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Joint rheumatism: symptoms and treatment, complications

"Rheumatism licks the joints, but bites the heart"
(expression of old doctors)

If you come to the clinic and listen to patients waiting for a doctor, you can hear various interesting diagnoses: “backache”, “sciatica”, and finally “rheumatism”. Currently, however, this word appears less and less in the official histories of the disease.

Previously, rheumatism suffered by people whose work proceeded in a damp and cold climate. Finally, the brave soldier Schweik already at the very beginning of the novel rubs his knees, as he suffers from rheumatism. What is this about?


Rheumatism of joints, what is it?

Rheumatism of the joints

With rheumatism, diagnostic confusion has reigned in our country for a long time. Judge for yourself: the end "- ism" in medicine means "like, aspiring." For example, "meningism" is a syndrome of irritation of the meninges, but not meningitis, since there is no inflammation. Parasitism is a way of life whose goal is to become a parasite. What does rheumatism “strive for”?

Translated from the Greek, "revma" is a process of spreading, pouring, dissolving (through the body). That is, it is again not clear: you can call it the process of taking the medicine, and drinking, and the spread of fever. The latter is closer to the truth, because the name “acute rheumatic fever” is adopted in world literature.

She met in an era when people lived without antibiotics, but now it appears quite rarely. This is a condition with periodic fever, damage to the membranes of the heart, joints, and brain. Russian doctors called it Sokolsky's disease - Buyo.

In the modern sense, rheumatism is a lesion of the connective tissue of the body, heart and joints, caused by β-hemolytic streptococcus group A.

The causes of rheumatism

This streptococcus is very "quirky." It can exist in healthy people, living in the nasopharynx. He causes a face that the grandmother still treats with a red rag. It causes streptoderma, scarlet fever in children and non-ill adults, a variety of sore throats.

This pathogen is armed with erythrotoxin, blood destruction enzymes, it successfully dies from antibiotics, but the rapid diagnosis of rheumatism is difficult (PCR, ELISA). The fact is that in this group of streptococci there are more than 80 similar to each other "relatives", and it is impossible to predict in advance whether they cause hemolysis (blood destruction) until it starts.

Therefore, the diagnosis of streptococcal lesions is carried out, like tens of years ago: a smear is sown on blood agar obtained from sheep blood, then incubated in a thermostat. After the colonies of a pure culture have grown, on the edges you can see bright rings - areas of hemolysis.

Risk factors

In order to get rheumatism ill joints, a lot of effort is not necessary. It is enough that the following situations arise:

  • carrier of this streptococcus with frequent sore throats, pharyngitis ;
  • "Undertreated" ARVI;
  • impaired immune response: autoimmune diseases - because erytotoxin can cause an increase in vascular permeability, which is similar to an allergic reaction;
  • genetic predisposition;
  • hypothermia, dampness, frequent colds.

Symptoms of rheumatism of the joints

Symptoms of rheumatism of the joints

The main feature that rheumatism can “boast” is the suddenness and volatility of joint damage. It appears as a night landing during a special operation: after a sore throat or a banal pharyngitis, which was forgotten to think about, a lesion of the joints suddenly appears, and in turn.

So, rheumatism of the joints of the legs often begins with a lesion of the knee joint. The time of a rheumatic attack lasts, on average, 10 to 12 days, after which the inflammatory phenomena in the joint subside, but the next joint takes over the baton. Sometimes the process is suddenly transferred to the hands of the feet and it is never possible to predict which joint will be the “next victim”.

The most commonly affected are wrist, knee, elbow and ankle joints, which “flash” in turn. Less often - hip.

Small joints of the hand, feet with rheumatism almost do not suffer. With a lesion, the most likely diagnosis is rheumatoid arthritis (this is a completely different disease) or psoriatic arthritis. And the spine is not affected at all. How does articular syndrome manifest?

Rheumatism of the knee, the symptoms of which we consider, can be applied to other locations:

  • Redness of the skin over the joint;
  • The appearance of edema of the joint, the joint "swells";
  • The temperature rises over the joint area, the feeling of heat;
  • Pains With this damage, the joint begins to hurt and with increasing load the pain increases, and during rest it decreases. In case of arthrosis, on the contrary, at first there is a “starting” pain at the beginning of movement, and then the joint “paces” and the pain disappears;
  • Impaired joint function: limitation of range of motion.

Usually, doctors note dissociation: the pain is quite strong, and externally the signs of inflammation are not very pronounced.

The older the patient is, the less joints are involved in the rheumatic process. A situation is possible in which there is monoarthritis, or damage to just one joint, for example, the knee. At the same time, it is necessary to exclude tuberculosis, which is also characterized by damage to one joint, and more often, it is the knee.

In the study of the joint with the help of X-ray examination, no changes are found.

It should be noted that such "rheumatic attacks" threaten the heart, and sooner or later the exact same "arthritis" of the heart will develop. Only the defeat of its tissues is called rheumatic heart disease.

With a mild course of the disease, it is asymptomatic, but then signs of heart failure follow: shortness of breath, first with physical exertion, and then at rest, edema in the legs and other unpleasant symptoms associated with a decrease in myocardial contractility.

In addition, damage to the joints is accompanied by fever, which resembles acute rheumatic fever.

In some cases, no sign of arthritis is detected, except for pain. This is an arthralgic syndrome, which is completely reversible, and lasts no more than 10-14 days.

Treatment of rheumatism of the joints

Treatment of rheumatism of the joints

Treatment for rheumatism of the joints is the “tip of the iceberg.” You can not begin to treat the joint without understanding the cause. After all, the pathogen remains in the body and if you begin to treat your knees with ointments, gels or taking anti-inflammatory drugs, the effect will either not be at all, or it will be temporary and short.

The fact is that reducing inflammation is a pathogenetic therapy. It is certainly applied, but it may become completely unnecessary if etiotropic treatment is carried out correctly, that is, the effect on the cause of the disease - the pathogen.

Therefore, the main cure for rheumatism of the joints is that which destroys the pathogen, namely antibiotics. In the event that arthritis is accompanied by general manifestations (fever), hospitalization is necessary.

Antibiotic therapy, surprisingly, is carried out by penicillin. Despite the more than 70-year history of use, streptococci have not yet acquired pronounced resistance to it. Cephalosporins, macrolides are also used, and in the case of resistance, a combination of amoxicillin with clavulanic acid (Amoxiclav) is recommended for use.

Streptococcus resistance is caused by a surprising reason: it is helped by "friends". Other microbes can synthesize beta-lactamase destroying penicillin. And, although they themselves do not cause disease, they are capable of lowering the concentration of penicillin so much that it does not affect streptococci.

In addition to antibacterial therapy, remedies for rheumatism of the joints belong to the group of non-steroidal anti-inflammatory drugs, but they need to be taken secondarily - only against the background of antibacterial therapy. It is then that their effect will be long and persistent.

Rheumatism Complications

The complications of rheumatism, first of all, include heart damage.

Myocarditis and cardiosclerosis

So, in the event of rheumatic inflammation of the myocardium and the absence of the necessary treatment, the outcome of the disease may be cardiosclerosis, with the replacement of connective muscle tissue. This leads to various disorders of conductivity and contractility.

In the case of focal cardiosclerosis, the contractile function of the myocardium is slightly impaired, but in the case of a diffuse lesion, it decreases significantly.

As a result, cardiac output is reduced, and circulatory decompensation occurs in a large circle: swelling of the legs, enlarged liver, shortness of breath - signs of heart failure are formed.

Dry and exudative pericarditis

Currently, these complications are rare, but among the rural population, taking into account the underdevelopment of the diagnostic base and its remoteness, as well as the low level of medical education of the population, these cases began to reappear.

So, with dry pericarditis, pericardial leaves rub against each other during contraction of the heart, causing pain and noise. Pain in the heart is constant.

When pericardial effusion begins to accumulate effusion in the pericardial cavity. This effusion "separates" the sheets, and the pain disappears. But instead of pain, the fluid accumulating in the pericardial cavity “squeezes” the heart outside and shortness of breath appears, especially in the supine position.

To relieve such patients, bend the chest forward, bending. The treatment uses puncture of the pericardium, with the pumping of fluid and the introduction of special substances.

The defeat of the pericardium often signals that all of the membranes of the heart are affected: the endocardium (with possible valve disorders), the myocardium and the pericardium.

Prevention of rheumatism of the joints

Prevention of rheumatism of the joints

Prevention of rheumatism is primary and secondary. Primary prophylaxis includes all methods and means that prevent the occurrence of rheumatism in the body, and secondary prophylaxis - the prevention of recurrence of the disease.

Primary prevention includes:

  1. Strengthening the body, hardening;
  2. Combating streptococcal carriage and infections;
  3. Sanitation of sick teeth, foci in the throat and middle ear, nasopharynx ( otitis , pharyngitis, tonsillitis, sinusitis);
  4. Lack of hypothermia;
  5. Full treatment of colds in case of their occurrence.

The objectives of secondary prevention include the "suppression" of streptococcal infection within the body.

After the elimination of the attack on the joints, it is recommended to repeat the prophylactic course in order to avoid recurrence, with penicillin-type drugs every month, and this should be done for several years. This is done if, in addition to the symptoms of joint damage, there was rheumatic fever and / or heart damage.

It is regrettable, but even after 5 years of monthly prevention, its cancellation is again able to repeat rheumatic attacks in 10% of patients.

Therefore, at present, prophylaxis is lengthened to 10 years, and in the case of rheumatic heart disease, even before the patient reaches 60 years of age. That is, in fact, it makes sense to carry out lifelong prevention.

Joint rheumatism, the symptoms and treatment of which we have described, is never an isolated process. Therefore, it is able to infect many organs, and, above all, the heart. At the slightest suspicion of streptococcal reason for arthritis, urgent treatment should be initiated, as well as an examination of the heart.


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