Treatment of rheumatism. Rheumatism: symptoms and treatment

Or rheumatic fever - a systemic inflammatory disease of connective tissue with a predominant localization of the process in the cardiovascular system and frequent damage to other organs and systems, in particular joints. Develops in connection with an acute infectious lesion, usually group A streptococcus, mainly in children and adolescents aged 7-15 years due to the development of an autoimmune response to streptococcal epitopes and cross-reactivity with similar epitopes of human tissue. There are acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD).

Rheumatism is found in all countries of the world, but its prevalence depends on the level of economic development of countries. Women get sick 2-2.5 times more often than men. In Ukraine, in recent years, there has been a positive trend towards a decrease in the incidence and prevalence of acute rheumatism, but the prevalence of chronic rheumatic heart disease does not decrease significantly. Rheumatic heart defects account for about 50% of cases of disability among rheumatological patients. Among the reasons for the late diagnosis of rheumatism, one should mention the low-symptomatic or completely asymptomatic nature of its course with a minimal degree of activity, as well as the insufficient availability of modern highly informative laboratory diagnostic methods that make it possible to identify heart damage already in the early stages of the development of rheumatism.

The body's sensitivity to streptococcal infection is of great importance in the development of the disease, which is apparently associated with genetically determined changes in humoral and cellular immunity. According to WHO experts, the degree of risk of developing rheumatism depends on the duration of carriage of group A streptococci and the intensity of immunological reactions to this infection. It has been proven that chronic foci of infection lead to a decrease in the body’s immunological reactivity and can be a background for the development of pathology of internal organs. Of all the localizations of infectious foci, chronic tonsillitis and dental pathology are more often (90% of cases) the cause of visceral lesions.

The main reason for the development of rheumatism is not the intensity of the chronic focus of infection, but the location of the infection, its effect on the tonsillar receptor apparatus, which is an important reflexogenic zone of the body, and chronic tonsillitis is found in 4-10% of the population.

Pathogenetic concepts of the formation of rheumatic carditis are based on the theory of an abnormal immune response to streptococcal antigens, which is based on cross-reactions between various structures of group A hemolytic streptococcus and host proteins. Recently, this theory has received new confirmation of the homology of the streptococcal M-protein molecule and tropomyosin, the M5 pepsin fragment and the sarcolemma, and the ability of antibodies to three epitopes of serotypes M3, M5 and M18 to react with heart tissue.

To initiate the rheumatic process, group A hemolytic streptococcus must be localized in the nasopharynx and regional lymph nodes. This is due to the following factors:

• selective tropism of streptococcus to the epithelium of the nasopharyngeal mucosa;
• specific features of the immunological response to the localization of streptococcal infection in the nasopharynx;
• the presence of a direct connection between the mucous membrane of the upper respiratory tract and the lymphoid formations of the lymphoepithelial throat ring (Waldeer's ring) along the lymphatic tract with the membranes of the heart.

For the development of the disease, the action of streptococcus alone is not enough. This requires a special, individual hyperimmune reaction of the body to antigens produced by streptococcus, i.e. the presence of a mechanism for long-term abstinence of group A streptococcus, which determines its carriage. It is known that children under 4-5 years of age do not suffer from rheumatism, since they do not have this mechanism. In children over 4-5 years of age, with repeated encounters with streptococcal infection, receptors for fixation of streptococcus appear in the mucous membrane of the nasopharynx. This phenomenon has a high degree of genetic determination and is one of the confirmations of a hereditary predisposition to rheumatism.

According to the mechanisms of development, acute rheumatic fever (ARF) is an autoimmune disease. The initiator of inflammation is immune reactions that arise as a result of the cross-reaction of antibodies directed at the components and factors of streptococcus with antigens of the tissue structures of the macroorganism. In this case, the main target of autoantibodies is the myocardium. A risk factor for rheumatism is also the negative influence of the external environment:

• failure to comply with general sanitary and hygienic measures,
• hypothermia,
• overwork,
• incorrect alternation of work and rest,
• malnutrition,
• low level of natural immunity,
• weakness of general adaptive mechanisms,
• physical lack of training.

Thus, a number of factors are involved in the development of rheumatic fever. Group A hemolytic streptococcus, which has rheumatogenous cross-reacting antigens, triggers processes of immune inflammation in a sensitized and susceptible human body.

The development of the pathological process in connective tissue goes through four phases, which partially overlap:

• mucoid swelling,
• fibrinous swelling,
• granulomatosis (formation of rheumatic granulomas),
• sclerosis and hyalinosis.

In the first phase there is an increase in the activity of mucolytic enzymes, as a result of which depolymerization and breakdown of glycosaminoglycans of the main substance of connective tissue occur. There is an accumulation of hyaluronic acid, which has hydrophilic properties, due to which tissue and vascular permeability increases, which leads to hydration and swelling of the main intermediate substance. Changes at this stage are reverse and in case of successful treatment, the structure of the connective tissue can be completely restored.

Second phase characterized by deep and permanent disorganization of connective tissue. Increased permeability of the vascular wall leads to the leakage of proteins (including fibrinogen) from the blood, which, combining at the site of damage with tissue components, form fibrinoid, which is deposited mainly in the ground substance or walls of blood vessels. This process leads to swelling of the intermediate substance and collagen fibers with their disintegration and rearrangement.

In the third phase Rheumatic granulomas form around the foci of fibrinous necrosis due to the proliferation of connective tissue cells, which is a manifestation of a specific cellular response to connective tissue damage. In this case, macrophages accumulate, which transform into large cells with heterogeneous nuclei. Subsequently, a typical rheumatic granuloma is formed with a characteristic arrangement of cells around centrally located masses of fibrinoid (the so-called mature, or flowering, granulomas). Over time, the granuloma cells stretch out, fibroblasts appear among them, and the fibrinoid masses in the center of the nodule almost disappear ("faded" granulomas). At the last stage of the formation of rheumatic granuloma, fibroblasts predominate in it, between which collagen fibers appear over time, while the fibrinoid is completely resorbed. The nodule shrinks and takes on the character of a granuloma, which scars.

Fourth phase completes the process of disorganization of connective tissue due to rheumatic inflammation and is characterized by the evolution of granuloma into sclerosis or the transformation of fibrinosis into hyalinosis (primary sclerosis), i.e. scar formation. Sclerosis is divided into relatively stable and progressive, since the scar that forms, leading to the development of myocardial cardiosclerosis, during the next exacerbation can be an area for the re-emergence of the rheumatic process.

Along with damage to the connective tissue in rheumatic carditis, changes in the muscle elements are also detected, in particular a decrease in the content of glycogen and sulfhydryl groups during exacerbation of the process and a decrease in the activity of redox enzymes, leading to a decrease in the contractility of the heart muscle.

Another morphological substrate of heart damage in rheumatic carditis is nonspecific cellular reactions in the form of histiolymphocytic infiltrates, similar to those contained in the serous membranes, joints and other organs. These reactions differ from granulomas in the diffuse arrangement of connective tissue in the intercellular substance.

The clinical picture of rheumatic fever is quite varied. It depends on the severity, the nature of the course, the degree of damage to the cardiovascular system and the involvement of other organs and systems in the pathological process. In typical cases, rheumatism develops 1-3 weeks after a sore throat or pharyngitis of streptococcal etiology.

The period after streptococcal infection is latent and is asymptomatic or with signs of prolonged convalescence (weakness, malaise, low-grade body temperature). Then comes the period of clinically advanced disease. The central place in the clinical picture of ARF is occupied by the nature of the damage to the membranes of the heart (endocardium, myocardium, core or pericardium). The severity of the initial stage of ARF depends on the age of the patients.

All three linings of the heart can be involved in the pathological process: myocardium, endocardium, pericardium. The difficulty of recognizing endocarditis and pericarditis against the background of acute rheumatic myocarditis led to the introduction into practice of the concept of “rheumatic carditis”, which in ICD-10 corresponds to the term “acute rheumatic heart disease, unspecified”.

During the first attack of rheumatism, its acute course involving the joints, the disease is manifested by an increase in temperature to subfebrile or febrile (38-40 ° C), chills and severe pain in the joints. Shortness of breath appears due to heart damage. A similar clinical picture is observed more often in children and young males.

In the last 15-20 years, the clinical picture of rheumatism has changed significantly: more primary chronic forms that occur latently, and forms with frequent relapses and predominant damage to the heart, have appeared. The most important symptom of rheumatic fever, which determines the severity of the patient’s condition and illness, is carditis. The criteria for carditis are as follows:

• organic noise(s) not previously heard;
• dynamics of noise that existed previously;
• enlarged heart (cardiomegaly);
• congestive heart failure in young people;
• pericardial friction rub;
• signs of effusion into the pericardial cavity.

More often, a symptom of carditis is a murmur that can be heard slightly with tachycardia, congestive heart failure through low volume during systole, and with pericarditis - a pericardial friction rub or signs of effusion.

With secondary ARF in adults, rheumatic carditis develops in 100% of cases. Rheumatic lesions of the heart, characterized by sequential involvement of the membranes of the heart (myocardium, endocardium, pericardium) in the pathological process, are called “rheumatic carditis”. The development of isolated diffuse or focal myocarditis, endomyocarditis, pancarditis is possible. Clinical manifestations of rheumatic carditis are determined by the predominant damage to one or another lining of the heart, the degree of general activity of the rheumatic process and the nature of the course of the disease. The following clinical gradations of rheumatic carditis are distinguished:

• bright (pronounced),
• moderate,
• weakly expressed.

There are five variants of the course of rheumatic inflammation:

• the acute course is characterized by bright, violent clinical manifestations (acute onset, high fever, polyarthritis with a pronounced exudative component, rheumatic carditis, polyserositis, other visceritis), which are characterized by reverse dynamics after 2 - 3 months from the onset of the disease against the background of antirheumatic therapy;
• subacute course is characterized by a duration of 3 to 6 months, the onset of the disease is usually acute or moderately severe, signs of process activity first increase, and then they decline, the severity and variability of clinical symptoms is less than in the acute version of the course; often severe rheumatic carditis comes to the fore in the clinical picture;
• a continuously relapsing course is characterized by the return of clinical and laboratory signs of the disease against the background of a rheumatic process that has not yet subsided, accompanied by pancarditis, polyserositis, vasculitis, oligoarthritis, fever, incomplete response to antirheumatic therapy;
• a protracted course is characterized by a duration of more than 6 months, clinical symptoms develop gradually, their signs are unclear, inactive, the degree of activity is I-II, the course is monotonous, without declines or increases in the activity of the process; the response to antirheumatic therapy is weak and unstable.
• The latent course is characterized by the absence of obvious initial clinical signs of the disease, laboratory activity does not appear, but productive inflammation gradually progresses, resulting in heart disease.

The diagnosis is retrospective, after detection of a heart defect, emerging or already formed, and with surgical correction of the defect based on histological data.

How to treat rheumatism?

A three-stage system is justified rheumatism treatment:

• the first stage is long-term (4-6 weeks) inpatient treatment in the active phase,
• the second stage - sanatorium or sanatorium-resort treatment in the post-hospital period,
• the third stage is dispensary observation in a clinic with the use of bicilinotherapy.

Treatment of rheumatism should be started in the first hours or at least days from the onset of the disease, since at this stage changes in the connective tissue of the heart and other organs (mucoid swelling phase) are still reversible. Treatment must be comprehensive, adequate and purely individual.

All patients with rheumatic fever should be hospitalized to clarify the diagnosis and determine treatment tactics, which includes etiotropic (antistreptococcal), pathogenetic (antirheumatic) and symptomatic therapy, as well as rehabilitation measures.

The regimen depends on the presence of rheumatic carditis and the degree of activity of the process. During the first 2-3 weeks of the disease, bed rest is indicated, but in the absence of carditis and if the arthritis subsides, the regime can be somewhat softened. Bed rest can be canceled only when the acute phase indicators remain normal or close to it for 2 weeks (ESR below 25 mm/h, C-reactive protein is normal).

Patients with polyarthritis and chorea without carditis are not prescribed bed rest.

By the time of discharge, that is, after 40-50 days, the patient should be transferred to a free regimen. The diet should correspond to table No. 10, contain at least 1 g of protein per 1 kg of body weight, no more than 3-6 g of table salt per day, be enriched with fruits and vegetables, contain vitamin C and potassium salts.

Drug therapy consists of prescribing antibiotics to which group A hemolytic streptococcus is sensitive, non-steroidal anti-inflammatory drugs, glucocorticosteroids, aminoquinoline compounds, vitamins, drugs that improve metabolic processes in the myocardium, and drugs for symptomatic therapy. Antibacterial agents are used to eliminate the focus of streptococcal infection in the nasal pharynx. Streptococci remain highly sensitive to penicillin antibiotics.

Therapy is started with a course of benzylpenicillin or benzathine benzylpenicillin. In the absence of risk factors (heredity, unfavorable social and living conditions), you can use a 10-day course of oral drugs of the penicillin group: phenoxymethylpenicillin, ampicillin, amoxicillin. The best of these drugs is amoxicillin, since it is not inferior in effectiveness to phenoxymethylpenicillin and ampicillin, but has greater bioavailability and is less bound to serum proteins. You can prescribe 1st generation cephalosporins (cephalexin, cefradine, cefadroxil) or 2nd generation (cefaclor, cefuroxime). In case of intolerance to penicillin drugs, macrolide antibiotics are used: erythromycin or new generation drugs azithromycin, clarithromycin, roxithromycin. These antibiotics are highly active against streptococci and are capable of creating a high concentration at the site of infection.

It is not recommended to treat patients with rheumatic fever with tetracycline, chloramphenicol (chloramphenicol), fluoroquinolones, sulfonamides, since hemolytic streptococcus is little sensitive or completely resistant to these drugs.

After completion of treatment with short-acting antibiotics, secondary prevention of rheumatism is immediately started by intramuscular administration of benzathine penicillin (long-acting penicillin) or bicillin-5.

The leading role in the pathogenetic treatment of the rheumatic process is played by NSAIDs, which are prescribed for rheumatoid arthritis, chorea, rheumatic carditis of mild and moderate severity, mild and moderate activity, with subacute, protracted and latent variants of the course. Preference is given to drugs from the group of indolic acid (indomethacin) and arylic acid (Voltaren).

The drug aceclafenac (Aertal), a derivative of phenylacetic acid, which has the same effectiveness as NSAIDs, but is significantly less ulcerogenic, has shown high anti-inflammatory activity in the treatment of rheumatic diseases. NSAIDs have pronounced anti-inflammatory activity; within 10-15 days they lead to the disappearance of fever, joint pain, shortness of breath, palpitations, normalization of ECG and acute phase indicators. The duration of anti-inflammatory therapy should be 9-12 weeks.

A direct indication for the use of GCS is severe, life-threatening carditis, with maximum activity of the process, and in some cases - moderate with a pronounced exudative component of inflammation, as well as other significant systemic manifestations that cannot be treated with NSAIDs. Most often, prednisolone is prescribed, and for reversible rheumatic carditis due to heart disease - triamsinolone. When reducing the dose of prednisolone, it is necessary to prescribe an NSAID to continue anti-inflammatory treatment for up to 9-12 months. Cancellation of treatment at an earlier time leads to the return of clinical and laboratory signs of the disease.

Since glucocorticoids affect water-salt metabolism, complex treatment includes potassium preparations (panangin, asparkam, potassium orotate), and for fluid retention in the body - aldosterone antagonists (aldactone, veroshpiron), diuretics (furosemide). To prevent a decrease in the functional activity of the adrenal cortex, stimulants of these glands are prescribed - etimizol, calcium pantothenate.

Symptomatic remedies are used when complications develop. With the development of circulatory failure, inotropic non-glycoside drugs (dopamine, glucagon), small doses of cardiac glycosides (corglycone, strophanthin, digoxin), diuretics, potassium preparations are prescribed, and with the development of arrhythmias - antiarrhythmic drugs. According to indications, hyperbaric oxygenation and efferent methods (hemosorption, plasmapheresis) are prescribed.

In the treatment of patients with rheumatism, sanitation of the chronic source of infection is important. If the rheumatic process is highly active, sanitation should be carried out after a decrease in body temperature to 37.0 - 37.2 ° C, normalization of hemodynamics, leukocytosis, ESR, and improvement in the general condition of the patient. Sanitation of foci of infection should be carried out under the guise of antibiotics. First, the teeth are sanitized. If there is a need to remove decayed teeth, their extraction is carried out gradually (with a break of 2-3 days). Treatment of chronic sinusitis is carried out after dental sanitation. Tonsillectomy should be planned for a “quiet” period (approximately 1-1.5 months after discharge from the hospital), if the patient’s condition is satisfactory and tests are normal. Removal of tonsils is carried out against the background of penicillin antibiotics.

IN treatment of rheumatism it is necessary to adhere to continuity at different stages:

• hospital - treatment of the active phase for 4-6 weeks,
• local sanatorium or clinic - completion of treatment started in a hospital;
• polyclinic - long-term clinical observation (at the outpatient stage, patients should be observed by a rheumatologist).

What diseases can it be associated with?

In the early stages of the rheumatic process, valve damage consists of warty formations appearing along the edges of the valves. The consequence of rheumatic valvulitis is thickening and deformation of the valve leaflets, shortening of the chords, which leads to the formation of valve defects and valve insufficiency.

Damage to the lungs, nervous system, and kidneys (rarely affected) in rheumatism is also based on perivasculitis. In articular tissues with rheumatic arthritis, processes of connective tissue disorganization, exudative inflammation, and vasculitis with transformation into moderate fibrosis are observed.

In the brain with rheumatism, atrophic and dystrophic changes in the nerve cells of the striatum, granular layer of the cortex, molecular layer of the cerebellum, subthalamic nuclei and substantia nigra, developing outside of vascular changes, can occur.

The most characteristic skin lesions in rheumatism are rheumatic nodules. Erythema annulare consists of pink ring-shaped elements located mainly on the inner surface of the arms, legs, abdomen, neck, but not on the face; reflects a high degree of sensitization of the body to streptococcal infection and therefore can be observed not only with rheumatism, but also with other conditions caused by streptococcus. Subcutaneous rheumatic nodules are dense, inactive, painless formations ranging in size from millet grains to beans, which are located on the extensor surfaces of the elbows, knees, metacarpophalangeal joints, ankles, spinous processes of the vertebrae, the back of the head, etc.

In case of untimely inadequate treatment, the course of rheumatic fever may be complicated by the formation of severe myocardiosclerosis with the development of arrhythmia and.

In this case, mitral valve insufficiency is predominantly formed. In recent years, there has been an increase in the incidence of mitral valve prolapse after both primary and repeated rheumatic attacks.

A frequent manifestation of cardiac pathology during an acute attack of rheumatism. The state of the cardiovascular system depends on the degree of its severity. With diffuse myocarditis, the general condition of the patient suffers significantly, pallor of the skin appears, expansion of the borders of the heart, weakening of the sonority of heart sounds, and circulatory failure may develop.

Rheumatic disease is difficult to diagnose in the first weeks of the disease, since the clinical picture is dominated by symptoms of myocarditis, which mask endocardial manifestations, and rheumatic endocarditis (valvulitis) is not accompanied by additional subjective symptoms.

Rheumatic develops in the case of severe rheumatic process and is usually combined with rheumatic myocarditis and endocarditis (pancarditis). Pericarditis can be dry (fibrinous) and exudative. Dry pericarditis occurs more often, which is characterized by a deterioration in the general condition of patients, an increase in body temperature, frequent complaints of pain in the heart area, radiating to the back, and increasing shortness of breath.

Vascular damage is manifested by vasculitis due to increased vascular permeability and deposition of immune complexes in the walls of capillaries and arterioles. In addition to capillaries and arterioles, veins can also be involved in the pathological process.

Rheumatoid arthritis of internal organs leads to the development of rheumatic visceritis (, etc.). Sometimes large vessels are affected - the aorta and pulmonary artery. Rheumatic lesions of the coronary arteries, mainly small and medium-sized, can lead to the development of coronary insufficiency, which is manifested by pain in the heart area of ​​​​various nature and localization, which is similar to angina attacks.

Develops in 12-15% of children, more often in adolescents (25%), mainly in girls of early puberty. It is caused by the involvement of various brain structures in the pathological process. Chorea is characterized by a pentad of symptoms: hyperkinesia, muscular dystonia, disturbances of statics and coordination, vascular dystonia, and mental disorders. These symptoms intensify with excitement and stop during sleep.

Treating rheumatism at home

Patients with a sluggish course of rheumatic carditis are recognized as temporarily disabled for the period of a full course of antirheumatic treatment in inpatient conditions and in cardiological sanatoriums. The duration of temporary disability with a minimal degree of rheumatic carditis activity ranges from 1.5 to 4 months. The ability of patients to work after treatment depends on the condition of the myocardium, the degree of cardiac and coronary insufficiency, the nature of valvular heart disease, damage to other organs and systems, as well as social factors. All patients with a sluggish course of rheumatic carditis are contraindicated from work associated with significant, even episodic, physical activity, constant moderate physical activity, or in adverse weather conditions.

Patients with rheumatism in the active phase (II and III degree) are temporarily disabled and subject to hospitalization. The duration of temporary disability is from 2 to 4 months. The patient can be discharged from the hospital after a sustained improvement in condition and normalization of all acute phase reactions. In the future, it is advisable to undergo treatment in a rheumatology clinic or cardiological sanatorium for 1-1.5 months.

A patient whose duration of sick leave exceeds 4 months must be examined by a medical sanitary and epidemiological commission. If the process continuously recurs, symptoms of heart failure increase and there is no effect from treatment, the patient is assigned disability group II, and if constant outside care is required, group I is assigned.

If there are positive changes in the patient’s condition as a result of treatment, there is reason to believe that he will soon be able to start work, he will continue to have sick leave. In the future, patients can perform work with minor physical and mental stress, in favorable weather conditions.

What drugs are used to treat rheumatism?

• - daily dose of 1.5-4 million units in the form of intramuscular injections for 10-14 days;
• - at a dose of 2.4 g per day, once every 3 weeks.
• - 0.5-1.0 g 4 times a day,
• - 0.5 g 4 times a day,
• - 0.5 g 3 times a day or 1.0 g 2 times a day,
• - 0.5 g 4 times a day,
• - 0.5 g 4 times a day,
• - 0.25 g 3 times a day,
• - 0.25-0.5 g 4 times a day,
• - 0.5 g on the first day, then on days 2-5, 0.25 g once a day, course - 5 days,
• - 0.25 g 2 times a day, course - 5-7 days,
• - 0.15 g 2 times a day, course - 10 days,
• - 0.5 g 3-4 times a day,
• - 0.15-0.45 g 4 times a day,
• - 1.2 g per day for 10 days,
• - 3.0-4.0 g per day,
• - 800-1200 mg per day, followed by a dose reduction to a maintenance dose.
• - at an initial dose of 0.7-0.8 mg, maximum - 1.0 mg per 1 kg of body weight, but usually no more than 20-30 mg per day for 2 weeks, and then the therapeutic dose is reduced to 2.5 mg once every 5-7 days until the drug is completely discontinued.

Treatment of rheumatism with traditional methods

When the acute stage of rheumatism is left behind and the patient is discharged from the hospital, further treatment at home is indicated. It is not recommended to refuse to take medications prescribed by the doctor and regular examinations, however, therapy can be supplemented with the use of folk remedies, the advisability of which is also worth discussing with a professional physician. You can take note of the following recipes:

• oats - pour oat grains into small cotton bags; Before use, place the allotted number of bags in water, put it on the fire and bring to a boil; Squeeze out the still hot bags of oats and apply to the joints affected by rheumatism, secure on top with a bandage, and leave overnight;
• sea ​​buckthorn - 1 tbsp. pour sea buckthorn with a glass of water, bring to a boil, boil for 10 minutes, strain; drink ½ glass twice a day;
• rosehip - 1.5 cups of crushed rosehip roots, pour 1.5 liters of vodka and leave in a dark place for 6 days, shake periodically; strain; take 1 tbsp. three times a day for three days, and in the next 18 days, 25-50 ml 15 minutes before meals; the course of treatment lasts 21 days, after a 10-day break the course can be repeated;
• barberry - pour 1 kg of barberry berries with water and cook until the pulp begins to separate from the seeds, strain, add sugar and boil for another half hour; Divide the resulting jelly into jars and consume as needed.

Treatment of rheumatism during pregnancy

The combination of pregnancy and rheumatism cannot be ignored. On the one hand, pregnancy can aggravate and aggravate the disease, on the other hand, rheumatism can affect the outcome of pregnancy. Determining the activity of the rheumatic process is one of the main elements in the system of measures during pregnancy management in such individuals.

Exacerbation of rheumatism is highly likely in the first trimester of pregnancy, as well as in the postpartum period, less often it occurs at 28-32 weeks. During such periods, a woman is prescribed anti-relapse treatment, which is determined purely individually. Antirheumatic therapy using salicylates, pyrazolone drugs, and steroid hormones is allowed. Specific prescriptions are made by a rheumatologist, taking into account the clinical form of rheumatism, the state of activity of the process, the duration of pregnancy, the presence or absence of its complications and other diseases associated with pregnancy.

The immunological manifestations of the inflammatory process that develop in the patient are varied and reflect the form, course and degree of activity of rheumatism:

• presence of circulating cardiac antigen and anticardiac antibodies;
• usually unchanged complement level;
• at the height of the activity of the process of increasing the level of IgG, IgA and IgM;
• absolute and relative increase in the number of B-lymphocytes;
• decrease in the total number and decrease in the functional activity of T-lymphocytes, especially the T-suppressor clone;
• the presence of clinical manifestations of carditis with a decrease in myocardial contractile function when a high titer of antibodies to streptolysin and some proteinases is detected, which indicates their cardiotoxicity;
• 60% of patients with rheumatism have a high level of CEC, which, if fixed in the vessels of the heart and its interstitium, lead to the development of immune complex cardiac vasculitis;
• Cytotoxic reactions that differ in the selectivity of damage develop in the presence of antibodies that cross-react.

Serological testing reveals elevated titers or, more importantly, increased antistreptococcal antibodies. An increase in titers is observed within 1 month from the onset of the disease, it persists for 3 months, and after 4-6 months the titers normalize.

Echocardiography is needed to identify valvular pathology of the heart and pericarditis. An ECG is important to clarify the nature of heart rhythm and conduction disturbances.

The analysis of the following syndromes helps to establish the diagnosis of rheumatism:

• clinical and epidemiological syndrome:
  • the anamnestic history clearly shows a streptococcal infection before the appearance of the first symptoms of rheumatism;
  • repeated nasopharyngeal infections;
  • "streptococcal" environment of the patient (in close proximity to the patient): in the family, at home, at school, at work;
• clinical and immunological syndrome:
  • clinical indicators - an incomprehensible delay in the restoration of vigor and full performance after a nasopharyngeal infection; fatigue that was previously unusual for the patient after usual work, sweating, mild low-grade fever, arthralgia, mild palpitations after normal exercise;
  • laboratory indicators - the ratio of OIR (per Ioffe) and specific sensitization to streptococcus (titers ASL-O, ASG, ASA), the appearance in the blood of streptococcal antigen and streptococcal antibodies, antigens of streptococci and cardiac muscle that cross-react, negative dynamics of albumins and globulins in the blood, increase in ESR; the appearance of C-reactive protein in the blood, an increase in DPA and seromucoids; negative dynamics of indicators;
• cardiovascular syndrome:
  • subjective indicators;
  • objective indicators are revealed by auscultation and phonocardiography (weakening of the first tone, noises during systole and diastole; the appearance of III and IV tones, accent, etc.);
  • ECG data,
  • X-ray kymography, phase structure of systole, increased capillary permeability.

These indicators are analyzed over time.

Diagnostic criteria for rheumatic carditis are:

• pain or discomfort in the heart area,
• dyspnea,
• heartbeat,
• tachycardia,
• weakening of the first sound at the apex of the heart,
• murmur at the apex of the heart: systolic, diastolic,
• symptoms of pericarditis,
• increase in heart size,
• ECG data: prolongation of the P-Q interval, extrasystole, junctional rhythm, other rhythm disturbances,
• symptoms of circulatory failure,
• reduction or loss of ability to work.

The presence of 7 out of 11 criteria in a patient in combination with a previous streptococcal infection allows us to establish a reliable diagnosis of rheumatic carditis.

Treatment of other diseases starting with the letter - r

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.

Basically, the disease occurs gradually and unnoticed by the human body. A person feels well for a long period, leads a normal life, while existing antibodies kill the body's own tissues.

When a large accumulation of antibodies occurs, all their components are damaged and inflammation of the joints begins. Deformation and slow destruction of tissue components leads to their functional impairment or their complete loss.

At a later stage of the development of the disease, arthritis can affect other vital organs: kidneys, lungs, cardiac system, and muscle tissue atrophy occurs.

Any doctor admits that today there are no specific etiological factors that stop the development of antibodies in arthritis. There are only two probable theories about the cause of the disease:

1. Genetic predisposition. The general picture of arthritis at the genetic level ranges from 15% to 30% of the total number of people suffering from this disease. This indicator of heredity cannot be discounted.
2. The role of infectious agents. Epstein-Barr antibody viruses in the blood are greatly increased. No direct evidence of a clear impact of this virus has been found to date. Therefore, the entire scientific world is inclined to the existence of some other antibody of unknown origin.

Clinical picture of rheumatoid arthritis

The clinical picture of this autoimmune pathology is quite bright and characteristic, so a highly qualified doctor will easily make a diagnosis based on the patient’s complaints and visual examination data. The diagnosis and treatment of rheumatoid arthritis is carried out by a rheumatologist, who pays attention to the presence of the following subjective complaints of the patient:

pain in small joints at night or early in the morning (usually the phalanges of the fingers and toes are the first to be affected);

stiffness and limited mobility of joints persists for 1-2 hours after sleep;

low-grade fever in the evening (rises up to 38 degrees);

the patient has insomnia;

increased fatigue and general weakness throughout the day;

decreased appetite and body weight;

increase in painful joints in volume;

the formation of nodules that become noticeable over the articular surface of the elbows and knees.

If such symptoms appear, you should consult a doctor immediately. You can visit a general practitioner who, if you suspect the development of rheumatoid arthritis, will prescribe a blood test for rheumatoid complex, which will confirm or refute his assumptions.

If they are confirmed, the therapist will coordinate the patient, that is, advise which doctor to contact. As a rule, he refers you for consultation to a rheumatologist, that is, to a doctor directly involved in the diagnosis and treatment of rheumatoid arthritis.

If rheumatoid arthritis is excluded, the patient is referred to a traumatologist, since the development of arthrosis, that is, nonspecific deformation of the joint, is expected. .

People whose hereditary history is burdened by the presence of rheumatoid arthritis should especially carefully monitor the condition of their joints, since a genetic predisposition in 85% of cases manifests itself under the influence of provoking factors.

What does a pediatric rheumatologist treat?

A pediatric rheumatologist is a doctor who diagnoses and treats connective tissue and joint diseases in children and adolescents.

A pediatric rheumatologist is consulted when:

• rheumatic diseases of periarticular soft tissues;
• arthritis (microcrystalline, reactive, rheumatoid and psoriatic);
• ankylosing spondylitis (Bechterew's disease);
• Wegener's granulomatosis;
• Goodpasture's syndrome;
• hemorrhagic vasculitis;
• systemic vasculitis;
• giant cell arteritis;
• Sjögren's syndrome;
• Takayasu's disease;
• dermatomyositis;
• periarteritis nodosa;
• thromboangiitis obliterans;
• systemic lupus erythematosus;
• rheumatism;
• systemic scleroderma, etc.

Signs of rheumatism

Rheumatism of the joints manifests itself extremely characteristically. The development of the disease is usually the result of a streptococcal infection in the respiratory tract, and usually begins a couple of weeks after it. Sometimes the period can increase to three weeks.

It should be borne in mind that the manifestations of streptococcal infection are not always bright enough. In some cases, not very experienced doctors make a diagnosis of acute respiratory infections, making a mistake due to the atypical course of the disease, which occurs secretly, without high fever and severe inflammation.

Therefore, special antistreptococcal treatment is not carried out, which is fraught with the development of articular rheumatism. This is especially dangerous if the infection strikes the patient again.

Literally a few days after the course of treatment, inflammation of any large joints (for example, the knee) may occur. Rheumatism of the joints affects small joints of the legs or arms extremely rarely.

After the onset of the development of the disease, alternate inflammation of the joints occurs, most often the damage to the joints of the legs is observed. First, inflammation of the knee joint may occur, which goes away after a short time. Inflammation appears on another joint, after which the process is repeated. It is this course of the disease process that characterizes rheumatism.

If rheumatism is not treated in a timely manner, the consequence may be the appearance of rheumatic carditis or chorea.

Rheumatoid arthritis: diagnosis

Given the preliminary diagnosis, the rheumatologist refers the patient to:

• X-ray, ultrasound of joints and periarticular tissues, CT, MRI, arthroscopy (minimally invasive surgical manipulation that allows diagnosing damage to the inside of the joint), densitometry (bone density scan), examination of synovial fluid in case of joint damage;
• duplex scanning (allows you to study the condition of an artery or vein, assess the speed of blood flow) in case of vascular damage;
• Ultrasound of the heart and ECG for damage to the membranes of the heart.

In addition, all patients are required to take:

• Blood test (general, biochemical, with rheumatic tests). Allows you to determine the concentration in the blood of neopterin (a product of purine base metabolism), rheumatoid factor, C-reactive protein (blood plasma protein that increases during inflammatory processes), uric acid, etc. In addition, the analysis can detect the presence of antinuclear antibodies and antibodies against hemolytic streptococcus.
• Analysis of urine.

Correct diagnosis of the disease is very important in the early stages of the disease. Pathological processes of changes in the immune system occur several months before obvious signs of the disease. The results of a synovial membrane biopsy will help establish the correct diagnosis and begin treatment. Rheumatism is examined in several stages:

1. Establish inflammation in more than 3 joints, where fluid can accumulate and swelling appears.
2. Determine symmetry (inflamed arthritis should be proportionally located on equal parts of the body).
3. Laboratory examination of blood tests and x-ray examination of joints for the presence of subcutaneous nodular secretions.

Drug treatment of rheumatoid arthritis

Rheumatoid arthritis must be treated comprehensively. Along with general therapy, physical therapy is a must.

At an early stage, the patient is prescribed non-steroidal anti-inflammatory drugs. Based on the results of many months of continuous treatment, further tactics for using these medications are determined.

If it is noticeable that the patient’s condition is significantly improving, then the treatment is correct. Arthritis can also be overcome using non-traditional folk remedies.

You can improve joint plasticity by carefully selecting effective treatment. This may take from several months to a year.

In order to avoid the chronic form of rheumatoid arthritis, the attending physician prescribes the drug methotrexate. Thanks to effective treatment with these medications, surgery can be avoided.

It is produced in the form of a concentrate for the preparation of injections or in tablets. Please note that before using the drug you must have your blood tested.

During the entire treatment process, constant blood monitoring is necessary. All advice on dosage and use of the drug should be obtained from a doctor.

Treatment of rheumatism

Many people wonder how to treat rheumatism of the joints. If you discover symptoms of joint rheumatism, you should immediately seek medical help. Today, the treatment of this pathology is quite successful.

The main task facing the doctor is to suppress streptococcal infection, which causes the development of the disease, provoking various complications. Modern medicine offers the use of penicillin, bicillin and their analogues in the treatment process.

Active treatment with penicillin lasts approximately two weeks, after which the patient will have to receive one intramuscular injection of bicillin every three weeks for five years. This approach can significantly reduce the risk of developing rheumatic complications in the heart.

In recent years, broad-spectrum antibiotics in tablets have been added to the treatment of rheumatism. The list of fairly effective drugs in this group is quite wide. Often, in addition to antibiotics, non-steroidal anti-inflammatory drugs are prescribed, which provide relief from painful sensations in the joints.

In most cases, antibiotics and anti-inflammatory drugs are enough to make the slightest signs of the disease disappear, and we can talk about a complete cure. However, although rare, such drugs are not enough. Then corticosteroid hormones are prescribed, which together with antibiotics suppress the inflammatory process in a matter of days.

Undoubtedly, treatment of rheumatism should be carried out by a doctor. After the first signs of the disease are noticed, it is recommended to immediately consult a specialist and follow all his instructions.

However, there are quite a large number of recipes that allow, if not to cure the disease completely with folk remedies, then to significantly reduce the manifestation of its unpleasant consequences. In addition, preventing the disease with folk remedies often has an effect quite comparable with taking official medications.

Traditional healers mainly define rheumatism as affecting the legs or lower back; other joints, in their opinion, are affected much less frequently.

Treatment of rheumatism with traditional medicine usually involves the use of exclusively natural ingredients, from which infusions, decoctions and ointments can be prepared. In addition, various foot baths are often used. And, of course, a certain diet is required.

Treatment of rheumatism with folk remedies has a huge number of different recipes and recommendations.

1. In the morning, it’s a good idea to take the juice squeezed out of half a lemon mixed with warm water.
2. Compresses made from finely grated potatoes relieve pain and swelling of inflamed joints quite well. Typically, such compresses are applied at night and are mainly used for the legs.
3. Traditional healers often recommend taking baths with the addition of a decoction of pine buds.
4. If rheumatism is just beginning, then treatment can be carried out with the help of bees, whose stings on the sore spot quickly remove the pain, and after several sessions the disease can recede completely.

Treatment with folk remedies usually lasts longer than with official medicine. And the effectiveness of many recipes has not been proven, so it is still recommended to consult a doctor.

The rheumatologist prescribes treatment depending on the type of disease:

• Non-steroidal anti-inflammatory drugs (diclofenac, indomethacin) and corticosteroids (hydrocortisone, prednisolone), plasmaphoresis courses and a diet with a high calcium content for arthritis. Reconstructive surgeries are also performed for persistent joint deformities. If therapy is ineffective, basic antirheumatic drugs (sulfasalazine, etc.), cytostatic immunosuppressants or anticytokine drugs are prescribed.
• For ankylosing spondylitis and systemic lupus erythematosus, non-steroidal anti-inflammatory drugs, glucocorticoids, TNF-a inhibitors and biological modifiers of the immune response (adalimumab) are prescribed.
• For rheumatism, corticosteroids and non-steroidal anti-inflammatory drugs are prescribed (in the acute period in combination with antibiotics for 7-10 days), psychotropic drugs for manifestations of minor chorea.

For vasculitis, a rheumatologist can also prescribe cytostatics, plasmaphoresis and a hemosorption procedure.

For gout, a rheumatologist prescribes a special diet, the anti-gout drug colchicine or non-steroidal anti-inflammatory drugs to relieve attacks, as well as purinol (reduces the formation of uric acid in the body).

For scleroderma, the basic drugs are derivatives of hyaluronic acid, enzyme preparations (based on lidase or ronidase), and physiotherapy and exercise therapy are also used.

To treat osteoporosis, a rheumatologist prescribes:

• a diet high in calcium and vitamin D;
• flavone compounds and osseino-hydroxyapatite complex to improve bone metabolism;
• hormones (estrogen and calcitonin) and bisphosphonates, strontium preparations to prevent bone destruction;
• fluoride salts, somatotropic and parathyroid hormone to stimulate bone formation.

A preliminary medical examination must be carried out by a general practitioner. It is necessary to examine the general condition of the patient. The complex of treatment measures includes measuring blood pressure, body temperature, and identifying side diseases. In the future, the patient will be referred to a more specialized specialist. As a rule, rheumatoid arthritis is treated by a rheumatologist.

Rheumatoid arthritis is the most common form of inflammatory joint disease. This disease is widespread among older people. Moreover, the female population is exposed to it much more often than the male population.

Rheumatoid arthritis is a complex systemic disease, so treatment must also be systematic to control and prevent its progression. To treat arthritis, the doctor uses a multifaceted approach and a set of the following measures:

anti-inflammatory therapy with steroid and non-steroidal drugs;

the use of medications that contain chondroitin and glucosamine;

physiotherapeutic procedures used during the period of remission;

method of biocorrection of immunity;

Antibacterial therapy is used only in some cases;

The doctor prescribes hormones in the later stages of pathology progression.

Proper nutrition, giving up bad habits and feasible physical activity are of great importance in the treatment of rheumatoid pathology.

Prevention of relapse of the disease

It is very important to organize treatment in a timely manner and stop rheumatism of the joints, but preventing the recurrence of rheumatic attacks and exacerbation of the disease is no less important. To do this, you need to work closely on restoring or strengthening your body’s immunity and its defense mechanisms.

In addition, attention will have to be paid to preventing re-infection with streptococci, to which the sensitivity of a person who has already had rheumatism is significantly increased. Therefore, people who have previously suffered from rheumatism are necessarily sent to a specialized sanatorium.

After undergoing a course of treatment in a sanatorium, a person will have to continue preventive measures. He is recommended to spend his holidays without leaving his climatic zone, because moving to other zones is associated with inevitable problems of acclimatization, and therefore the danger of complications.

In addition, it is better to organize a vacation in the summer, while avoiding prolonged exposure to the sun and cool water. All water procedures should be carried out so that the weakened body is not exposed to extreme influences.

It must be remembered that even if all the signs of rheumatism are absent, there is always the possibility of relapse.

For several years after suffering from rheumatism, it is not recommended to engage in serious sports. However, moderate physical activity is useful and welcome, so physical education and hardening are necessary. A person must constantly monitor the condition of the legs, lower back and other joints where relapses are possible.

Following several tips developed by experienced doctors can help prevent relapses of rheumatism:

• Keep in constant contact with your doctor;
• follow all doctor’s recommendations regarding routine, physical activity and diet;
• any acute illness, deterioration in health, and even more so the slightest signs of rheumatism must be immediately examined by a doctor; self-medication is strictly prohibited;
• treat sore teeth, inflammation of the tonsils and pharynx in a timely manner;
• Prophylactic antibiotic therapy must be carried out in due time.

Considering that rheumatism of the joints quite often affects children, parents need to remember that a friendly and calm environment in the family has an extraordinary influence on strengthening the child’s health.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and back, and the state fully finances the treatment for each patient

Elena (rheumatologist) 6 days ago

Yes, indeed, a program is currently underway in which every resident of the Russian Federation and the CIS will be able to completely cure diseased joints. And yes, the program is personally supervised by Professor Park.

Treatment of rheumatism in China and Israel

In China, rheumatism is treated with an integrated approach to healing the whole body. The most common methods are: herbal treatment, acupuncture, massage.

Treatment of rheumatism in Israeli clinics is based on the use of gifts from the Dead Sea and homeopathic medicines. However, it is impossible to do without traditional treatment regimens, so Israeli doctors use different combinations of drugs in combination with plasmapheresis and immunomodulators.

Plasmapheresis

Conclusion

In order to avoid rheumatism: it is important to lead a healthy lifestyle and undergo timely diagnosis. The speed of contacting a doctor determines the amount of effort that will have to be made to eliminate the disease. There is no need to worry, treatment for rheumatism is carried out successfully, especially if you go to the clinic in a timely manner. The disease must be treated in time, otherwise the person may become disabled.

Children over 3 years of age and adolescents under 15 years of age are most susceptible to the disease. About 80% of them had previously suffered from infectious and inflammatory diseases of the upper respiratory tract of streptococcal etiology. The percentage of child and adolescent mortality does not exceed 1.5% of the total number of recorded cases of rheumatism. In most post-Soviet countries, the incidence of rheumatism among children aged 3 to 15 years is 1 in 5000.

Etiology of rheumatism

It is believed that one of the potential causes of the development of this disease is the Coxsackie A13 virus. But hemolytic streptococcus remains a key factor in the occurrence of rheumatism in humans. Also play a role in etiology:

• hereditary characteristics of the child’s immunity, which were passed on to him from his parents;
• decreased immune status due to upper respiratory tract diseases such as laryngitis, tonsillitis, pharyngitis;
• allergic factor.

Factors that increase the likelihood of developing the disease include:

• female;
• age range from 3 to 15 years;
• frequent episodes of incidence of infectious and inflammatory pathologies of the upper respiratory tract.

Treat your tonsils on time!

Forms of rheumatism

According to the flow, rheumatism comes in two forms:

• Acute form. The appearance of the first symptoms of rheumatic fever is observed 2-3 weeks after the clinical manifestations of streptococcal infection. The acute form is characterized by a sudden onset and rapid progression. The initial manifestations of rheumatism have much in common with the clinical picture of colds, however, after a short period of time, manifestations of carditis, skin rashes and polyarthritis join the symptoms of a cold. The acute form of the disease lasts from 3 to 6 months and can lead to the development of serious complications. In the absence of timely treatment, rheumatic carditis develops into heart defects.
• Chronic form. Characterized by a sluggish course with periods of relapse. Exacerbation can be provoked by prolonged exposure to low temperatures. Pathological changes affect the musculoskeletal system and the heart.

Locations

Depending on the location, the following types of disease are distinguished:

1. Rheumatism of the skin– manifests itself in the form of nodular and annular erythema, specific rheumatic nodules, excessive sweating, and pinpoint hemorrhages.
2. Rheumatism of the heart(rheumatic carditis) - localization - the membranes of the heart. If the muscle membrane is involved in the process, the disease is called rheumomyocarditis. The pathological process covering all the membranes of the heart is called pancarditis. Accompanied by a number of clinical symptoms such as elevated body temperature (above 38 degrees), rapid heartbeat (tachycardia), general weakness, loss of appetite, decreased blood pressure, and the appearance of heart murmurs.
3. Rheumatism of the joints(rheumatic polyarthritis) - pathological changes affect the elbow, knee and ankle joints. Body temperature is increased to 39 degrees, weakness increases, episodes of nosebleeds may occur, and sweating increases.
4. Rheumatism with lesions Central nervous system (rheumatic chorea) - foci of vasculitis are observed in the small blood vessels of the brain. The condition is accompanied by increased activity, motor restlessness, muscle hypotonia, incoordination of movements, disorders of psycho-emotional activity, as well as disturbances in the functioning of the musculoskeletal system.
5. Rheumatism of the eyes– leads to the formation of iridocyclitis, iritis and retinitis. With untimely treatment, atrophy of the visual apparatus develops.
6. Rheumatism of the digestive system– damage to the liver and other organs of the digestive system.

How does rheumatism manifest in children?

The main symptoms of rheumatic damage to the body in children do not differ significantly from those in adults. Depending on the location, the disease manifests itself as:

1. Cardiac rheumatism. Acute manifestations of rheumatic carditis in a child are characterized by rapid fatigue, weakness, and rapid heartbeat. Children complain of shortness of breath and the inability to climb stairs normally. In rheumatic carditis, one or all of the membranes of the heart are involved in the pathological process. If the inflammatory process affects the endocardium, pathological changes will be observed in the valvular apparatus of the heart, as a result of which the child may develop defects. When examining such a child, a slow or rapid heartbeat is noted, as well as a displacement of the borders of the heart due to the accumulation of fluid in the pericardial cavity.
2. Articular rheumatism– affects large joints. In children, the so-called migration of pain is observed. If today a child complains of pain in the elbow joint, then tomorrow these complaints will affect the knee or ankle joint. Depending on the severity of the pathological process, a child or adolescent may experience an increase in body temperature and swelling of the soft tissues around the damaged joints. The articular form of the disease occurs in combination with rheumatic carditis.
3. Minor rheumatic chorea. The incidence of pathological changes in the nervous system during rheumatism is no more than 13% of the total number of cases. In children with rheumatic chorea, involuntary contractions of the muscles of the legs, arms, and facial muscles are observed. Increased muscle twitching is observed with emotional arousal. Chorea minor is characterized by a lack of coordination, so the child may fall from a chair, drop objects, and show sloppiness and absent-mindedness. Such children often change their handwriting, speech and behavior. With severe rheumatic chorea, children develop paralysis.

Less common extracardiac manifestations of acute rheumatic fever include:

• polyserositis;
• pneumonia;
• nephritis;
• hepatitis.

It is possible to avoid severe complications of rheumatism only if the child was promptly examined and complex therapy was prescribed.

Diagnostics

Diagnostics of rheumatism includes the following laboratory and instrumental research methods:

• general clinical blood test;
• electrocardiography;
• Ultrasound examination of the heart;
• bacteriological examination of smears from the oropharynx and nasopharynx for streptococcal infection;
• laboratory assessment of immune status.

Treatment of rheumatism

In an outpatient setting, only diagnosis and prevention of the disease is permissible. Treatment is carried out in a hospital. The average length of a person's stay in hospital ranges from 1.5 to 3 months. If the disease continuously recurs, the issue of extending the period is decided.

Medication is the basis for the treatment of rheumatism. The choice of a particular antibiotic depends on the sensitivity of a particular pathogen to it.

Table 1. Drugs used to treat acute rheumatic fever

When treating patients with an artificial aortic or mitral prosthesis, the therapeutic regimen is supplemented with indirect anticoagulants (Phenilin) ​​under the control of INR levels.

High doses of Prednisolone are used for severe rheumatic carditis, including manifestations of heart failure. After achieving stable ESR levels, the therapeutic dosage of glucocorticosteroids is reduced within 7 days.

Antibacterial therapy is used not only for diagnosed rheumatism, but also for the purpose of its prevention after previous acute tonsillitis. It is preferable to use penicillin antibiotics. Antibiotics of this group have the property of causing allergic reactions. As an alternative, antibacterial drugs from the macrolide group are used in patients with hypersensitivity.

In order to stop the inflammatory reaction, the non-steroidal anti-inflammatory drug Diclofenac sodium is used in tablet or injection form. This group of medications can cause adverse reactions in the form of erosive and ulcerative lesions of the gastrointestinal tract. To avoid the consequences, it is recommended to take proton pump inhibitors simultaneously (Omeprazole, Omez).

Treatment of chronic rheumatism

In order to prevent another exacerbation of the chronic form, it is necessary to carry out timely prevention. The pain syndrome in the chronic form of the disease is of a volatile nature (migration of pain from one joint to another). When the cardiovascular system is involved in the pathological process, characteristic swelling is observed. Treatment of cardiac edema is carried out using diuretic medications.

During the period when the clinical signs of acute rheumatic fever subside, patients are sent to special sanatoriums. Treatment and preventive institutions are located on the territories of the Southern Coast of Crimea, Kislovodsk and Gelendzhik. Sanatorium-resort treatment and climatotherapy have a pronounced therapeutic effect, which makes it possible to achieve stable remission in patients with chronic rheumatism.

Treatment of rheumatism of the legs

When streptococcal infection spreads, symptoms of damage to the joints of the legs may occur. Most often, the disease affects the area of ​​the knee and ankle joints. When chronic, migration of pain is observed from the knee joint to the ankle joint and vice versa.

To treat this form of the disease, antibacterial agents, non-steroidal anti-inflammatory drugs for internal and external use are used, and, if necessary, additional drugs. Children's rheumatism with damage to the joints of the legs is treated in a similar way. The only difference is in the dosage of the medications. For the treatment of rheumatism of the knees, Diclofenac gel is widely used, as well as other products for external use, which include this anti-inflammatory substance. Traditional medicine can only be considered as a supplement.

Ivan Pavlovich Neumyvakin.

Dr. Ivan Pavlovich Neumyvakin developed his own treatment regimen, which involves the use of a 3% hydrogen peroxide solution to treat many diseases of the gastrointestinal tract and musculoskeletal system. According to Ivan Pavlovich, ordinary hydrogen peroxide can treat many diseases and have a beneficial effect on the entire body. Before using the technique, it is recommended to coordinate treatment with a medical specialist.

Treatment of rheumatism of the heart

Symptoms of rheumatic carditis are associated with damage to the inner lining of the heart with a subsequent increase in the symptoms of valvular insufficiency. Treatment of rheumatic carditis with folk remedies is inappropriate, since this pathology is susceptible only to powerful medications. With rheumatic heart disease in children, the symptoms are the same in adults. As the pathology develops, the person complains of pain in the heart area, shortness of breath, and difficulty climbing stairs.

In addition, rheumatic carditis is accompanied by cardiac arrhythmia, edema and symptoms of general intoxication of the body. The outcome of the disease directly depends on the timeliness of the treatment started. If rheumatic carditis was diagnosed at an early stage, doctors are able to stop the inflammatory process and prevent structural changes in the valvular apparatus of the heart.

Treatment of hand rheumatism

Pathological changes in acute rheumatic fever affect not only the joint area of ​​the lower extremities, but also the small joints of the fingers. When this condition develops, a person complains of pain and discomfort in the hand area. Depending on the severity of the inflammatory process, an increase in body temperature and signs of inflammatory damage to the heart may be observed.

Treatment of muscular rheumatism

Despite the fact that in medical practice there is no separate term, “muscular rheumatism,” pain in the muscle area (myalgia) often occurs with acute rheumatic fever. Muscle pain is relieved by analgesic drugs, as well as non-steroidal anti-inflammatory drugs for external and internal use. The intensity of the pain syndrome with so-called muscular rheumatism very often forces a person to observe gentle, and even bed rest, for several days.

Folk remedies

Traditional medicine recipes should be used as a supplement to the main treatment and only in consultation with the attending physician. Traditional healers offer remedies from birch leaves, propolis and pine needles. Some sources advise using aconite to treat rheumatism. This plant contains toxic substances, the entry of which into the body can lead to serious intoxication, even death.

Be sure to consult your doctor before treating any illness. This will help take into account individual tolerance, confirm the diagnosis, ensure the correctness of treatment and eliminate negative drug interactions. If you use prescriptions without consulting your doctor, it is entirely at your own risk. All information on the site is presented for informational purposes and is not a medical aid. All responsibility for use lies with you.

A systemic inflammatory disease of connective tissue of an injective-allergic nature, usually affecting the cardiovascular system, joints, skin, and nervous system, is called rheumatism.

Rheumatism– a chronic disease characterized by damage to connective tissue with the primary involvement of the cardiovascular system and joints in this process. The main cause of rheumatism is the presence of toxins in the blood as a result of poor nutrition. The origin of rheumatism can also be caused by streptococcal infections (angina, scarlet fever, pharyngitis) and the genetic predisposition of the body. When hypothermia occurs, the disease worsens.

Manifestations of rheumatism– pain and stiffness of muscles and (or) joints, redness and swelling of joints – elbows, knees, ankles (rheumatic arthritis). Rheumatic damage to the heart valves over time can lead to permanent deformation and the formation of heart defects.

Causes of rheumatism.

Rheumatism appears in people predisposed to it after a previous acute or chronic nasopharyngeal infection caused by one of the types of streptococcus.

Symptoms of rheumatism.

The disease begins 1-2 weeks after a sore throat or pharyngitis. One of the earliest signs of rheumatism is pain in the joints, most often in the knees, ankles, and elbows. Often, especially at the beginning of the disease, lethargy, malaise, and increased fatigue are observed. The heart muscle (myocardium) and the inner lining of the heart chambers (endocardium) are affected - as a result, shortness of breath, rapid heartbeat, arrhythmias, chest pain, and heart failure develops. Rheumatic inflammation of the heart wall (rheumatic carditis) often recurs, and heart defects gradually form. A skin rash may appear, the elements of which are ring-shaped, and subcutaneous nodules. Damage to the blood vessels of the brain is accompanied by headache, memory loss, drowsiness, muscle weakness, and a variety of neurological symptoms.

Treatment of rheumatism.

At the first stage of the disease, antibacterial therapy, anti-inflammatory drugs are prescribed, and in severe cases - corticosteroid drugs. Then therapeutic exercises, hardening, and normalization of lifestyle are necessary.

Medicines for the treatment of RHEUMATISM (AS PRESCRIPTED AND UNDER THE CONTROL OF A DOCTOR - RHEUMATOLOGIST)

Antibacterial drugs
Azithromycin (Azitrox, Sumamed)
Amoxicillin (Ospamox, Amine, Amoxillate, Gonoform,
Dedoxil, Flemoxin) Ampiox
Bicillin-5
Clarithromycin (Binoclar, Klacid, Fromilid)
Midecamycin (Macropen)
Penicillin
Roxithromycin (Rulid)
Phenoxymethylpenicillin (Vepikombin, Cliacyl, Megacillin) Cefuroxime (Axetin, Zinacef, Zinnat, Ketocef)
Corticosteroids
Dexamethasone (Daxin, Dexasone, Cortidex, Novomethasone,
Fortecortin)
Prednisolone (Decortin, Metypred, Prednol) Triamcinolone (Berlicort, Delficort, Kenacort, Kenalog)
Nonsteroidal anti-inflammatory drugs
Acetylsalicylic acid (Anopyrin, Aspecard, Aspivatrin, Aspilight, Aspinat, Aspirin, Acesal, Acetylene, Bufferan, Jasprin, Novandol, Novasan, Ronal, Salorin, Trombo ACC, Upsarin Upsa)
Diclofenac (Voltaren, Diclogen, Diclomax, Diclomelan, Naklof, Naklofen, Neodol, Novo-Difenac, Olfen, Ortofen, Feloran, Flameril, Ecofenac, Etifenac, Yumeran)
Ibuprofen (Bonifen, Brufen, Burana, Dolgit, Ibupron, Ibuprof, Markofen, Motrin, Motrin, Nurofen, Profinal, Reumafen, Solpaflex)
Indomethacin (Indobene, Indovis, Indopharm, Indocid, Inteban, Metindol, Novo-Metacin, Tridocin, Elmetacin)

Non-traditional and folk remedies for the treatment of rheumatism

Home remedies for rheumatism

Cut 3 large peeled onions and cook in 1 liter of water for 15 minutes, strain. Take 1 glass of decoction in the morning, after waking up, and in the evening, before bed, for the treatment and prevention of rheumatism.

Apply fresh onion, mashed into a paste, to sore joints for 20-30 minutes, 2-3 times a day.

Grate 1 kg of raw potatoes (preferably pink). Fold the linen fabric in half, spread the potato pulp in the middle, fold it, and wrap it around the sore spot. It’s good to tie something warm on top. Cover the patient with rheumatism with a blanket all night. Apply compresses every other day. At the same time, take 5 drops of aspen tar and 50 ml of 50% vodka daily orally at night. Drink for 1.5 months. Used for rheumatic pain.

A good effect for rheumatism is obtained by combining the external use of potatoes with the intake of raw potato juice - at least 0.5 glasses per day. The course is 1 month, sometimes to consolidate the treatment a repeat course is given after a week's break.

Boil broth from potato peels, drink it and apply compresses to areas affected by rheumatism.

Herbs and infusions for the treatment of rheumatism

Pour 10 g of St. John's wort herb into 1 glass of hot water, boil for 30 minutes over low heat, cool and strain. For rheumatism, take 0.3 cups 3 times a day 30 minutes before meals. Store for no more than 3 days.

Pour 1 tablespoon of tansy flower baskets with 1 cup of boiling water. Leave, covered, for 2 hours, strain. For rheumatism, take 1 tablespoon 3-4 times a day 20 minutes before meals for rheumatism. An infusion of flower baskets and an infusion of herbs are used externally in the form of warm baths and compresses.

Fill a liter bottle with fresh May pine needles, fill to the top with 56% alcohol, leave in a warm place for 21 days. Take 8 drops of sugar 3 times a day 30 minutes before meals. The course of treatment for rheumatism is 5-6 months.

Pour 4 tablespoons of celery (leaf and roots) into 0.5 liters of water and cook until 1 cup remains, strain. Drink a portion during the day for rheumatism.

Pour 1 teaspoon of Scots pine buds into 1 glass of water, boil for 5 minutes, stirring, strain. For rheumatism, take warm, 1 tablespoon 3-4 times a day after meals.

Pour vodka over lilac flowers in a ratio of 1:10. Leave in a sealed container for 8-10 days and strain. For rheumatism, take 30 drops 2-3 times a day and at the same time rub the sore spots or make a compress from the same tincture.

Pour 1 tablespoon of lingonberry leaf with 1 glass of boiling water, leave for 30 minutes. For rheumatism, take 1 tablespoon 3-4 times a day.

Pour 1 teaspoon of black nightshade herb with 2 cups of boiling water, leave for 1 hour. Take 1 tablespoon 3 times a day. For pain in joints affected by gout and rheumatism.

Pour 2 teaspoons of crushed blueberries with 1 cup of boiling water, leave until cool. Drink the infusion, as well as jelly and decoctions, 2-3 glasses a day for rheumatism and gout.

Pour 1 teaspoon of dried herbs and curly parsley roots with 2 cups of hot water, leave for 9 hours. Take the infusion 2-3 tablespoons before meals for 3 days. For joint diseases.

Pour 1 teaspoon of clubmoss grass with 2 cups of boiling water, leave for 30 minutes, strain. Take 1 tablespoon 3 times a day after meals. As an analgesic and sedative for neuralgia, rheumatoid joint lesions.

Fill a liter jar to a third of its volume with chopped young shoots and leaves of lingonberries, fill to the top with vodka, leave in the sun. Drink 2 tablespoons 2 times a day.

Pour 1 tablespoon of bearberry into 1 cup of boiling water, leave for 2 hours, strain. For rheumatism, take 2-3 glasses a day.

Pour 1 tablespoon of crushed bearberry leaf into 1 glass of water and leave for 8-10 hours. Boil for 5 minutes over low heat and leave for another 2 hours, strain. For rheumatism, take 4 dessert spoons 2-3 hours after meals.

Take equal parts of elderberry flowers and chamomile flowers, brew with boiling water, place the mixture in a linen bag. Apply to sore joints for rheumatism.

Pour 1 cup of boiling water over 5-6 potato flowers, leave for 1 hour, strain. Drink during the day. The course of treatment for rheumatism is 2 months, then a break for 2 months and repeating the course.

Vanga's recipes for rheumatism

Along with treatment, patients with rheumatism are recommended to eat celery salad every day.

(On nerves). Lubricate your feet with gun oil and take sunbathing.

Infuse one leaf of large-rooted arma in 0.5 liters of alcohol and use for rubbing.

Make an alcohol tincture from yellow acacia branches along with leaves and flowers. Take a few drops.

For 10 days, take 0.2 g of “mummy” per day, it can be mixed with any oil and yolks of 3 – 4 eggs. The same mixture is applied to the damaged area. Break 10 days.

Drink 0.2 g at night for 10 days, break for 5 days, repeat 3-4 courses. At the same time, apply compresses to sore joints at night (3 g solution per 100 g of water).

Vanga's recipes for attacks of rheumatism

Take baths in a decoction of dryweed.

Pour 20 - 30 g of lingonberry leaves into three glasses of boiling water, boil for 10 minutes, strain. Drink liquid 1 day in 3 doses. (The product helps well with articular rheumatism.)

When the dandelion is in bloom, it is very beneficial to eat its milk stems. At this time, dandelion juice is an old and proven remedy for rheumatism.

Infuse 1 tablespoon of white lilac flowers with 0.5 liters of vodka. Use for compresses.

Take a quarter of a pound of aconite roots (you need to take only the root, not the stems), pour one quart of brandy (vodka) or diluted 60-proof apothecary alcohol into it and put it in a warm place for 3 days. When the tincture acquires the color of strong tea, it is ready for consumption. Dose – one tablespoon of tincture for each rubbing (and no more).
If both legs and arms are numb, you should rub only one leg, and the next day the other; then one hand, etc. Rub the tincture dry. Keep the area to be rubbed warm, avoiding the influx of cold air. Rubbing is best done at night. Two hours before the patient gets out of bed, remove the bandage. In the morning, when the patient gets up, that is, two hours after removing the bandage, you should soak a rag in cold water and, after squeezing it well, wipe the area to be rubbed with it. This must be done quickly. Slow wiping can lead to colds. You should not drink tincture of aconite roots, as aconite is highly poisonous.

Take 30 g of crushed medicinal raw material from dubnik root, pour in 500 ml of white wine, leave for 24 hours with frequent shaking, then strain and take half a glass of wine twice a day.

Folk remedies for the treatment of rheumatism:

1 tablespoon of wormwood flower baskets is poured into a thermos with 300 ml of boiling water and left for 2 hours, filtered and used as an external pain reliever for rheumatism, neuralgia and lumbago.

Take 50 g of chopped dry meadow clover grass per 1 liter of boiling water. Leave for 2 hours, strain. Take a bath at night. Course of treatment: 12–14 baths.

Lilac flowers are loosely poured into a half-liter bottle to the top, filled with 40% alcohol, left for 21 days in a dark place and filtered. Take 30 drops 3 times a day before meals. The course of treatment is 3 months. You can use another recipe: pour 2 tablespoons of flowers into a glass of vodka or 70% alcohol, leave for 7 days in a warm place, shaking occasionally. Drink 50 drops of vodka or 20–30 drops of alcohol tincture 3 times a day 20 minutes before meals and rub on sore areas (joints, heel spurs).

1 tablespoon of dry birch leaves is poured with a glass of boiling water, left for 6 hours and filtered. Drink 1/2 glass 2-3 times a day. You can also use a decoction of birch buds. Pour 5 g of buds into a glass of boiling water, leave for 15 minutes on low heat, leave for 1 hour and filter. Drink 1/4 glass 4 times a day 1 hour after meals.

Take 3 tablespoons of St. John's wort herb and pour 4 cups of boiling water, let it brew for 2 hours and strain. This herbal infusion should be drunk 1/3 glass 3 times a day before meals for rheumatism and chronic gout. Course of treatment: 1–2 months.

If you often suffer from gouty pain, rheumatism, radiculitis or myositis, then you should take therapeutic and prophylactic baths. In this case, ordinary horseradish is effective. 50-70 g of roots and leaves must be ground and placed, wrapped in gauze, in a bath with a water temperature of up to 40 ° C. Make sure that the water is evenly mixed with the horseradish juice. Take a bath at night. The procedure time is 10 minutes. Course of treatment: 12-14 procedures. It should be repeated several times a year. Infusion and juice of horseradish roots are also recommended to be taken orally.

Drink 2-3 glasses of corn silk decoction every day. Take a heated teaspoon of raw material into a glass of water and cook over low heat for 10 minutes. Drink for 6–8 weeks. The oldest muscular rheumatism disappears.

Pour 40 g of chopped garlic cloves into 100 ml of vodka. Infuse in a closed container in a dark place at room temperature, shaking occasionally, for 7–10 days, strain. Take 10 drops 2-3 times a day 20-30 minutes before meals for rheumatism and gout.

A tablespoon of dried burdock roots is poured with 2 cups of boiling water, left for 2 hours and filtered. Take 1/2 cup 3-4 times a day.

A plant mixture of burdock roots (10 g) and elecampane (10 g) is poured with a glass of water and boiled over low heat with the lid closed for 20 minutes, then infused for 4 hours and filtered. Take 1 tablespoon 3-4 times a day before meals.

Pour 20 g of crushed bean fruit leaves into 1 liter of water, boil for 3-4 hours, cool and strain. Drink 100 ml per day for rheumatism and gout.

Prepare a tincture of 100 g of dry crushed rosehip roots, pour 0.5 liters of vodka over them, and keep in a dark place for 3 weeks, shaking the contents periodically. Take tincture 20-30 g 3 times a day before meals, washed down with boiled water. At the same time, you can rub the tincture into sore spots or make compresses from it.

Pour 100 g of celery along with the root with water and cook until 1 cup remains. Strain and drink this portion at intervals throughout the day. The remedy can relieve rheumatism in a few days. The decoction must be prepared daily.

Brew a tablespoon of crushed black currant leaves with 2 cups of boiling water, leave for 6 hours, strain. Drink 100 ml 4 times a day. The infusion is drunk for rheumatism and gout, as it helps rid the body of excess uric acid and purine substances. It can also be used in the form of baths for rheumatic and gouty joints.

Pour 200 ml of boiling water over a teaspoon containing the roots and leaves of bearberry (bearberry), leave and strain. Drink the infusion 2-3 cups per day.

Pour 3 tablespoons of shepherd's purse herb into 400 ml of boiling water (daily requirement), leave in a thermos, strain. Used for rheumatism, gout. Contraindicated during pregnancy and thrombophlebitis.

Prepare a steam of elderberry flowers at the rate of 20 g per 1 liter of water. Drink 3 glasses a day. Use for rheumatism, gout and arthritis.

Brew a teaspoon of yarrow herb with 200 ml of boiling water, leave and strain. Take from 1 tablespoon to 1/3 cup per day before meals for rheumatism and gout.

Pour 2 tablespoons of wheatgrass rhizomes into 1 glass of hot water, boil for 5–10 minutes, cool, strain and squeeze. Drink 1/3 glass 3 times a day before meals. It is used to treat rheumatism and gout as an anti-inflammatory, diuretic, diaphoretic, and also to remove salts from the body.

Pour a tablespoon of crushed lingonberry leaves into 200 ml of water and boil for 5-10 minutes. Take 1 tablespoon 3-4 times a day. Store in a cool place for no more than a day.

Brew 4 tablespoons of dried chamomile flowers with 200 ml of boiling water, boil for 10 minutes and strain. Take 70 ml 3 times a day after meals for rheumatic joint pain.

Pour a teaspoon of dogwood roots into 200 ml of water and boil for 15 minutes. Take 2 tablespoons 3 times a day.

Prepare a decoction at the rate of 2 g of fragrant violet herb per glass of boiling water. Take 2-3 tablespoons 3 times a day. When treating rheumatism, it is useful to mix violet with bean leaves, columns (with stigmas) of corn, bearberry leaves and buds or birch leaves.

Brew 30 g of raspberries with a glass of boiling water. Leave for 20 minutes. Drink at night as a diaphoretic, 2 glasses at a time for chronic rheumatism.

Pour 20 g of dried red clover flowers into a glass of boiling water, leave and strain. Take from 2-3 tablespoons to 1/2 cup 3 times a day for chronic rheumatism.

5-6 g of calamus rhizome powder should be drunk with water during the day between meals or on an empty stomach. Used for rheumatism, arthritis, joint pain.

A mixture of wild rosemary herb (25 g), stinging nettle herb (15 g) pour 1 liter of boiling water, leave and strain. Drink 100 ml 5-6 times a day.

Mix wild rosemary and coltsfoot herbs equally. Pour a tablespoon of the mixture into 200 ml of hot water, boil for 5 minutes and strain. Take 1 tablespoon every 2 hours as a diaphoretic in the treatment of rheumatism and gout.

Place a fresh egg in a glass and pour vinegar essence. At the same time, lightly melt 200 g of unsalted butter and pour it over the egg with the essence. Wrap and place in a dark place for 3 days, then mix well. Apply this remedy to sore areas. Used for bumps on the fingers, heel spurs, and all kinds of aches.

Mix burdock roots, elecampane roots and walnut leaves equally. Pour 200 ml of boiling water over a tablespoon of the crushed mixture, boil for 10 minutes and strain. Drink 1 glass every 3 hours.

Pour two tablespoons of a mixture of oregano herb (1 part), coltsfoot leaves (2 parts), raspberry fruits (2 parts) into 400 ml of boiling water, boil for 5-10 minutes and strain. Drink 100 ml hot 3-4 times a day.

Pour 25 g of annual capsicum fruits into 100 ml of vodka. Use the tincture in a mixture with double the amount of sunflower oil for rubbing against rheumatism and joint pain.

Ointment for rubbing according to the Mexican recipe: camphor - 50 g, mustard powder - 50 g, alcohol - 100 ml, raw egg white - 100 g. Pour alcohol into a cup and dissolve camphor in it, pour mustard into the resulting solution and stir it. Stir 100 g of protein separately and turn into lipstick. Mix both ingredients together. The result is a liquid ointment that should be rubbed dry once a day before bed. Then wipe the sore areas with a damp cloth.

Pour 200 ml of boiling water over a teaspoon of mistletoe herb, leave for 8 hours and strain. Use externally for rheumatism, arthrosis, spondylosis, chronic joint diseases.

Pour 50 g of chopped thyme herb into 1 liter of boiling water, boil for 5 minutes, strain. Take a bath (36–37 °C) at night for articular rheumatism and paralysis. Course of treatment: 14–18 baths.

Pour 2 tablespoons of finely chopped calamus rhizomes into 1 liter of boiling water, boil for 20 minutes, leave for 30 minutes and strain. Take a bath (35–36 °C) during the day or at night for rheumatism and gout. Course of treatment: 10-12 baths.

One of the most effective remedies for the treatment of articular rheumatism is birch buds. The kidneys are infused with alcohol or vodka and rubbed into the joint area. Birch bud ointment is also an effective remedy. To prepare it, you need to take 800 g of fresh unsalted butter and birch buds. Place butter in layers of 1.5 cm in a clay pot, then a layer of buds of the same thickness on top, and so on, until the pot is completely filled. Close the lid tightly and cover with dough. Place in a warm place for a day, preferably in a low-heat oven. After a day, cool and squeeze through cheesecloth. Add 7–8 g of camphor to the resulting oil and mix. Store the ointment in a tightly sealed jar in a cool place. Use for articular rheumatism, rubbing into joints in the evening, before bed, 1 time per day.

Diet for rheumatism.

In case of exacerbation of rheumatism, it is recommended to use a fruit diet for 3-4 days, and then switch to a balanced diet.
Foods consumed by the patient must contain sufficient amounts of proteins and vitamins (especially vitamin C). Table salt, carbohydrates (sugar, white bread, potatoes), fatty, fried foods, spices, tea, coffee, alcohol should be limited. Watermelons, fresh blueberries, as well as jelly, infusions and decoctions from them (1-2 teaspoons per glass of boiling water), cranberry juice with honey are useful.