Hospital therapy. Treatment of rheumatism (most important)

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Hospital therapy. Treatment of rheumatism (most important)

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5. Treatment of rheumatism

The whole complex of treatment of rheumatism consists of antimicrobial and anti-inflammatory therapy, measures that are aimed at restoring immunological homeostasis. It is recommended to use a rational balanced diet, focus on adaptation to physical activity, preparation for work, timely surgical treatment of patients with complex heart defects. All patients during the active phase of rheumatism are shown penicillin (1-200 IU for 000 doses per day, every 1 hours), which has a bactericidal effect on all types of A-streptococcus. The course of treatment is 500 weeks during the active phase of rheumatism, in the future, a transfer to the prolonged drug bicillin-000 (6 units) is required. With intolerance to penicillin, erythromycin 4 mg 2 times a day can be prescribed.

Drugs with anti-inflammatory effect, which are used in the modern treatment of the active phase of rheumatism, are glucocorticosteroids, salicylic, indole derivatives, derivatives of phenylacetic acid, etc.

Prednisolone is used at 20-30 mg per day (for 2 weeks, then the dose is reduced by 2,5-5 mg every 5-7 days, for a total of 1,5-2 months) for primary and recurrent with III and II degree activity of the process of rheumatic heart disease, with polyserositis and chorea, with the development of heart failure due to active carditis.

Corticoid agents affect water-salt metabolism, therefore, potassium chloride 3-4 g / day, panangin and others should be used in the treatment, with fluid retention - aldosterone antagonists (veroshpiron up to 6-8 tablets per day), diuretics (lasix 40 -80 mg / day, furosemide 40-80 mg / day, etc.), with euphoria - tranquilizers, etc.

Non-steroidal anti-inflammatory drugs are also widely used for rheumatism: average doses of acetylsalicylic acid are 3-4 g per day, less often 5 g per day or more.

Acetylsalicylic acid is used 1 g 3-4 times a day after meals for 1-3 months or more with normal tolerance and subject to control of side effects.

The successful use of indolacetic acid derivative - indomethacin in rheumatism for more than 20 years. It has a pronounced therapeutic effect: subjective symptoms of carditis (cardialgia, palpitations, shortness of breath) disappear by the 8-10th day of therapy, and objective signs - by the 14-16th day. The disappearance of polyarthritis and polyserositis occurs even faster.

In the treatment of rheumatism, a combination of three main stages is important: hospital - clinic - resort.

At stage I, treatment is carried out with the drugs listed above. After reducing the activity of rheumatism and normalizing the patient's condition, they are transferred to stage II - treatment in a rheumatological sanatorium.

The main goal of this stage is to continue treatment with non-steroidal anti-inflammatory drugs.

Stage III includes dispensary observation and preventive treatment.

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