause of stable joint changes. The pulse is arrhythmic, frequent, chest pains, expansion (dilatation) of the heart appear, in some cases, the sound of pericardial friction is heard, which indicates heart damage.

Rheumatism has the following common symptoms:

• hyperthermia, when the temperature rises to threatening values ​​(from 38 to 40 degrees); this is due to the formation of an acute immune response to the pathogen;
• headache, which is felt in the forehead;
• lethargy, according to the description of patients, they always want to sleep, the body is like “cotton”.

Specific signs of rheumatism:

• joint pain, primarily affecting large joints (elbow, knee), drawing, prolonged and dull pain. Rheumatism is characterized by the rapid development of the inflammatory process, just as rapidly the signs of inflammation and joint pain disappear, restoring their functions;
• vascular disorders: nosebleeds, vascular fragility, etc.
• pain behind the sternum: heartaches of aching or dull nature, which do not appear immediately, but after one or several days;
• annular rashes, which appear in about 4-10% of cases of the disease, are externally a pink rash, rounded in shape and with uneven edges; the patient does not bother;
• rheumatic nodes that appear on sore joints; these are formations under the skin with a diameter of 5 mm to 2-3 cm, motionless and dense, but at the same time painless; they appear very rarely, remain for two months from the onset of the disease. Treatment for active rheumatism should be timely.

Specific signs appear only after 1-3 days. In rare cases, there are symptoms of damage to the peritoneal organs (pain in the right hypochondrium, etc.), which indicates a severe course of pathology and needs to be hospitalized as soon as possible.

Treatment for rheumatism in children is also carried out. Their pathology has either a chronic or milder course, without any special signs. Rapid pulse, malaise in general, joint pain, soreness are not felt during movement (the so-called "pain of growth"). In the absence of symptoms of heart damage, the disease rarely ends in death, although if carditis occurs in patients, life expectancy is significantly reduced.

More details on the treatment of rheumatism in children will be described below.

Diagnosis of rheumatism

None of the diagnostic procedures will allow with absolute accuracy to confirm the presence of rheumatism in the patient. Only with a comprehensive assessment of the information received will an experienced specialist be able to draw conclusions about the presence of the disease. That is why the diagnosis of rheumatism is complicated.

Diagnostic measures include the following instrumental and laboratory studies:

• blood tests;
• ECG (cardiography);
• Ultrasound diagnostics.

Ultrasound scan

Thanks to the ultrasound examination of the heart (it is also known as echocardiography), it is possible to determine the condition of the valves and their ability to contract. In the process of developing rheumatism, cardiac activity also changes. Echocardiography allows you to identify defects in the early stages and take the necessary actions in a timely manner.

Is rheumatism treated at home? About it further.

ECG (cardiography)

This study makes it possible to clarify the level of nutrition of the heart muscle. An ECG detects minimal defects in cardiac activity and shows them graphically using a special sensor. The most effective will be conducting cardiographic studies for several days, because rheumatism is a constant violation, and changes in heart activity are best determined in dynamics. Most people with rheumatism (about 90%) have similar pathologies of the functioning of the heart muscle.

Analyzes

To diagnose rheumatism, blood is drawn from a vein. Doctors may be alerted by indicators such as:

• leukocytosis, that is, an increased concentration of leukocytes;
• the presence of antibodies to streptococci;
• protein defects in the blood composition;
• detection in the body of antibodies to enzyme substances streptococci;
• increase in ESR;
• decrease in the degree of hemoglobin;
• detection of a 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 the diagnostic measures are carried out comprehensively, it is possible to diagnose the patient with rheumatism with high accuracy.

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

• impaired cardiac function (carditis), as well as the release of antibodies from the patient’s blood against streptococcus;
• bright external manifestations (joint swelling, etc.) and deviations of the heart;
• defects in cardiac activity and the existence of two laboratory indicators that indicate rheumatism;
• two specific symptoms in the anamnesis (abnormalities of the heart, joint inflammation, skin rashes, rheumatoid nodes, small chorea) and one non-specific (hyperthermia, cardiac arrhythmias, changes in laboratory tests);
• three non-specific symptoms and one specific.

The treatment for rheumatism and arthritis is much the same.

Types of Rheumatism

Rheumatologists have adopted the main classification, which includes two types of rheumatism:

• Chronic rheumatism, which is characterized by a frequent recurrent course, even during treatment. Its exacerbations occur at different times of the year, mainly in the cold seasons (winter and autumn). A similar effect is also characteristic of patients who live in cold or damp apartments. Exacerbations occur several times a year. Most patients (about 85%) are people under the age of forty. The heart and joints are affected. The disease is severe and significantly affects the quality of life. The patient feels constant pain in the heart and joints. After relapse passes (acute phase), the disease can last 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 mainly characteristic of young patients (up to twenty years). Its causative agent is streptococcus. The disease is associated with a patient’s infection of the upper respiratory tract, which is a later manifestation of its symptoms (from two to three weeks).

Now we know the symptoms of rheumatism in the joints. What treatment is prescribed in each case, we will consider further.

What kind of medicine to drink is interesting to many. Acute rheumatism is characterized by rapid development. At first, signs of general intoxication appear, like a cold, which makes the disease difficult to determine immediately. Then, after 1-2 days, specific symptoms appear (carditis, polyarthritis, rashes on the skin, in rare cases, nodules). The duration of the acute phase on average is about three months. It may be a longer course - 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 a heart defect is formed due to it.

Remedies for the treatment of rheumatism will help you choose a doctor.

Disease classification

Rheumatism is divided into the following forms, allocated depending on the affected organ or system:

• Heart form, or rheumatic heart disease. In this case, damage to the muscle heart structures occurs. The patient can either be bothered by severe pain, or a barely noticeable manifestation of them. However, the processes of destruction will still occur. Treatment of rheumatism of the heart should be comprehensive. The course of the disease is almost imperceptible in the early stages and is determined only by means of an ECG. During the late stage, severe heart lesions occur, as well as acute heart failure due to a decrease in the nutrition of his muscles, and as a result, the ability to contract is reduced. The patient has cardiac arrhythmias (tachycardia), which is determined by echocardiography (ultrasound). The treatment of heart rheumatism is described below.
• Joint form. It can exist in the form of an independent manifestation of the disease or in combination with a heart lesion. With this form of the disease, large joints suffer. Small joints are involved in the process at a late stage. Under the influence of antibodies of streptococcal enzymes and lymphocytes with rheumatism, cartilage and articular bag are destroyed. That is why there is no problem with diagnosis: the joint is red and very swollen. The patient cannot make movements with inflamed limbs, as he feels severe pain. The acute phase of this form of rheumatism is characterized by an increase in temperature to 38-39 ° C.
• Neurological form. Damage to the nervous system is less common. This form of the disease is characterized by damage to neurons in the cerebral cortex, which are responsible for motor activity. Their involuntary stimulation with active substances causes the patient to have uncontrolled spontaneous muscle movements. This is manifested by twitching limbs and grimaces. This form of the disease is very unpleasant, as it complicates a person’s life in society and interferes with his everyday self-care. Symptoms last from two to four weeks. Manifestations are absent in a dream.
• Pulmonary form. It manifests itself along with damage to the heart and joints, but is very rarely present (from 1 to 3% of the total number of clinical cases). The disease develops in the form of bronchitis or pleurisy.
• Skin form. It manifests itself in the form of rashes on the skin or rheumatic nodules. It can occur in no more than five percent of all diseases.
• Ophthalmic form. It can only be diagnosed comprehensively, along with the "classic" signs of rheumatism. It manifests itself in damage to the retina (retinitis) or other structures of the organs of vision (iridocyclitis, iritis, etc.). This form can cause partial or complete loss of vision.

If treatment for rheumatism is not started in a timely manner, complications can occur.

Possible complications of the disease

Complications of rheumatism suffered by the patient include:

• recurrent chronic course - the disease can become chronic;
• the development of heart defects - their formation occurs in about a quarter of all cases of pathology in an acute form; the defect affects the main muscle cardiac structures, which leads to a deterioration in the quality of the organ;
• ischemic and thromboembolic disorders, the consequence of which is the occurrence of blockage of blood vessels (strokes) or ruptures, including renal arteries, retina of the organs of vision, etc .;
• inflammation of the membranes of the heart, which is infectious and can pose a serious danger to the patient’s life.

Features of the treatment of rheumatism

In therapy, the following drugs are most often prescribed.

"Bicillin"

A disease such as rheumatism is of mixed immune-bacteriological origin. That is why the treatment is complex, and the pathology is almost not completely cured. Since the disease causes a streptococcal bacterium (the immunity reaction is secondary and is a response to the penetration of a foreign organism), the main medical task is to eliminate the bacteria and remove the products of their decay and vital activity as soon as possible.

The main drug in the fight against the causative agent of the disease was Bicillin, an antibiotic from the penicillin group, which has a longer lasting effect compared to simple penicillin.

The active (first) phase of antibiotic treatment lasts from ten days to two weeks. As the studies show, a shorter period is impractical, since the infection persists. At the same time, a long period is ineffective, because streptococcus produces substances that destroy the active active ingredients of drugs for the treatment of rheumatism, and the antibiotic becomes dangerous for the patient.

After this, the passive (second) phase begins. Three weeks after the end of the medication, the same drug is administered intramuscularly to the patient orally. Such treatment is carried out for 5-6 years (every three weeks, one injection) to reduce the likelihood of a recurrence of the disease and prevent possible heart complications. Treatment of rheumatism is carried out by other drugs.

"Aspirin"

A drug such as acetylsalicylic acid has proven itself in medical practice. The use of aspirin has a number of contraindications (the time of carrying a child and breastfeeding, vascular fragility, problems with the digestive organs), but such treatment of rheumatism allows to obtain a significant effect in neurological and articular forms of the disease. “Aspirin” eliminates pain and reduces joint inflammation. In the first two weeks it is used in the maximum permissible dosage. After the main period of treatment, “Aspirin” should be taken another 30 days, two grams per day.

Hormonal drugs for the treatment of rheumatism. In the treatment of a severe illness, Prednisolone is used (dosage is the maximum permissible).

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Folk methods

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• 10 tablets of "Analgin" 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. Then rubbing twice a day.
• Mustard tincture relieves pain with rheumatism. It will take 100 ml of vodka, 1 tsp. mustard powder. Stir everything and insist for five days in the refrigerator. Use if necessary.
• A mixture made from green leaves of indoor ficus gives good results. 100 ml of alcohol, 20 gr. shredded ficus leaves. Mix the ingredients and insist in the refrigerator for a week. The strained mixture is rubbed on the affected areas in the morning and evening for 7 days.

Therapy in children

Treatment in children is carried out in three stages.

The first stage is inpatient treatment (within 2-2.5 months). In the active phase of rheumatism, bed rest is required with a gradual expansion of motor activity. Drug therapy includes: antibiotics, NSAIDs, antihistamines, immunosuppressive drugs, if necessary - cardiac drugs, diuretics and other drugs.

The second stage is spa treatment. Rehabilitation of children is carried out for 2-3 months in a sanatorium. Medicines are used in half dose. Use medical gymnastics, aeration, good nutrition, vitamin therapy.

The third stage is dispensary observation. It is carried out to identify manifestations of the activation of the process, the implementation of year-round prevention of relapse. Use antibacterial drugs of prolonged action. Reorganization of foci of chronic infection is also carried out and the possibility of attending school classes is determined.

Disease prevention

There is only one preventive measure to avoid rheumatism - this is to prevent the development of streptococcal infection from the very beginning. With timely antibiotic treatment, the possibility of pathology becomes minimal.

The following preventative measures will help reduce the likelihood of this disease:

• Strengthening the immune system. The main reason for the appearance of rheumatism is the ingress of streptococcal infection with an influx to blood systems and organs. Most often, unhindered infection is possible due to weakened immunity, which cannot suppress the activity of the pathogen in a timely manner. To strengthen the immune system, you need to choose the right diet, rich in vitamins, and relax properly.
• Avoidance of contact with streptococcus. It is necessary to adhere to personal hygiene standards, try to tolerate infectious pathologies as rarely as possible. In addition, it is necessary to exclude human contacts with patients infected with streptococcus infection.
• Timely treatment of colds. Rheumatism can form not only due to repeated interaction with the pathogen bacterium, but also in the absence of treatment for a long time. If the patient has the first signs of a cold, then you should immediately consult a specialist. This recommendation particularly applies to individuals who have been confirmed to have streptococcus or have previously had a disease.
• Preventive debridement after interaction with the pathogen. It is advisable to take "Bicillin" in an adequate dosage (intramuscularly and once a half million units).

Rheumatism, therefore, is complex in nature, not only in terms of etiology, but also in its symptoms. The disease has not been adequately studied, therefore, there are certain difficulties in determining the correct diagnosis. In addition, a complete disposal of it is impossible. However, thanks to modern methods of therapy, it is possible to eliminate the negative manifestations of the disease, to minimize the danger to the patient’s life and the harmful consequences, to provide patients with a high quality of life.