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Rheumatism of joints: symptoms and causes, how to treat rheumatism?

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What is rheumatism?

Rheumatism is a systemic inflammatory disease that is localized mainly in the membrane of the heart. At risk are people with a genetic predisposition to the disease and the age from 7 till 15 years. Rheumatism pain is generally teenagers and young people, at least – the elderly and debilitated patients.

Rheumatic heart is one of the main causes of death (in the United States from this disease die around 50,000 people each year). This disease often begins in the cold season, especially in Northern latitudes. Rheumatism is not related to epidemic diseases, although the preceding streptococcal infection may make the epidemic. For this reason, arthritis may begin from a group of people – for example, schools, orphanages, hospitals, military camps, families living in poverty and cramped living conditions.

Bacteriological and serological studies have shown that rheumatism is a specific allergic reaction to infection with one of the beta-hemolytic streptococci group A.

During the month, a 2.5 % undergoing streptococcal infection ache acute rheumatism. Often such diseases, as quinsy, scarlet fever, puerperal fever, acute inflammation of the middle ear and the face is preceded by the development of rheumatic fever. The body does not produce immunity to infection, and response to re-infection starts an autoimmune attack.


The etiology of rheumatic fever

Rheumatism is a complex pathological process disrupting the synthesis of connective tissue affecting primarily the musculoskeletal apparatus and heart.

Despite the fact that contemporary research and practice, rheumatism is defined in several ways, the essence of the pathological process is the same.

The basis for the development of rheumatic pathology aredisorders of the connective tissue cells and destruction of the intercellular substance. The main change is the destruction of collagen fibers, which are formed of tissue of the joints and heart. For this reason, most strongly affected the heart (especially the valves), blood vessels and musculoskeletal system (joints and cartilage).

The etiology of rheumatism is now represented in three theories:

  • Integrated theory. Comes from the multiplicity of reasons for the formation of rheumatism, among them an allergic reaction and bacterial (kill the organisms of the genus Streptococcus);
  • Infectious theory. Comes from the fact that the main cause of rheumatism is the bacterium Streptococcus;
  • Bacterial-immunological theory. The gist of it is that the microorganism is a trigger of the disease, giving rise to an immune response and eventually the destruction of the substances of the connective tissue.

A comprehensive theory

According to complexity theory, arthritis — polietiologic process that includes several aspects. In contrast to the bacterial-immunological theory, it is about the microorganism as an independent cause, not trigger.

The basis of this concept lies the idea of the development of the disease as a result of penetration of streptococcal infection in the tissues of the body and dislocation of the bacteria in the heart and the joints (they are spread with blood flow).

However, the necessary condition is the repeated contact with the pathogen, which leads to increased sensitivity of the organism. As a result, the organism becomes less resistant to a particular strain of strep, and the immune response are not able to completely suppress the development of infection.

The concentration of antibodies, nonetheless sufficiently high that a destructive act on the cellular structures and the extracellular matrix of the body. The same effect have substances produced by Streptococcus.

And the bacteria, and the antibodies equally detrimental impact on the body, causing rheumatism. In support of the theory, often put in the study of patients with rheumatism samples (assays) detected by the strep.

Infectious theory

Proceeds from the single cause of the disease — bacterial lesions. Taken in patients with rheumatism of fluid from the pleural cavity or pericardium found specific disease-causing particles, and this serves as confirmation of the theory.

Bacterial-immunological theory

Gives the immune system a major role in the mechanism of the disease. The reason is that in the blood of patients detected by high concentration of antibodies to the Streptococcus, but the samplethe Streptococcus also remain positive. Therefore, the immune response of the body in this case acts as a destructive factor.

Under this theory, the organism does not have a significant impact on human and is only a trigger.

Thus, all theories point to the complex nature of the disease, which is based on infection and immune response.


The causes of rheumatism

The main causes of rheumatism, are three:

  • Transferred streptococcal infection (sore throat, etc.);
  • Immune (allergic) reaction;
  • Genetic predisposition.

The disease

As mentioned, the formation of the disease affects only Streptococcus (group a Streptococcus, beta-hemolytic), and only after repeated interaction, in which there is a decrease in the protective ability of the body.

Because within the group of microorganisms is, and serological subgroups, it is important to say that the interaction should be carried out with streptococci of the same subgroup. This explains why after any transferred colds develops rheumatism.

The risk of rheumatism and above in a single contact, if the patient does not receive the necessary treatment. The disease becomes chronic, and the patient growing of a bacterial hotbed, able at any moment to provoke rheumatism and other severe complications.

Allergic reaction

Severe allergic reactions can cause the strep and secreted substances (toxins and proteins enzymes). As for the blood, the pathogen spreads throughout the body, the immune response may be systemic, but most of all it is manifested by lesions of the heart and joints.

According to research, the bacteria responsible for the development of acute rheumatic fever with involvement of joints (this is the classic form of the disease).

However, chronic rheumatism is not associated with streptococcal lesions, because the test results no antibodies to strep or strep itself is not detected. Missing also the effectiveness of preventive measures against the recurrence of diseases. These arguments speak in favor of unexplored allergic or autoimmune process.

Genetics

The disease is not transmitted genetically, however, the "inheritance" goes the predisposition to the disease. This is due, in the first place, the similarity of the immune systems of parents and child, as well as rheumatismprimarily immune disease, the mechanism of its development and the reasons are similar to other allergic pathologies (tireodit Hashimoto's, asthma , etc.).

About the root cause of rheumatism will tell you Elena Malysheva:

Be sure to watch the video until the end to understand the cause of rheumatism.


The symptoms of rheumatism

Rheumatism is not a single disease. Often he "goes along" with other pathologies, for the reason that harmful substances secreted by the Streptococcus, and antibody immunity to damage many organs and systems, and all these manifestations can be considered as forms of rheumatism.

The first symptoms of rheumatic fever are not allow to diagnose the disease. They are manifested 2-3 weeks after re-infection of the upper respiratory tract (pharyngitis, laryngitis, tonsillitis) installed streptococcal defeat. The picture looks as recurrence of colds. Symptoms of acute rheumatism are fever sometimes up to 40 degrees, increased heart rate, fever, excessive sweating, fatigue, swollen and painful joints. Primarily affects the largest and most actively used joints.

Further, the inflammation extends to the other joints, often symmetrically. Joints are badly swollen, red, hot to the touch, with pressure and with movement the pain is felt. Usually the inflammatory process does not lead to stable changes in the joints. Pulse frequent, irregular, there is pain in the chest, dilation (expansion) of the heart, sometimes listening to the noise of friction pericardium is evidence of heart damage.

  1. Common symptoms of arthritis:

  2. Specific symptoms of rheumatism:

    • Pain in the joints. Primarily affects the large joints (knee, elbow), pain pulling character, a dull and long. Forrheumatism is characterized by rapid development of the process, and the same rapid disappearance of inflammation and pain in the joints with the restoration of their functions;

    • Pain behind the breastbone. Pain in the heart area, or dull aching. The symptom is not immediately, but after a day or a few days;
    • Vascular disorders. The fragility of blood vessels, nosebleeds, etc.
    • Annulare rash. Appear no more than 4-10% of all cases. Looks like the rash is pink in color, forming the oblong with jagged edges. Not disturbing the patient;
    • Rheumatic nodes. Are formed on the affected joints. Looks like a subcutaneous education from 5 mm up to 23 cm in diameter, dense and motionless, but painless. Are extremely rare and stored for about 2 months since the start of the disease.

    Specific symptoms only appears after 1-3 days. Occasionally there are symptoms of defeat of organs of the abdominal cavity (pain in the right hypochondrium, etc.), which indicates a severe disease and requires immediate hospitalization).

Rheumatism in children occurs in a mild form or chronic, without any symptoms. Marked malaise, rapid pulse and pain in the joints, the pain is not felt (the so-called "growing pains"). If there are no signs of damage to the heart, the disease rarely ends in death, although during the development of carditis, the average life expectancy of cases in the future is significantly reduced.

Signs of rheumatism

Other signs of rheumatic fever include:

  • Secondary. The disease is a result of the development of chronic hearth unique streptococci beta-hemolytical. Therefore, manifestations of the disease do not occur immediately, but after a certain period of time (several weeks);
  • Polyetiological. The disease is caused by antibodies like lymphocytes and toxins, as well as enzymatic substances of Streptococcus;
  • The tendency to a relapsing course. After the first occurrence of rheumatic fever in the acute form of the disease even with successful treatment becomes chronic with frequentrelapses;
  • Monopropionate. For rheumatism, regardless of its etiology, a specific characteristic of a single complex of symptoms indicating lesions of the heart, blood vessels, cartilage and joints. Most strongly affected heart tissue which are destroyed by antibodies. The mechanism of injury also one;
  • Many comorbidities. Some doctors call comorbidities forms of rheumatism. This is not entirely accurate, moreover, they occur not in all patients. Among them chorea (nerve disease), nodular erythema, etc.;
  • Remedy symptoms. The symptoms of acute rheumatism are alone and just as quickly as it appeared (with the exception of cases of severe when there is an acute heart failure);

  • Unpredictability. The symptoms subside after a certain period, but to accurately predict it is impossible. Even on the background of treatment relapse. The frequency of relapses also varies. The disease can "calm down" for a long time, and then occur again, and can give to know about itself every month. The duration of the relapse is not an exact prediction;
  • The swiftness. The first specific symptoms are developing rapidly and all at once;
  • The complexity of diagnostics. Rheumatism is similar to other diseases symptoms. Since striking symptoms indicating pathology can be found very often, rheumatism easily "missed". For example, in lesions of the joints, with rheumatoid arthritis, but this is a completely different disease, unrelated to rheumatic fever.

Diagnosis of rheumatism

With absolute accuracy, none of the diagnostic procedures will not indicate the presence of rheumatism. Only evaluating the complex data obtained, an experienced specialist can make a conclusion about the existence of the disease. And the difficult diagnosis of this disease.

Diagnostic measures include a number of laboratory and instrumental studies:

  • Ultrasound diagnostics;
  • Cardiography (ECG);
  • Blood tests.

Ultrasound

Ultrasound of the heart (known as ECHOCARDIOGRAPHY) to evaluate the condition of the valves and the ability to contract. With the development of rheumatism are growing changes in the activities ofheart. Thanks to the ECHO on early detection of defects and time to take the necessary action.

Cardiography (ECG)

The survey helps to clarify the degree of security the nutrition of the heart muscle. ECG detects cardiac activity and displays them graphically using a special sensor. It is most efficient to hold a series of cardiographic studies during several days, because rheumatism is a permanent violation, and best of all changes in the work of the heart visible in the dynamics.

Changes in the heart muscle, occur in the vast majority of patients with rheumatic fever (90%).

Tests

For the diagnosis of rheumatism is made by the venous blood. To alert the physician should the following characteristics:

  • Leukocytosis – elevated white blood cells;
  • Protein disorders of the blood;
  • The presence of antibodies to the Streptococcus;
  • The detection of antibodies to substances-enzymes of Streptococcus (ASL-O);
  • The identification of specific C-reactive protein;
  • The decline of hemoglobin;
  • Increase in ESR.

Also the doctor at the initial examination can detect symptoms of arthritis (swelling of joints, redness, the joints hot to the touch). In these complex diagnostic manipulations allow with high accuracy to establish the diagnosis of "rheumatism".

For diagnosis it is important to have one of the following symptoms complexes:

  • The disruption of the heart (carditis) and the selection of the patient's blood of antibodies against Streptococcus;
  • The disruption of the heart and the presence of two laboratory indicators indicate the rheumatism;
  • A heart disorder, and significant symptoms (swelling of the joints, etc.);
  • Two specific symptom of disease (inflammation of the joints, disorders of the heart, small chorea, skin rashes, rheumatic nodes) and one nonspecific (abnormal heart rhythm, hyperthermia, changes in laboratory tests for the type specified above, etc.);
  • One specific feature and three are nonspecific.

Forms of rheumatic fever and its classification

The main classification adopted by doctors-rheumatologists, includes two kinds of rheumatism.

Acute rheumatism

Rheumatism in the acute phase oftenmanifests itself in young people up to 20 years. The causative agent — Streptococcus. The Association of disease with infection of the upper respiratory tract is a delayed manifestation of symptoms (14-21 days).

Developing acute rheumatism rapidly. First symptoms of intoxication, like the flu, which does not allow to immediately identify the disease, then after a day or two there specific symptoms (polyarthritis, carditis, skin rashes and very rarely nodules). The acute phase lasts, on average, up to 3 months. Perhaps a longer period (up to six months). The most dangerous in acute rheumatic fever cardiac involvement (carditis), as in 1/4 of all cases, it promotes the formation of heart disease.

Chronic rheumatism

Chronic form is characterized by frequent relapsing course, even during therapy. Exacerbations occur at any time of the year. Often, especially in cold seasons (autumn, winter). The same effect is subject to patients living in damp or cold homes. Exacerbations — several times a year. The majority of patients (about 85%) is aged 40 years.

Affects the joints and heart. Severe course of the disease and significantly reduces the quality of life. The patient experiences persistent pain in the joints and heart. After the acute phase (relapse) are, limp over can last few months, and even years.

Classification of rheumatism

Rheumatism is divided into forms according to the criterion of the damaged system or organ:

  • The cardiac form of rheumatism. Otherwise, rheumatic heart disease. In this case, affects the muscular structure of the heart. Can bother the patient severe pain, and can hardly manifest itself. But the destructive processes still going on. In the early stages for virtually invisible and is only detectable using EKG. In the later stages of development causes severe heart damage and acute heart failure on the background of reducing the power of the muscles of the body and, as a consequence, the decline of contractility. Manifest disorders of cardiac rhythm (tachycardia) and detected through ultrasound (ECHOCARDIOGRAPHY);

  • The articular form of rheumatism. Can exist as an independent clinical manifestation of rheumatic fever, or in conjunction with heart damage. In this form of disease affects large joints. At a late stage of the process involved and the small joints. In rheumatoid arthritis under the influence of lymphocytes antibodies and enzymes of Streptococcus destroyed joint capsule and the cartilage. So diagnosing problems is not: the joint looks very swollen and red. The patient cannot move the affected limb, since having severe pain. For the acute phase synovialform is characterized by increased body temperature to 38-39 degrees;
  • Damage to the nervous system. The neurologic form occurs less frequently. In this form of the disease there is a loss of cells called neurons of the cerebral cortex responsible for motor activity. Their spontaneous stimulation of active substances leads to the fact that patients have the uncontrolled spontaneous muscle movements. This is manifested by twitching of the extremities and grimaces. Form is very bad, because it complicates the social life of man and prevents self-care in the home. The symptoms last from 2 to 4 weeks. In the dream manifestations are absent;
  • The pulmonary form. Manifested in complex lesions of the joints and heart, but there is extremely rare (approximately 1-3% of the total number of clinical cases). Develops in the form of pleurisy or bronchitis;

  • The cutaneous form. Manifests itself with skin rashes, or rheumatic nodules. Occurs no more than 5% of cases;
  • Ophthalmic form. Diagnosed only in combination with "classic" symptoms of rheumatism. Is the defeat of the retina (retinitis), or other structures of the eye (iritis, iridocyclitis, etc.). Can cause full or partial loss of vision.


Complications of rheumatic fever

Postponed complications of rheumatic fever include:

  • Chronic relapsing course. The disease can become chronic;
  • The development of cardiac malformations. The formation of the defects found in 25% of cases after the acute phase of the disease. The flaw affects major muscle structures of the heart and leads to a decrease in the quality of work of the authority;
  • Chronic heart failure. Heart, being plagued by rheumatism, can no longer cope with their functions. May have diffuse changes, reduced cardiac contractility and arrhythmias;
  • Thromboembolic and ischemic disorders. The result can be outbreaks of tears or blockage (stroke) of blood vessels, including retinal, renal arteries, etc.;

  • Inflammation of the cardiac membranes. Is infectious in nature and may present a direct threat of life of the patient.

How to treat rheumatism? Drugs rheumatism

Bitsillin

Rheumatic fever — pathology, with mixed immune-biological nature. Therefore, it is difficult to cure and is almost completely cured. Since the primary source of the disease acts streptococcal bacteria (a secondary immune response and is a response to the "attack" of the alien body), the main goal of treatment is to eliminate bacteria and the rapid excretion of their metabolic products and decay.

The main (and primary) drug to combat the causative agent of the disease is bitsillin (represents the antibiotic penicillin, has a longer effect than normal penicillin).

The first (active) phase of antibacterial therapy lasts 10 to 14 days. Studies show that a shorter period is not advisable, since the infection persists, and the more inefficient, because the strep begins to produce substances that destroy the antibiotic, and the antibiotic becomes detrimental to the patient.

Then begins the second (passive) phase. After three weeks since the end of the oral dose bitsillina the patient an intramuscular injection of the same drug. Such treatment must continue for 5-6 years (1 injection every 3 weeks) to reduce the likelihood of recurrence and prevention of possible complications on the heart.

Aspirin

In medical practice is well established drug acetylsalicylic acid. Aspirin has many contraindications (period of gestation and lactation, the fragility of blood vessels, problems with the digestive organs), but such therapy of rheumatism gives a significant effect in articular and neurological forms of the disease. Aspirin relieves pain and reduces inflammation in the joints. The first two weeks are taken in maximum doses.

After the main period of therapy aspirin is taken for 30 days at a dosage of 2G/day.

Note: aspirin irritates the mucous membrane of the stomach and duodenum. This side effect occurs quite often, especially if the violation of the guidelines for taking the drug. This leads to erosion, gastric ulcer, gastroduodenitis and peptic ulcer bleeding.

Hormones

In the treatment of severe forms of rheumatism used prednisolone maximum dosage.

General guidelines

If the disease is mild, is assigned to polupostelny mode for up to 10 days. If severe, need to rule out any motor activity, because it exacerbates the process. Assigned bed rest for a period of up to a month.

Forevaluation of the effectiveness of treatment resort to laboratory tests. Once the indicators are approaching normal values, bed rest can be canceled. If the disease is severe, with severe disturbances of cardiac rhythm, pain in the joints, you need hospital treatment, which lasts up to two months.

On topic: the 5 most powerful tools from rheumatism


Disability in rheumatoid arthritis

A common list of diseases in which the patient is guaranteed to be set to the degree of disability, no.

The medical Commission to determine disability based on three main criteria:

  • The ability to separate domestic service;
  • The overall health and quality of life;
  • Employability and employment opportunities.

Depending on the severity of rheumatism, the ability to self, as to self-motion, can fall sharply. Many factors labour can cause aggravation of patients, for example, work related to physical activity or high physical activity. Quality of life is determined by the frequency of relapses and their severity.

Based on these criteria, the medical Board is prescribed to the patient or third, or second group of disability. There are rare cases of assignment of the first group.

III group is assigned, if pronounced functional disorders do not exist, the patient is able to serve himself, and the relapses occur no more than 3 times a year. Disability in this case is minimal and relate only to physical activity and immobilization during periods of exacerbations.

II a group can be assigned if the patient there are striking manifestations of rheumatism. Frequent exacerbations (more than 3 times a year), the ability to self-care is reduced during periods of exacerbations. Employment allowed on places that do not require constant physical activity, lack of humidity and cold.

I group is assigned in the case of severe functional disorders. Exacerbation of frequent and protracted nature. Even in periods of remission, the symptoms persist and manifest themselves in the form of pain in the joints and heart. The ability to work is substantially impaired, the period of inability to work are from 3 months to half a year.


Prevention of rheumatism

The primary prevention of streptococcalinfection is the only possible measure of prevention of rheumatic fever. If early antibiotic treatment, the likelihood of developing disease is minimized.

Preventive measures can reduce the probability of disease:

  • Increased immunity. The main cause of rheumatism is the penetration of streptococcal infection with blood flow to the organs and systems. Most often, the smooth penetration of the infection is lowered immunity, not able to suppress activity of the pathogen. To strengthen the immune system requires vitamin correct diet and proper rest;

  • Avoiding contact with strep. You should observe good personal hygiene and to try less likely to get sick with infectious diseases. You should also avoid contact with infected streptococcal infection people;
  • Timely treatment of colds. The formation of rheumatism contributes not only to the repeated contact with the bacterium and the causative agent, but also a long period without treatment. When the first cold symptoms you need to go to the doctor. Moreover, this recommendation applies to individuals with confirmed streptococcal lesions or have survived the disease earlier;
  • Preventive sanitation after contact with the pathogen. Consider taking bitsillina in an adequate dose (1.5 million units as a single dose, intramuscularly).

Thus, rheumatism is complex, both in terms of etiology and symptomatology. The disease is not well understood, so there are difficulties with the formulation of correct diagnosis, and cured it completely.

However, modern methods of treatment allow to eliminate the negative manifestations of disease, to minimize danger to life and harmful effects, and to ensure a high quality of life of patients with rheumatism.