Rheumatic diseases - treatment in Russia

Rheumatic diseases include a wide range of diseases that mainly affect the joints and periarticular tissues. A special group among them are systemic diseases – collagenoses and vasculitis, characterized by autoimmune genesis, local or diffuse lesions of the connective tissue. Rheumatic diseases are studied by a specialized section of internal medicine – rheumatology. The course of rheumatic diseases is often accompanied by multiple organ damage with the development of cardiac, renal, pulmonary, cerebral syndromes, which are treated not only by rheumatologists, but also by narrow specialists – cardiologists, nephrologists, pulmonologists, and neurologists. Rheumatic diseases have a progressive course, disrupt the patient’s functional activity and can lead to disability.

Rheumatic diseases such as gout and arthritis have been known since the time of the ancient Greek healer Hippocrates. In the II century. n. NS. Roman philosopher and surgeon Galen introduced the term “rheumatism”, which denoted a variety of diseases of the musculoskeletal system. And only in the XVIII – XIX centuries. descriptions of individual rheumatic diseases began to appear. Currently, according to the American Rheumatological Society, there are over 200 types of rheumatic pathology.

Depending on the primary lesion, all the variety of rheumatic diseases can be divided into three large groups: joint diseases, systemic vasculitis and diffuse connective tissue diseases. Joint diseases are mainly represented by arthritis (rheumatoid, psoriatic, gouty, reactive, infectious, etc.), as well as osteoarthritis, ankylosing spondylitis, rheumatic diseases of the periarticular soft tissues. The group of systemic vasculitis includes hemorrhagic vasculitis, periarteritis nodosa, Wegener’s granulomatosis, Horton’s disease, Goodpasture’s syndrome, Takayasu’s disease, thromboangiitis obliterans. Diffuse connective tissue diseases, or systemic diseases, are represented by systemic lupus erythematosus, scleroderma, dermatomyositis, Sjogren’s disease, Sharp’s syndrome, etc. Separately in the classification of rheumatic diseases is rheumatism, in which there is a simultaneous rheumatic damage to the joints, connective tissue and blood vessels.

Currently, the etiology of rheumatic diseases is considered from the perspective of a multifactorial concept, according to which their development is explained by the interaction of genetic, environmental and endocrine factors. In this case, the genetic factor acts as a predisposing factor, and the external and endocrine factors act as producing, triggering moments. The most frequent provoking factors of rheumatic diseases are infections caused by Epstein-Barr viruses, cytomegaly, herpes simplex, picornaviruses, etc.; intoxication, stress, insolation, hypothermia, injury, vaccination; pregnancy, abortion. The unifying links of pathogenesis for all rheumatic diseases are the violation of immune homeostasis and the development of a severe immune-inflammatory process in the connective tissue, microvasculature and joints.

Rheumatic diseases are found among patients of various age groups, including among children and adolescents (for example, arthritis in children, rheumatism in children, juvenile rheumatoid arthritis, connective tissue dysplasias, etc.). However, the peak incidence occurs in adulthood – 45 years and older. Some rheumatic diseases often develop in persons of a certain gender: for example, systemic diseases, rheumatoid arthritis, polymyalgia rheumatica are more typical for women, but gout, psoriatic arthritis, and ankylosing spondylitis usually affect men.

The clinical manifestations of rheumatic diseases are extremely diverse and changeable, however, certain symptomatic markers can be distinguished, in the presence of which one should immediately consult a rheumatologist. The main ones include: prolonged unreasonable fever, arthralgias, swelling and changes in the configuration of the joints, morning stiffness of movements, muscle pain, skin rash, lymphadenitis, a tendency to thrombosis or hemorrhage, multiple lesions of internal organs. Systemic diseases are often disguised as diseases of the skin, blood, musculoskeletal system, oncopathology, with which differentiation is required in the first place.

In the diagnosis and treatment of rheumatic diseases, significant progress has been outlined in recent years, which is associated with the development of genetics, immunology, biochemistry, microbiology, pharmacology, etc. The basis for making the correct diagnosis is immunological studies that allow identifying antibodies corresponding to a specific nosology. Also, for the diagnosis of rheumatic diseases, radiography, ultrasound, CT, MRI, scintigraphy, arthroscopy, and biopsy are widely used.

Unfortunately, today a complete cure for rheumatic diseases is impossible. Nevertheless, modern medicine in most cases is able to help alleviate the course of the disease, prolong remission, avoid disabling outcomes and severe complications. Treatment of rheumatic diseases is a long, sometimes lifelong process and consists of drug therapy, non-drug methods, orthopedic treatment and rehabilitation. Basic anti-inflammatory drugs, glucocorticosteroids and biological drugs form the basis of therapy for most rheumatic diseases. An essential role in complex therapy is assigned to extracorporeal hemocorrection – plasmapheresis, hemosorption, cytapheresis, plasmasorption, etc. Such non-drug methods of treating rheumatic diseases, such as physiotherapy, balneotherapy, exercise therapy, acupuncture, kinesiotherapy, can significantly improve the functional status of patients. Orthopedic treatment (orthotics, surgical correction of joint function, endoprosthetics) is shown mainly in the late period of rheumatic pathology to improve the quality of life of patients.

Prevention of rheumatic diseases is non-specific. To prevent them, it is important to avoid provoking factors (stress, infections, other stresses on the body), pay sufficient attention to physical activity and take care of your health, and eliminate bad habits. The rapid development of medical technologies allows us to hope for the earliest possible resolution of unclear issues related to the emergence and course of rheumatic diseases.