Rheumatism of the joints: symptoms and causes, how to treat rheumatism? Causes, symptoms and treatment of rheumatism What causes rheumatism

Rheumatism as a disease that affects and eventually cripples joints has been known for quite some time. People also noticed a connection between acute attacks of this disease and hypothermia and colds. In the 19th century, the study of rheumatism by world medical science began. Over the next century, the signs of rheumatic inflammation of the joints and heart, as well as the etiology (cause) of the disease, were studied and described in detail.

One of the symptoms of rheumatism is pain in large joints, most often the knees and ankles.

Currently, rheumatism is much less common than one or two centuries ago. Often it flows secretly, manifesting itself decades later as a heart defect. But the joints often remain practically healthy. First of all, the decrease in the incidence of rheumatism is associated with the widespread use of antibiotics, which destroy the microorganisms that cause rheumatism.

Etiology of rheumatism

Cause of rheumatism - group A hemolytic streptococcus. It often causes upper respiratory tract infections: tonsillitis, pharyngitis, sore throat and is transmitted by airborne droplets (by breathing, sneezing, etc.). This type of streptococcus is similar to the structure of heart muscle cells. If the immune system of a child or adult is “defective” and cannot recognize the difference between streptococcus and the heart or is unable to expel (eliminate) this bacterium from the body, rheumatic inflammation develops. It extends not only to the heart and joints, but also to other organs. The degree of its activity and spread depends on the weakness of the immune system, which is often inherited.

Symptoms and manifestations of rheumatism

The first acute attack of rheumatism is called acute rheumatic fever(ORL). It occurs more often in children and adolescents, 1-2 weeks after tonsillitis or tonsillitis. First the temperature rises, usually more than 38 Celsius. Then a symptom complex typical of ARF develops.

1. Pain in large joints, most often knees and ankles. The joints are swollen, red, and hot to the touch. However, the inflammation in them passes quickly and is completely reversible.
2. Damage to the heart is carditis, manifested by weakness, palpitations, shortness of breath, and aching pain. The appearance of noise when listening to heart sounds is characteristic. The murmur occurs when the heart valves are involved in the process; the mitral valve most often suffers from rheumatism. The severity of the lesion can vary: from mild, practically asymptomatic, to severe with the development of heart failure.
3. The appearance of rheumatic nodules. These round small formations (“bumps”) usually appear on the arms and legs in the joint area 3-4 weeks after the onset of the disease.
4. Chorea is a lesion of the nervous system. The child’s handwriting, speech, and coordination of movements are impaired, and tics appear—violent movements and twitches that are not subject to volitional efforts. It occurs quite rarely, in 15-17% of cases and goes away after 1-2 months of treatment.
5. Round, ring-shaped spots of pink color on the skin. They appear quickly and pass quickly. Nowadays they are also rare.

In addition, abdominal pain of varying localization and severity may occur, and fluid may accumulate in the lungs (more precisely, in the pleural cavity).

Diagnosis of rheumatism

Rheumatologists diagnose and treat rheumatism. The patient must be hospitalized and examined: blood tests, urine tests, and a throat swab are taken for group A hemolytic streptococcus. The blood test is characterized by an increase in ESR (less than 30 mm/h), C-reactive protein, and the appearance of antistreptococcal antibodies. There may be slight proteinuria (protein), some red blood cells, casts in the urine.

An ECG and echocardiography are required, which allow the doctor to assess the degree of damage to the heart muscle, valves, as well as the effect of the therapy.

Treatment of rheumatism

All patients with acute rheumatic fever are prescribed penicillin antibiotics in fairly large dosages for 10-14 days in order to destroy the pathogen - streptococcus. If you are intolerant to penicillins, you can prescribe macrolides (sumamed, etc.). In addition to antibacterial therapy, non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, Nise, etc.) are used, sometimes with high activity of rheumatic inflammation - glucocorticoids, for example prednisolone.

During treatment, the patient needs to adhere to bed rest for 2-3 weeks, and in case of severe carditis (inflammation of the heart), strict bed rest is prescribed for 2-3 weeks, and then bed rest for up to 6 weeks, then the patient will be in the hospital for another 4-6 weeks , and then 8-10 weeks at home.

Outcomes and prognosis of acute rheumatic fever

In modern conditions and the possibilities of antibiotic therapy, acute rheumatic fever most often ends in recovery, without any consequences for the heart and joints. However, after suffering from ARF, the patient will be under regular follow-up by a rheumatologist for 5-10 years, depending on whether there was inflammation of the heart (carditis) or not. During this period, it is necessary to receive so-called bicillin prophylaxis. Such prevention consists of regular administration of extended-release penicillin, first throughout the year, and then, if everything is in order, in the autumn-spring periods. The goal of bicillin prophylaxis is to prevent the re-entry of streptococcus into the body and the development of heart disease.

In 20-25% of cases, ARF ends with the formation of a heart defect, i.e. valve defects that interfere with the normal pumping function of the heart to pump blood. In this case we talk about development chronic rheumatic heart disease. Its manifestations will be determined by the degree of valve destruction (the formation of insufficiency, more often than the mitral valve), or the fusion of its leaflets (stenosis) and the compensatory capabilities of the myocardium. Over the course of many years, the heart defect progresses (intensifies), and chronic heart failure forms. If the defect of a valve (or two valves) is serious, then they resort to the help of cardiac surgeons who install an artificial valve. Patients with chronic rheumatic heart disease are monitored by a rheumatologist for life and receive bicillin prophylaxis, since each relapse of streptococcal infection will “eat” the heart valves and the defect will progress.

For a long time rheumatism all diseases in which muscles, joints, soft tissues and other organs of movement and support suffered were considered. In recent decades, this meaning of rheumatism has changed and has been replaced by the term rheumatic diseases.

Another definition of rheumatism: rheumatism – This is an independent disease associated with streptococcal infection, damage to the heart, joints, nervous system and other organs. But in modern medical literature the term “rheumatism” is not used in this meaning either; it has been replaced by the term generally accepted by the world community "acute rheumatic fever."

For many years, acute rheumatic fever (rheumatic fever) was the most common rheumatic disease and the most common cause of heart defects. But lately it has been observed significant reduction in the number of patients thanks to the development of effective preventive measures (mainly the use of antibiotics during streptococcal infections). Modern doctors are much more likely to deal with the consequences of childhood rheumatism (acute rheumatic fever), dating back to a time when antibiotic prophylaxis was not widespread, than with the disease itself.

Acute rheumatic fever is a connective tissue disease that mainly affects the cardiovascular system (heart defects - dysfunction of the valves, carditis - inflammation of the heart), the nervous system and skin (the appearance of special rheumatic nodules, red spots shaped like a circle). This disease mainly affects young people ( 7-15 years) after infection of the body with a certain infection (group A beta-hemolytic streptococcus).

Many people mistakenly consider rheumatic fever to be a joint disease. Rheumatic joint disease is completely reversible and short-lived. In this case, heart damage, on the contrary, leads to heart disease and early cessation of work. IN 20-25 % cases, heart disease develops. A heart valve defect can occur without any symptoms for several years; it can be detected during a routine examination or when a complication develops (for example, heart failure or arrhythmia).

Symptoms of rheumatism

Typically, symptoms of acute rheumatic fever appear two to three weeks after past infection caused by streptococci (in most cases - tonsillitis, less often - skin infections - pyoderma). Feeling worse, the temperature rises, pain, redness and swelling of the joints (arthritis) appear. As a rule, medium and large joints (knees, shoulders, elbows) are involved, in rare cases – small joints of the feet and hands. Migrating pain may appear (they change location and may be in different joints). The duration of joint inflammation (arthritis) is no more than one week to ten days.

Develops simultaneously with arthritis rheumatic carditis – joint damage. In this case, both minor changes may appear, which can only be identified with a special examination, as well as severe lesions, accompanied by palpitations, shortness of breath, swelling, and pain in the heart.

The danger of rheumatic carditis is that even in mild cases, inflammation affects the heart valves (structures inside the heart that separate the heart chambers necessary to ensure proper blood flow). Wrinkling, loss of elasticity and destruction of the valves occurs. The result of this is that the valves either cannot open completely or do not close tightly. As a result, valve disease develops. Most often, the development of rheumatic carditis occurs in the age period 12-25 years. At a later age, primary rheumatic heart valve disease is very rare.

IN 15 % cases, rheumatic damage to the nervous system develops (more often in childhood). As a result, the child becomes distracted, capricious, and irritable. He begins to get tired quickly, he has problems with memory, his gait, handwriting, and speech change.

Anular erythema - manifestation of acute rheumatic fever in the form of ring-shaped rashes on the skin, as well as rheumatic (subcutaneous) nodules, which, today, are rare.

Causes of rheumatism

The causes of acute rheumatic fever have been established (this distinguishes it from other rheumatological diseases). The reason for this is a special microorganism called "group A beta-hemolytic streptococcus." After the lapse of 1-6 weeks after suffering a streptococcal infection (pharyngitis, scarlet fever), some patients develop acute rheumatic fever.

It is important to know that acute rheumatic fever is not an infectious disease (such as intestinal infections, influenza, etc.). The main difference is that directly Streptococcus does not cause damage to the heart and joints. The consequence of the infection is a disruption of the immune system (there is an opinion that a number of streptococcal proteins are similar in structure to joint proteins and heart valve proteins; the consequence of the immune response to streptococcus is an erroneous “attack” of the body’s own tissues in which inflammation occurs), which is the cause of the disease.

Risk factors for rheumatism

Weakened patients and people whose relatives have suffered from any rheumatic diseases, including the pathology in question, have a high risk of getting sick. Most often, acute rheumatic fever develops in children from 7 to 15 years. Young children and adults get sick much less often. Cases of the disease occurring in children under three years of age are extremely rare.

It must be remembered that rheumatic fever is included in the group social diseases. Under unfavorable living conditions (dirt, hypothermia, etc.) and poor nutrition, the likelihood of developing this disease increases significantly.

Prevention of rheumatism

Primary prevention of acute rheumatic fever (i.e., preventing its occurrence in healthy people) consists of proper treatment of streptococcal infections (pharyngitis, sore throat and streptococcal skin infections). For streptococcal infection Be sure to take antibiotics! Duration of antibiotic therapy (usually derivatives) penicillin) should not be less than ten days (if the course is shorter, there is a possibility that the infection will persist). In modern practice, the treatment of streptococcal tonsillitis does not use drugs such as biseptol, tetracycline, ofloxacin, chloramphenicol.

Secondary prevention, aimed at preventing recurrent attacks of acute rheumatic fever, involves use for at least five years benzathine benzylpenicillin (retarpen, extensillin) - extended action antibiotic.

In everyday life, you should not neglect simple rules: stick to a daily routine, eat regularly, exercise and do sports, do hardening, temporarily isolate a person with a fever. A hardened body better resists the penetration of streptococcal infections. Streptococcus is widely represented in the world around us: it is present in dust, dirty linen, and handkerchiefs. From this we can conclude about the importance of ventilation and wet cleaning of premises, and regular change of linen. It is necessary to promptly treat chronic tonsillitis and carious teeth.

Diagnosis of rheumatism

Detection of acute rheumatic fever is based in most cases on an analysis of the clinical picture of the disease. It is very important to identify a streptococcal infection (skin infection, sore throat) at least six weeks before the onset of joint damage. A rather specific sign of acute rheumatic fever is combination of articular and cardiac symptoms.

It is extremely important to find the causative agent of the disease, for which it is necessary to culture the tonsils, etc.

The following laboratory tests are required: an increase in the level of C-reactive protein in the blood, an increase in ESR - the erythrocyte sedimentation rate.

If the so-called “rheumatic tests” (antibodies to the component of bacteria - streptolysin O - ASL-O) show a positive result, this can only indicate an existing streptococcal infection, but does not indicate a diagnosis of “acute rheumatic fever”.

To confirm the diagnosis, it is very important to conduct an ECG - electrocardiography and EchoCG - examination of the heart using ultrasound.

Treatment of rheumatism

The basis of treatment for acute rheumatic fever is strict adherence to the regime if the disease is active, strict bed rest is prescribed) and the use of various medications in order to get rid of symptoms and prevent relapses (repeated attacks). If the patient carditis (heart inflammation), he may need to reduce his salt intake.

To get rid of the streptococcus microorganism that causes the disease, antibiotics are prescribed. Penicillin antibiotics are used; if the patient is intolerant to this group, macrolides are prescribed. Over the next five years from the moment the disease activity is suppressed, it is necessary to take long-acting antibiotics.

An important part of the treatment of rheumatism are non-steroidal anti-inflammatory drugs, such as ibuprofen, diclofenac, allowing to reduce the activity of inflammation. The dosage of drugs and the duration of their use are discussed in each specific case and depend on the condition of the patient.

If fluid is retained in the body, diuretics are prescribed.

Formed defects are treated depending on the degree of their severity, the presence of heart failure, valve damage, etc. Antiarrhythmic drugs that eliminate or prevent cardiac arrhythmias, nitrates, diuretics, etc. are often used.

If the vice is severe, surgery on heart valves is necessary plastic or prosthetic replacement of the affected valve.

Rheumatism is a disease of the body's connective tissue. The predominant location of the pathological process is the cardiovascular system, although other organs can be affected in humans. The disease often begins in childhood, but due to the prevailing latent course, it is diagnosed mainly in adulthood. The article outlines questions about what rheumatism is, its symptoms and treatment, characteristic signs and causes of its occurrence.

What is rheumatism

This inflammatory pathology is systemic. It can damage the membranes of the heart and cause heart failure. The causative agent of rheumatism is beta hemolytic streptococcus.

As long as this microorganism circulates in the body, it is impossible to treat rheumatism, because it will not give results. For various reasons, it is impossible to cure all people from streptococcus. This also explains the fact that today no effective medicine has been developed that can cure it. Thus, rheumatism is a chronic incurable disease.

Chronic rheumatism is characterized by a wave-like course. This means that periods of exacerbations are followed by remissions and vice versa. Exacerbation is caused by stress, excessive physical work, hypothermia, etc. The pathological process can affect the entire heart muscle or only one of the tissues of this organ.

Important: rheumatism does not affect the pulmonary valve.

Provoking factors for the development of pathology, its pathogenesis

There are certain factors that contribute to the activation of streptococcal infection in humans and the development of characteristic pathological processes in rheumatism. The causes of rheumatism include:

• exacerbation of chronic tonsillitis;
• scarlet fever;
• poor quality, irrational and insufficient nutrition;
• poor living conditions, unsanitary conditions;
• unfavorable genetic disposition.

The etiology of rheumatism, its pathogenesis is that the occurrence and development of rheumatism is associated with the fact that its causative agent, streptococcus, has certain antigens that have common properties with the tissues of the membranes of the heart. The bacterium is capable of producing substances that selectively attack these tissues.

If a streptococcal infection occurs and develops in the body, then specific anti-streptococcal antibodies are produced in it.

They can also infect heart tissue. Accumulating in the blood, toxins and antibodies damage connective tissue and heart muscle. Thus, this disease is also an autoimmune disease.

Classification of the disease

Today, this classification of rheumatic disease is accepted.

1. Rheumatic carditis, or cardiac form. In this case, specific damage to the membranes of the heart occurs. The myocardium is primarily affected.
2. Rheumopolyarthritis. This is the articular form of the disease. It is characterized by inflammatory processes primarily in the musculoskeletal system.
3. Skin form.
4. Rheumapleurisy, or pulmonary form of the disease.
5. Chorea, or dance of St. Vitus.

Manifestations of the disease

The symptoms of rheumatism in adults are very diverse, since along with heart disease, the patient may be affected by joints, the nervous and respiratory systems and other organs. Signs of rheumatism appear approximately one to three weeks after an illness caused by a specific type of streptococcus. In some patients, the first signs of primary rheumatism appear a few days after an episode of hypothermia. In this case, it is customary to talk about a rheumatic attack. The disease develops suddenly and is characterized by severe rheumatic pain.

Let's learn everything about rheumatism and its most characteristic manifestations.

Rheumatic carditis

With rheumatic heart disease, patients complain of:

• pain in the heart area that becomes permanent;
• shortness of breath not only during physical activity, but also at rest;
• increased and rapid heartbeat;
• swelling in the area of ​​the right hypochondrium.

Pericarditis is quite rare. Its dry form is accompanied by the appearance of constant pain in the heart. With exudative pericarditis, a large amount of effusion accumulates in the heart sac. Pain is usually not felt.

Important! Rheumatism of the heart often leads to the development of severe heart defects.

Polyarthritis

If inflammation leads to damage to the musculoskeletal system, the patient experiences slowly increasing pain in the joints. The primary localization of the inflammatory process is in the knee, elbows, wrist joints, shoulder, and ankles.

Rheumatism of the joints is characterized by the appearance of swelling in the joints. Active movements are noticeably reduced. The pain is relieved by taking non-steroidal anti-inflammatory drugs.

Along with joint damage, some patients may develop muscular rheumatism. It manifests itself as severe pain in the muscles. Rheumatism of bones is characterized by persistent inflammatory damage to bone tissue. A person's movements are limited and the tendency to fractures increases.

Rheumatic skin disease

With the cutaneous form of rheumatism, capillary permeability increases sharply. Numerous small foci of hemorrhages - petechiae - appear on the legs of such patients. Painless rheumatic nodules can be seen on the skin of the lower leg and forearm. Their sizes may vary significantly.

The cutaneous form of this disease is characterized by the appearance of dark lumps in the thickness of the skin. They penetrate its layer and rise above its surface. Such formations are erythema nodosum. It is often localized on the scalp.

Rheumatic granuloma is relatively rarely diagnosed. In this case, the nodules become large.

Rheumatic pleurisy

This form of rheumatism is quite rare. It is characterized by acute rheumatic fever, when the patient’s body temperature can rise even to 40 degrees. Along with this symptom, acute rheumatic pain appears in the lung area. They intensify significantly during inhalation. Patients develop a dry and very painful cough. On auscultation, a pleural noise is heard.

As the disease progresses, pain and pleural noise subside. The person’s condition deteriorates significantly: fever, shortness of breath appear, weakness and cyanosis develop. In some cases, half of the chest noticeably lags behind in breathing, and the person feels a sharp lack of air.

Such severe symptoms in pulmonary rheumatism are relatively rare.

Chorea and other manifestations of the disease

In rheumatism, the nerve membranes, subcortex and medulla can be affected. The patient develops signs of chorea - involuntary contraction of skeletal muscles. This symptom appears most often in adolescence. If a person's glottis contracts, this can lead to an attack of suffocation and even death.

Often children may develop peritonitis (as an outcome of infectious rheumatism). The patient suddenly develops a fever, nausea, and vomiting. Rheumatic fever in children can last for several days, making the condition worse.

Rheumatism of the eyes often manifests itself as xerophthalmia. It is accompanied by itching and burning in the eyes. It is often combined with another autoimmune disease - Sjögren's syndrome.

Features of pathology diagnosis

It is quite difficult to determine rheumatism: its symptoms can also be observed in other pathologies. The detection of a streptococcal infection and the appearance of the above symptoms may indicate the possible development of a rheumatic disease in a person.

A combination of symptoms such as low-grade fever, increased fatigue, and heart rate disorders indicate the presence of an infectious process in a person caused by a specific streptococcus. To make an accurate diagnosis, it is necessary to prescribe biochemical blood tests: with rheumatism, an increase in ESR and an increase in the activity of C-reactive protein are observed.

Instrumental methods for diagnosing rheumatism include:

• electrocardiography (disturbance of heart rhythm is detected);
• ultrasound examination of the heart;
• radiography of the heart (this study helps to detect an increase in the size of the organ and pathologies of its contractile activity).

Treatment of the disease

Treatment of rheumatism should be carried out only in stages and comprehensively. The main goal of all therapeutic measures is to reduce the activity of specific streptococcus and prevent the development of complications of rheumatism.

At the first stage of therapy, the patient must be in the clinic. All medications are prescribed only taking into account the individual characteristics of the human body and the degree of heart damage.

Antibiotic therapy is indicated to combat streptococci. The only drugs that can reduce the activity of this microorganism contain penicillin. Adults and children over 10 years of age are prescribed Phenoxymethylpenicillin. In severe cases, Benzylpenicillin is indicated. Drugs from a number of macrolides and lincosamines are used as an alternative to penicillin.

The duration of antibiotic use is at least 2 weeks. The use of another antibiotic is indicated in case of frequent recurrences of colds.

Antirheumatic treatment is also carried out by taking non-steroidal anti-inflammatory drugs. They are taken until the symptoms of inflammatory phenomena are completely eliminated (sometimes even up to one and a half months).

With a latent course, it is necessary to take quinolines.

At the second stage of treatment, it is necessary to achieve normalization of the cardiovascular system and remission of the pathology. It is advisable to prevent rheumatic heart disease. It is advisable to do this in specialized sanatoriums. Patients are prescribed:

• physiotherapy;
• massages;
• mud treatment;
• baths with radon, oxygen, sodium, hydrogen sulfide, carbon dioxide.

At the third stage, clinical observation and prevention of possible relapses are indicated. Patients with heart defects need treatment for circulatory diseases.

Children are prescribed highly active and effective antibiotics. Penicillin sodium salt is administered once. Acid-fast penicillin is prescribed orally. Glucocorticoids are indicated for rheumatic carditis.

Prevention

Primary prevention is aimed at preventing streptococcal infection. Its components are as follows.

1. Isolation of a patient with streptococcal infection.
2. Hardening.
3. Bicillin prophylaxis for rheumatism consists of a single administration of this drug to everyone who has been in contact with patients.
4. High-quality and balanced nutrition.
5. Correction of living conditions.
6. Two-month observation by a doctor if the patient has suffered a streptococcal infection.

Forecast

Rheumatism is a pathology that is not dangerous to humans. The course of the skin and joint forms of the disease is most favorable. Encephalitis and diffuse type myocarditis pose a certain danger to humans.

The main prognostic criterion for rheumatism is the reversibility of disorders and the severity of heart defects. The later treatment is started, the higher the likelihood of developing heart failure.

Note! In children, rheumatism is very severe. If the pathological primary process began after 25 years, then heart disease does not develop. The course of this disease is favorable.

Rheumatism is a chronic disease. An important place in its treatment belongs to the prevention of severe heart pathologies. Timely diagnosis, prevention of rheumatism and compliance with all medical recommendations can minimize risks.

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In this article we will look at the symptoms and treatment of joint rheumatism. We will also tell you what pills to take.

Rheumatism is an inflammatory systemic disease localized primarily in the cardiac lining. The risk group includes people with a hereditary predisposition to this disease, as well as those in the age group from seven to fifteen years. Rheumatism usually affects young people and adolescents, and in more rare cases - debilitated and elderly patients.

Rheumatic heart disease is one of the leading causes of death (about 50,000 people die from this disease every year in the United States). Often this pathology begins in the cold season, especially in northern latitudes. It is not one of the epidemic diseases, although streptococcal infection, which precedes rheumatism, can manifest itself as an epidemic in nature. That is why the disease can begin in a whole group of people - for example, in orphanages, schools, military camps, hospitals, in life 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 suffered a streptococcal infection suffer from acute rheumatism. Often, diseases such as scarlet fever, tonsillitis, erysipelas, and acute inflammation in the middle ear 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 re-infection. The treatment of rheumatism is described below.

What causes rheumatism?

Rheumatism can be caused by three main reasons:

• streptococcal infections suffered by the patient (for example, sore throat, etc.);
• hereditary predisposition;
• allergic (immune) reaction.

Symptoms of rheumatism

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

The first signs of rheumatism do not make it possible to diagnose the pathology. They appear approximately 2-3 weeks after the patient suffers repeated upper respiratory tract infections (sore throat, laryngitis, pharyngitis) with established streptococcal infection. Externally, the picture resembles a relapse of a cold. Symptoms of acute rheumatism are an increase in body temperature up to forty degrees, chills, rapid pulse, loss of strength, excessive sweating, painful and swollen joints. The disease affects the actively working and largest joints first. Treatment of rheumatism of the hands is carried out quite often.

The inflammation then affects the remaining joints, often symmetrically. They become very red, swollen, hot to the touch, and 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, there are chest pains, enlargement (dilation) of the heart, in some cases the sound of pericardial friction is heard, which indicates damage to the heart.

Rheumatism has the following general symptoms:

• hyperthermia, when the temperature rises to alarming levels (from 38 to 40 degrees); this is due to the formation of an acute immune reaction to the pathogen;
• headache that is felt in the forehead;
• lethargy, according to patients’ descriptions, they always want to sleep, their body feels like “cotton.”

Specific signs of rheumatism:

• joint pain, primarily affecting large joints (elbows, knees), nagging, prolonged and dull pain. Rheumatism is characterized by the rapid development of the inflammatory process, just as quickly the signs of inflammation and joint pain disappear, restoring their functions;
• vascular disorders: nosebleeds, vascular fragility, etc.;
• pain behind the sternum: aching or dull heart pain that does not appear immediately, but after one or several days;
• annular rashes, which appear in approximately 4-10% of cases of the disease, appear as a pink rash, round in shape and with jagged edges; the patient is not bothered in any way;
• which appear on inflamed joints; these are formations under the skin with a diameter of 5 mm to 2-3 cm, immobile and dense, but painless; they appear very rarely and remain within two months from the onset of the disease. Treatment of 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 pathology and requires prompt hospitalization.

Treatment of rheumatism in children is also carried out. Their pathology is either chronic or milder, without any special symptoms. Characterized by rapid pulse, general malaise, joint pain, pain that is not felt when moving (the so-called “growing pains”). In the absence of symptoms of heart damage, the disease is rarely fatal, although when carditis occurs, patients' life expectancy is significantly reduced.

More details about the treatment of rheumatism in children will be discussed below.

Diagnosis of rheumatism

None of the diagnostic procedures will confirm with one hundred percent accuracy the presence of rheumatism in a 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. This is why diagnosing rheumatism is complicated.

Diagnostic measures include the following instrumental and laboratory studies:

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

Ultrasound

Thanks to an ultrasound examination of the heart (also known as echocardiography), it is possible to determine the condition of the valves and their ability to contract. During the development of rheumatism, cardiac activity also changes. EchoCG allows you to identify defects at an early stage and take the necessary actions in a timely manner.

Is rheumatism treated at home? More on this later.

ECG (cardiography)

This study makes it possible to clarify the level of nutritional supply to the heart muscle. The ECG detects minimal defects in cardiac activity and shows them graphically using a special sensor. The most effective would be to conduct cardiographic studies over several days, because rheumatism is a permanent disorder, and changes in the activity of the heart are best determined over time. Most people with rheumatism (about 90%) experience similar pathologies in the functioning of the heart muscle.

Analyzes

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

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

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

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

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

The treatment of rheumatism and arthritis is largely similar.

Types of rheumatism

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

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

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

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

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

Classification of the disease

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

• Cardiac form, or rheumatic carditis. In this case, damage to the muscular cardiac structures occurs. The patient may either experience severe pain or a barely noticeable pain. However, destruction processes will still occur. Treatment of rheumatism of the heart should be comprehensive. The course of the disease is almost imperceptible in the first stages and is determined only by ECG. During the late stage, severe cardiac damage occurs, as well as acute heart failure due to decreased nutrition of its muscles, and as a result, the ability to contract is reduced. The patient has heart rhythm disturbances (tachycardia), which is determined using echocardiography (ultrasound). Treatment of rheumatism of the heart is described below.
• Articular form. It can exist as an independent manifestation of the disease or in combination with cardiac damage. With this form of the disease, large joints are affected. Small joints are involved in the process at a late stage. Under the influence of antibodies, streptococcal enzymes and lymphocytes, cartilage and joint capsule are destroyed in rheumatism. That is why there are no problems with diagnosis: the joint is red and very swollen. The patient cannot move the 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 slightly 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 by active substances causes the patient to experience 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 for two to four weeks. Manifestations are absent in dreams.
• 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 manifests itself in the form of skin rashes or rheumatic nodules. Can occur in no more than five percent of cases of all diseases.
• Ophthalmic form. It can only be diagnosed comprehensively, along with the “classical” signs of rheumatism. It manifests itself in damage to the retina (retinitis) or other structures of the visual organs (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 may arise.

Possible complications of the disease

Complications of rheumatism experienced by the patient include:

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

Features of the treatment of rheumatism

The following medications are most often prescribed in therapy.

"Bicillin"

A disease such as rheumatism is characterized by a mixed immuno-bacteriological origin. That is why treatment is difficult, and the pathology is almost never completely cured. Since the disease is caused by streptococcal bacteria (the immune reaction is secondary and represents 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 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 antibacterial treatment lasts from ten days to two weeks. As studies have shown, a shorter period is not advisable, 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 finishing taking the medication orally, the same drug is administered intramuscularly to the patient. Such treatment is carried out for 5-6 years (one injection every three weeks) to reduce the likelihood of recurrence of the disease and prevent possible cardiac complications. Rheumatism is also treated with other drugs.

"Aspirin"

A drug such as acetylsalicylic acid has proven itself well in medical practice. The use of aspirin has a number of contraindications (during pregnancy and breastfeeding, vascular fragility, problems with the digestive organs), but such treatment of rheumatism can 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 consumed in the maximum permissible dosage. After the main period of treatment, Aspirin should be taken for another 30 days, two grams per day.

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

Inpatient treatment of rheumatism includes:

• Hospital regime in combination with bed rest for the entire period of acute and subacute symptoms of the disease.
• Diet.
• Medicines and physiotherapy.
• Surgery in severe cases.

Below we will consider the treatment of rheumatism symptoms with folk remedies.

Traditional methods

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

Folk remedies for the treatment of rheumatism are varied.

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

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

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

Therapy in children

Treatment in children is carried out in three stages.

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

The second stage is sanatorium-resort treatment. Rehabilitation of children is carried out within 2-3 months in a sanatorium. Medicines are used in half the dose. They use therapeutic exercises, aeration, good nutrition, and vitamin therapy.

The third stage is clinical observation. It is carried out to identify manifestations of process activation and implement year-round relapse prevention. Long-acting antibacterial drugs are used. They also sanitize foci of chronic infection and determine the possibility of attending school classes.

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 treatment with antibiotics, the possibility of pathology becoming 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 into the blood systems and organs. Most often, unimpeded infection is possible due to weakened immunity, which cannot promptly suppress the activity of the pathogen. To strengthen the immune system, you need to choose the right diet, rich in vitamins, and get proper rest.
• Avoid contact with streptococcus. It is necessary to adhere to personal hygiene standards and try to experience infectious pathologies as rarely as possible. In addition, it is necessary to exclude human contact with patients infected with streptococcal infection.
• Timely treatment of colds. Rheumatism can develop not only due to repeated interaction with the causative bacteria, but also in the absence of treatment for a long time. If the patient shows the first signs of a cold, he should immediately consult a specialist. This recommendation particularly applies to individuals who have been confirmed to have streptococcal infection or have previously had the disease.
• Preventive sanitation after interaction with the pathogen. It is advisable to take Bicillin in an adequate dosage (intramuscularly and one and a half million units once).

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