Symptoms and treatment of rheumatism. Consequences of rheumatism
In the article we will consider the symptoms and treatment of joint rheumatism. What tablets to take, also tell.
Rheumatism is inflammatorysystemic 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. Rheumatism usually affects young people and adolescents, in less frequent cases - weakened and elderly patients.
Cardiac rheumatic disease is oneof the main sources of mortality (approximately 50,000 people die of this disease every year in the United States). Often, this pathology begins in the cold season, especially in the northern latitudes. It is not among the epidemic diseases, although streptococcal infection, preceded by rheumatism, can manifest itself 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 conditions of life and poor families. Serologic and bacteriological studies show that rheumatism is a very special allergic reaction to the infection that occurred with any of the beta-hemolytic streptococci included in group A.
During the month, 2.5% of patients whohave suffered a streptococcal infection, are ill with rheumatism in an acute form. Often, diseases such as scarlet fever, sore throat, erysipelas, acute inflammation in the middle ear, and maternal fever precede the onset of rheumatism. At the same time, the body does not develop immunity to this infection, and an autoimmune attack begins as a response to repeated infection. The treatment of rheumatism is described below.
What causes rheumatism?
Rheumatism can cause three main reasons:
- the patient's streptococcal infections (eg, angina, etc.);
- hereditary predisposition;
- allergic (immune) reaction.
Symptoms of rheumatism
Such a disease, as rheumatism, is notsingle. It is often accompanied by other diseases due to the fact that harmful substances and antibodies of immunity released 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 allowto diagnose pathology. They appear about 2-3 weeks after the patient has been re-infected with the upper respiratory tract (sore throat, laryngitis, pharyngitis) with established streptococcal lesions. Externally, the picture resembles a relapse of a cold. Symptoms of rheumatic fever are an increase in body temperature up to forty degrees, chills, rapid pulse, loss of strength, excessive sweating, painful and swollen joints. The first and foremost suffer from the disease are actively working and the largest joints. Treatment of rheumatism of the hands is carried out quite often.
Then the inflammation affects the other joints,often symmetrical. They strongly redden, swell, hot to the touch, with movement and pressure, pain is felt. Most often the inflammatory process is not the cause of joint stable changes. The pulse is arrhythmic, frequent, there are pains in the chest, dilating (dilating) the heart, in some cases the sound of friction of the pericardium is heard, which indicates the defeat of the heart.
Rheumatism has the following common signs:
- 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;
- a headache that is felt in the forehead;
- lethargy, according to the description of patients, they always want to sleep, the body as "wadded."
Specific signs of rheumatism:
- joint pain, primarily affectinglarge joints (elbows, knees), pulling, long and dull pain. Rheumatism is characterized by the rapid development of the inflammatory process, just as rapidly signs of inflammation and joint pain disappear, restoring their functions;
- Vascular disorders: nasal bleeding, vascular brittleness, etc .;
- painful sensations behind the sternum: heart pains of a aching or dull character that do not manifest immediately, but after one or several days;
- annular eruptions, which appear in about 4-10% of cases, outwardly represent a pink rash, round in shape and with uneven edges; the patient does not worry;
- rheumatic nodules that appear on theinflamed joints; this is the formation under the skin with a diameter of 5 mm to 2-3 cm, fixed and dense, but painless; they appear very rarely, remain for two months from the onset of the onset of the disease. Treatment of active rheumatism should be timely.
Specific signs appear only after 1-3day. 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 requires prompt hospitalization.
Treatment of rheumatism in children is also carried out. In them, the pathology has either a chronic or a milder form of leakage, without special signs. Characterized by a rapid pulse, malaise in general, joint pain, soreness is not felt during movement (the so-called "pain of growth"). In the absence of symptoms of heart disease, the disease rarely ends in a lethal outcome, although the appearance of carditis in patients significantly reduces life expectancy.
More details about the treatment of rheumatism in children will be described below.
Diagnosis of rheumatism
None of the diagnostic procedures will allowwith 100% accuracy does not confirm the patient's rheumatism. Only with a comprehensive assessment of the information obtained, an experienced specialist will be able to draw conclusions about the presence of the disease. That is why the diagnosis of rheumatism is complicated.
The diagnostic activities include the following instrumental and laboratory studies:
- blood tests;
- ECG (cardiography);
- Ultrasound diagnosis.
Thanks to ultrasound examination of the heart(it is also known as echocardiography), it is possible to determine the state of the valves and their ability to contract. In the process of developing rheumatism, cardiac activity also changes. Echocardiography allows to identify at the early stages of defects and to take the necessary actions in a timely manner.
Is rheumatism treated at home? About it further.
This study gives the opportunity to clarifylevel of supply of nutrition to the muscles of the heart. The ECG determines the minimal defects of cardiac activity and displays them graphically with a special sensor. Cardiographic studies over the course of several days will be most effective, because rheumatism is a permanent disorder, and changes in the activity of the heart are best defined in dynamics. Most people with rheumatism (about 90%) have similar pathologies in the functioning of the heart muscle.
To diagnose rheumatism, blood is taken from a vein. A doctor may alert such indicators as:
- leukocytosis, that is, an increased concentration of leukocytes;
- the presence of antibodies to streptococci;
- protein defects of blood composition;
- detection in the body of antibodies to the enzyme substances of streptococci;
- increased ESR;
- decrease in hemoglobin;
- detection of specific C-reactive protein.
In addition, during the initial examination, the doctor maynotice signs of polyarthritis (redness and swelling of the joints, they feel 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, one of the following complex symptoms is required:
- violation of cardiac functioning (carditis), as well as the selection of antibodies from the patient's blood against streptococcus;
- bright external manifestations (articular edema, etc.) and deviations of the heart;
- defects of cardiac activity and the existence of two laboratory parameters that indicate rheumatism;
- two specific symptoms in the anamnesis (deviationsheart work, articular inflammation, skin rash, rheumatic nodes, small chorea) and one non-specific (hyperthermia, arrhythmias, changes in laboratory test results)
- three non-specific symptoms and one specific.
The treatment of rheumatism and arthritis is much the same.
Varieties of rheumatism
Rheumatologists have adopted the main classification, which includes two types of rheumatism:
- Chronic rheumatism, which is characterizedfrequent recurrent course even during treatment. Its exacerbations occur at different times of the year, mainly in 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. The majority of patients (about 85%) are people under the age of forty. Affected the heart and joints. The disease is difficult and significantly degrades the quality of life. The patient feels constant pain in the heart and joints. After a relapse (acute phase), 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 mainly characteristic of young patients (up to twenty years). Its pathogen is streptococcus. The disease is associated with the patient's infection of the upper pathways of the respiratory system, which lies in the later manifestation of its symptoms (from two to three weeks).
Now we know the symptoms of rheumatism of the joints. What treatment is prescribed in each case, consider next.
What medicines to drink, it is interesting to many. For acute rheumatism is characterized by rapid development. Initially, symptoms of general intoxication appear, like a cold, which makes it difficult to identify the disease immediately. Then after 1-2 days, specific symptoms appear (carditis, polyarthritis, skin rash, in rare cases - nodules). The duration of the acute phase on average is about three months. It may be longer for up to six months. The most dangerous in the acute form is carditis, that is, heart damage, because in a quarter of all cases a heart defect is due to it.
Means for the treatment of rheumatism will help pick a doctor.
Classification of the disease
Rheumatism is divided into the following forms, depending on the affected organ or system:
- Cardiac form, or rheumatic heart disease. In this case, there is a lesion of muscle cardiac structures. The patient may either be disturbed by severe pain, or their barely noticeable manifestation. However, the processes of destruction will still occur. Treatment of rheumatism of the heart should be complex. 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 appear, 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 a cardiac arrhythmia (tachycardia), which is determined by echocardiography (ultrasound). Treatment of rheumatism of the heart is described below.
- Articular form. It may exist as an independent manifestation of the disease or in conjunction with a heart lesion. With this form of the disease, large joints are affected. Small joints are involved in the process at a later stage. Under the influence of antibodies of streptococcal enzymes and lymphocytes in rheumatism, cartilage and articular sac are destroyed. That is why there are no problems in the 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. The defeat of the nervous system is a little less. This form of the disease is characterized by lesions of neurons in the cerebral cortex, which are responsible for motor activity. Their involuntary stimulation by 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 appears 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 appears as a rash on the skin or rheumatic nodules. 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. Manifested in the lesion of 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 rheumatism is not started on time, complications may occur.
Possible complications of the disease
Complications of rheumatism suffered by the patient include:
- relapsing chronic course - the disease may become chronic;
- development of heart defects - their formationoccurs in about a quarter of all cases of acute pathology; the defect affects the basic muscular cardiac structures, which leads to a deterioration in the quality of organ activity;
- ischemic and thromboembolic disorders,the result is the occurrence of blockage of blood vessels (strokes) or ruptures, including the renal arteries, the retina of the organs of vision, etc .;
- inflammation of the lining of the heart, which is infectious in nature and can pose a serious danger to the life of the patient.
Features of the treatment of rheumatism
In therapy, the following drugs are most often prescribed.
A disease like rheumatism is different.mixed immuno-bacteriological origin. That is why the treatment is difficult, and the pathology is almost not completely cured. Since the disease causes streptococcal bacteria (the reaction of immunity is secondary and is a response to the penetration of a foreign organism), the main therapeutic task is to eliminate the bacteria and remove the products of their decay and life as soon as possible.
The main drug in the fight against the causative agent of the disease has become "Bicillin" - an antibiotic from the penicillin group, which has a more lasting effect than simple penicillin.
Active (first) phase antibacterialThe treatment lasts from ten days to two weeks. As studies show, it is impractical for a shorter period, since the infection persists. At the same time, a long period is ineffective, because streptococcus produces substances that destroy the 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 injected intramuscularly into the patient orally. Such treatment is carried out for 5-6 years (every three weeks, one injection), to reduce the likelihood of repetition of the disease and prevent possible heart complications. Treatment of rheumatism is carried out and other drugs.
Excellent proven in medicalpractice drug such as acetylsalicylic acid. The use of aspirin has a number of contraindications (time of childbearing and breastfeeding, vascular fragility, problems with the digestive organs), but such treatment of rheumatism allows to get 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 treatment period "Aspirin" you need to take another 30 days, two grams per day.
Hormonal drugs for the treatment of rheumatism. In the treatment of severe illness, Prednisolone is used (dosage is the maximum allowable).
Inpatient treatment for rheumatism includes:
- Hospital mode in combination with bed rest for the entire period of acute and subacute symptoms of the disease.
- Exercise therapy.
- Medications and physiotherapy.
- Surgical intervention in severe cases.
Below we consider the treatment of symptoms of rheumatism folk remedies.
Therapy must be started with water procedures, with the help of which inflammation is relieved, blood circulation improves and there is a general strengthening effect.
For the treatment of rheumatism folk remedies are diverse.
Baths with sea mud or salt or hayhusk is very effective. To prepare a bath of hay, pour 1 kg of husk with water in the amount of 2 liters and boil for 30 minutes. The resulting broth is poured into a full bath. You need to take it for at least 10 minutes.
Treatment of rheumatism folk remedies based on the preparation of solutions for rubbing. Good effects can be obtained using the following recipes:
- 10 tablets "Analgin" pounded, addedto 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.
- Well relieves pain when rheumatism mustardtincture. It will take 100 ml of vodka, 1 tsp. mustard powder. Mix everything and insist for five days in the refrigerator. Use if necessary.
- A mixture made of green sheets of indoorficus, gives good results. 100 ml of alcohol, 20 gr. crushed leaves of ficus. Ingredients to mix and insist in the refrigerator for a week. The affected places are rubbed with the mixture 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 (during2-2.5 months). In the active phase of rheumatism, bed rest with a gradual increase in motor activity is required. Drug therapy includes: antibiotics, NSAIDs, antihistamines, immunosuppressive drugs, if necessary, heart drugs, diuretics and other drugs.
The second stage is the spa treatment. Rehabilitation of children is carried out in 2-3 months in a sanatorium. Therapeutic agents used in half the dose. They use medical gymnastics, aeration, good nutrition, vitamin therapy.
The third stage - dispensary observation. Conducted to identify manifestations of the activation process, the implementation of year-round prevention of relapse. Use antibacterial drugs of prolonged action. They also carry out rehabilitation of chronic infection foci and determine the possibility of attending school.
Prevention of disease
There is only one preventive measure inavoiding rheumatism is preventing development of a streptococcal infection from the very beginning. With timely treatment with antibiotics, the possibility of the appearance of pathology becomes minimal.
The following preventive measures will help reduce the likelihood of this disease:
- Strengthening the immune system. The main cause of rheumatism is the entry of a streptococcal infection with an influx of blood to the systems and organs. Most often, unhindered infection is possible due to a 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 properly relax.
- Avoiding contact with streptococcus. It is necessary to adhere to the standards of personal hygiene, try to transfer infectious pathologies as rarely as possible. In addition, it is necessary to exclude human contact with patients infected with streptococcus infection.
- Timely treatment of colds. Rheumatism can be formed not only because of repeated interactions with the causative agent, but also if left untreated for a long time. If the patient has the first signs of a cold, you should immediately contact a specialist. This recommendation is especially true for individuals who have been confirmed to have streptococcus, or who have previously had the disease.
- Preventive rehabilitation after interaction with the pathogen. It is advisable to take in an adequate dosage "Bicillin" (intramuscularly and once a half million units).
Rheumatism, therefore, is complexcharacter, not only in terms of etiology, but also in its symptoms. The disease has not been adequately studied, so there are certain difficulties in determining the correct diagnosis. In addition, complete disposal of him 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 harmful consequences, to provide patients with a high quality of life.