The system of staging treatment of rheumatism

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The first stage - the hospital. Inpatient treatment shall, as a rule, all patients with active phase of rheumatoid arthritis. The only exceptions are those patients whose condition allows to carry out the necessary treatment in outpatient conditions, under systematic observation of cardiorheumatology.
It is recommended to place patients in a small house, the house must be regularly aired and make them ultraviolet irradiation.
All patients with acute and subacute for rheumatism, especially with severe carditis, shown in bed in 2-3 weeks, followed by a rational use of motor mode with the inclusion of individualized complexes of therapeutic exercises. Set the feasibility relatively early expansion in bed with the use of breathing exercises, passive, and then the active movements directly after the disappearance of the acute rheumatic fever.
The task of inpatient treatment of patients is to develop the most rational method of complex treatment of not only the active phase in the hospital and to determine the strategy of the management of the patient at the subsequent stages.
Experience shows that patients with active phase of arthritis do not require a special diet. However, it is necessary to take into account that in a feverish period of food should be rich in vitamins, legkousvoyaemyh enough nutrients but low calorie content. The diet should include a certain number of proteins (not less than 1 g per 1 kg of body weight ), which is proved by data of more favorable for rheumatism in full and sufficient protein nutrition, and data peculiar to the active rheumatism violation of protein metabolism. Along with this there are also indications protective against streptococcal infection action lipids, particularly lecithin egg yolk, rheumatism. Fresh vegetables, fruits should be considered an important part of the diet.
As noted, the establishment of differential diagnosis of rheumatic fever requires and different approach to the implementation of remedial measures in appropriate clinical groups of patients.
Firmly established that a vigorous anti-inflammatory therapy, carried out with the assistance of glucocorticoids, large doses of salicylic, pirazolonovykh derivatives particularly necessary in the treatment of acute and subacute forms of the disease, most often detected in primary rheumatism. Sooner launched anti-inflammatory therapy usually prevents the further development of the productive phase of inflammation and rough fibrous deformations. In turn, in connection with weak enforcement, reduced by the nature of the inflammatory process, his haste, persistent violations of immunological reactivity with severe autoimmune component with medication protracted and latent rheumatism on the foreground there is an immunosuppressive aspect of therapy.
In recent years, there were reports about the effectiveness of this option, the current intramuscular injection of gamma globulin, titrated to eksperimentam β-hemolytic Streptococcus and Coxsackie virus AB, A18, EOI (O. I. yasakova, etc., 1976).
The reason for its use are expressed violations of anti-infection immunity, and the introduction of the organism significant concentration of antibodies serves as a kind of substitution therapy.
When continuous recurrent variant of the disease, at the height of exacerbation accompanied bright exudative inflammatory reaction and severe autoimmune disorders, necessary equally vigorous anti-inflammatory and active immunosuppressive effects. When this clinical form, usually on developing the background of advanced valve and the muscle of the heart diseases, methods of treatment should be especially designed and customized.