Rheumatism is an inflammation of the joints (arthritis) and heart (carditis). The cause of its development is streptococcal infection, in most cases sore throat. At the same time, the trend is as follows: in developed countries, this disease occurs quite rarely among children under four years of age and adults after eighteen years of age. In developing countries, cases of the disease are much more common. This is due to the fact that in countries with a high level of development, antibiotics are used in the early stages of streptococcal infections.
However, it is worth noting that in recent years the number of cases of rheumatism has increased significantly. Today, a child in whose body there is a streptococcal infection, or more precisely, a sore throat, who does not receive treatment, has a risk of getting sick. In this case, the probability of the disease occurring is 1:1000. If the infection is severe enough, then the risks increase to 3:100. It is important to know that the prevention of the disease is the use of antibiotics and a healthy, nutritious diet.
The main symptoms of the disease are:
- Acute joint pain;
- Increased body temperature;
- Rapid heartbeat and chest pain (usually these symptoms are caused by carditis, that is, inflammation of the heart);
- Small subcutaneous nodules;
- Muscle twitching that cannot be controlled;
- Skin rash.
The most common signs of this disease are acute pain in the joints and a significant increase in body temperature. With the development of rheumatism, the joints suddenly begin to ache, and they become unusually red and swollen, and very hot to the touch. The tendency of the disease is as follows: as soon as the pain in one joint or area subsides, painful sensations arise in another. This is especially noticeable if the patient is not immediately prescribed bed rest and a course of anti-inflammatory drugs.
It should be noted that there are cases when pain in the joints is quite weak and not clearly expressed. In this case, the temperature in the presence of the disease appears suddenly, then sharply increasing, then decreasing. These symptoms usually last for about two weeks.
Inflammation of the heart occurs almost simultaneously with the above signs of rheumatism. At the beginning of the disease, carditis does not manifest itself in any way. In the complete absence of symptoms, the disease can only be detected by the attending physician by listening to the heart, detecting its rapid beating. As the disease progresses, the outer lining of the heart becomes inflamed, causing pain in the chest area. Carditis can also be accompanied by heart failure, which appears along with shortness of breath, abdominal pain and vomiting, nausea and cough. These symptoms especially appear in children, but they are expressed so weakly that parents do not consider it necessary to show the baby to the doctor.
Inflammation of the heart can be very serious and in most cases causes damage to the mitral valves. It leads to rheumatic damage to this organ. It can be detected by the appearance of characteristic heart murmurs, allowing the doctor to diagnose rheumatism.
As for uncontrollable muscle twitching, such symptoms of rheumatism appear gradually. It may take more than a month before the symptoms become noticeable and intense enough to require immediate medical attention. This occurs during a period of time when muscle twitching turns into fast and chaotic movements that disappear during sleep. At the same time, rheumatism is characterized by twitching of any muscle group. The only exceptions are the eyes. It is very difficult to identify such a symptom in children: parents attribute muscle twitching on the face to pampering and grimaces, and uncontrolled movements of the arms and legs and frequent self-injury to clumsiness. Such signs may be present for four to six months.
When all of the above symptoms disappear, a skin rash may occur: flat spots with wavy edges appear on the surface of the epidermis, which are painless and do not cause itching. The rash does not last long and usually disappears in one to two days.
It is worth noting that with rheumatism, abdominal pain often occurs, the child develops nausea, and loses appetite. Against the background of such manifestations in young patients, appendicitis is often falsely diagnosed, delaying treatment of the underlying disease.
Diagnosis of foot diseases
Any pain in the feet that does not go away within a few days requires seeing a doctor. After all, it may indicate the presence of a serious disease, the development and severe consequences of which can be prevented by starting treatment in a timely manner. In the diagnosis of foot diseases, many laboratory and instrumental methods are used, which doctors at our clinic prescribe depending on the patient’s medical history and examination results.
In our clinics you can also undergo computer plantography (allows you to find out whether your feet are functioning correctly and what is the load on the joints) or anthropometric scanning of your feet (allows you to receive recommendations on the selection of comfortable shoes, insoles and corrective devices) in order to preserve and maintain the health of your feet for as long as possible .
Detection of the disease in the early stages: diagnosis of rheumatism
Timely diagnosis of rheumatism becomes possible by analyzing the main symptoms. In addition, the disease is determined by a blood test: in children, this study reveals a high content of leukocytes and an increased erythrocyte sedimentation rate, and antibodies to streptococci are detected.
Heart rhythm disturbances that accompany its inflammation, caused, in turn, by rheumatism, are detected using an electrocardiogram. In order to timely diagnose and begin treatment of heart valve damage, echocardiography is performed.
On the issue of prevention
Issues of preventing foot diseases are primarily the responsibility of the patient himself. You should only choose shoes that are comfortable, spacious enough so that they do not squeeze your toes and comfortably fix your ankle. Of course, even the most correct shoes will not correct an already formed deformity, but in any case they will create optimal comfort for your feet.
In the list of preventive measures, priority positions are given to the choice of orthopedic insoles, exercises from a complex of physical therapy, as well as massage or physiotherapy. It is recommended to perform several warm-up exercises during the working day, allowing the muscles to rest, and after work, self-massage, accompanied by twisting the foot, rubbing or stroking, will help relieve tension.
Effective treatment of rheumatism
Effective treatment of rheumatism should be aimed not only at suppressing streptococcal infection, but also at preventing relapse and suppressing inflammation, especially in the heart and joints. You need to know that getting rid of this serious disease must necessarily be accompanied by limiting the patient’s physical activity, which negatively affects the condition of tissues damaged by inflammation. In order to recover, it is necessary to adhere to bed rest.
If streptococcal tonsillitis is detected, the patient is prescribed internal penicillin, which is prescribed for ten days. Residual infection in a sick child is eliminated by injections of penicillin. To eliminate pain and inflammation, non-steroidal drugs, including aspirin, are prescribed.
A child who suffered from rheumatism in childhood should receive penicillin internally or intramuscularly until the age of eighteen. This is necessary in order to prevent relapse of the disease. If a person has suffered heart damage during the course of his illness, then throughout his life the patient must take an antibiotic before any operation (even tooth extraction).
Treatment of foot pain
Depending on the established diagnosis and individual characteristics of the patient, he is prescribed the most effective treatment regimen, which may contain therapeutic, surgical, and physiotherapeutic methods. Taking medications helps eliminate the cause of the disease and relieve pain. Surgical methods are used to eliminate purulent processes and correct pathological changes in the anatomy of joints and bones. Physiotherapy methods speed up rehabilitation and help achieve complete recovery or stable remission.
Etiology and pathogenesis
It is impossible to determine exactly why RPM occurs, but, according to statistics, the appearance of the disease is usually provoked by the following factors:
- viral infection;
- hypothermia;
- prolonged exposure to stressful situations;
- suffered acute respiratory diseases;
- hereditary factors.
So, previous viral infections can be considered predominantly risk factors, since examination of patients with polymyalgia rheumatica reveals the presence of elevated titers of antibodies to adenoviruses and respiratory syncytial viruses. Possible causes of the pathology may also be: infections caused by parainfluenza viruses and giant cell temporal arteritis (so-called Horton's disease).
Psoriatic arthritis - symptoms and treatment
Therapeutic goals for the treatment of psoriatic arthritis:
- Achieve remission or minimal activity of clinical manifestations if it is impossible to achieve remission.
- Prevent or slow down the progression of the disease, including radiographic progression.
- Increase the patient's life expectancy and improve its quality.
- Reduce the risk of comorbid diseases.
Non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCS), synthetic and targeted synthetic basic anti-inflammatory drugs, as well as genetically engineered biological drugs with different mechanisms of action are used in treatment.
NSAIDs and corticosteroids are “symptom-modifying drugs” that reduce pain, swelling and other symptoms of arthritis, enthesitis and dactylitis. When prescribing NSAIDs, the patient's concomitant diseases are taken into account. For diseases of the gastrointestinal tract, selective COX-2 inhibitors are predominantly prescribed, for pathologies of the cardiovascular system - non-selective COX inhibitors. In some cases, special protective drugs (Nolpaza, Omez, etc.) are prescribed to prevent complications from the gastric tract.
GCS is mainly administered intra-articularly. Systemic use (i.e. for the whole body) for psoriatic arthritis is inappropriate, as it can cause exacerbation of psoriasis, up to pustular forms.
If therapy with NSAIDs and corticosteroids is ineffective, synthetic and targeted synthetic basic anti-inflammatory drugs, as well as genetically engineered biological drugs, are added to treatment. All of them have a “disease-modifying effect,” that is, they affect the mechanism of disease development.
Synthetic disease-modifying anti-inflammatory drugs (sDMARDs) include Methotrexate, Sulfasalazine, Leflunomide, Cyclosporine. They suppress inflammation in the osteoarticular apparatus and in the skin, and also delay structural damage to the joints. Indications for the use of DMARDs: continued activity of psoriatic arthritis, high levels of ESR and C-reactive protein, severe psoriasis, the presence of erosions of the articular surfaces. However, these drugs are ineffective for spondylitis and enthesitis [4][5][16].
Among cDMARDs, Methotrexate is the first to be prescribed, starting with a minimum dosage of 10 mg/week. Methotrexate has many side effects, so before prescribing it, the patient is examined: the level of liver enzymes, creatinine, glucose is determined, a general clinical blood test is performed, a test for HIV and viral hepatitis is performed, and a chest x-ray is taken. When prescribing Methotrexate, it is imperative to take folic acid in a dose of at least 5–10 mg/week. If the patient has contraindications to taking Methotrexate, other drugs of this group are prescribed.
Targeted synthetic disease-modifying anti-inflammatory drugs (tsDMARDs) are a new group of drugs for the treatment of psoriatic arthritis. This group includes Apremilast and Tofacitinib. These drugs effectively suppress inflammation in the skin and joints, slow down the radiographic progression of the disease, and they are also effective against dactylitis, enthesitis and spondylitis [4][5][6].
Among genetically engineered biological drugs (GEBPs), inhibitors of tumor necrosis factor α (Infliximab, Adalimumab, etc.), monoclonal antibodies to interleukin 12 and 23 (Ustekinumab) and to interleukin 17 (Secukinumab) are used.
GEBD reduce the activity of arthritis, enthesitis, dactylitis and slow down the radiographic progression of arthritis [4][16]. Tumor necrosis factor α inhibitors are used both in monotherapy (single drug therapy) and in combination with Methotrexate. Before prescribing a biologically active drug, it is necessary to examine the patient for tuberculosis. To do this, a Mantoux test, a Diaskin test, a chest x-ray and a consultation with a phthisiatrician are prescribed.
Diagnostic methods
Diagnosis of RPM is quite simple, since based on symptoms alone it is difficult to confuse it with any other disease. After a general survey and examination of the patient, to determine the etiology of the disease, the specialist prescribes the following laboratory blood tests:
- clinical;
- biochemical;
- for rheumatic tests.
With polymyalgia rheumatica, indicators of the presence of an inflammatory process in the patient’s body (increased ESR and leukocytosis) are clearly visible in a blood test, in addition, there are a number of parameters for changes in muscle structure, which also indicates the development of this disease.