Questions to a rheumatologist

In November, all the subscribers of our Instagram account @ medcenter.mrt.by had the opportunity to ask a question to the rheumatologist Galina Gennadyevna Stepanyuk under the heading ".... I just have to ask." We would like to thank all participants for their interesting questions and kind words addressed to Galina Gennadievna.

For those who are not active users of social networks, we publish answers to questions here.

ARE ANY ANALYSIS NEEDED FOR THE FIRST TAKE?

PAIN IN THE LUMBAR, BREAST, BRUSH. WHAT TESTS ARE NECESSARY FOR THE FIRST ADMISSION?

WHAT TESTS TO TAKE ON THE FIRST RECEPTION WITH PAIN IN THE JOINTS?

It is recommended to take with you to the initial appointment:

  • general blood analysis;
  • Analysis of urine;
  • CRB;
  • rheumatoid factor;
  • ASLO.

If there are radiographs, they must also be taken with you. As well as any other medical documentation. If you have taken any medications, then you need to know their names, doses and how long you have taken. The need for more specific tests and examinations can only be determined during the patient's appointment.

MRI OF THE LUMINAL AND SACRAL REGIONS DETECTED: PARTIALLY DEGENERATIVE SPONDILOARTHROSIS OF THE 1ST DEGREE, THE PHENOMENON OF SACROYLEITIS ON THE RIGHT, MULTIPLE TARLOV'S CYSTS AT THE S1-3 LEVEL. WHAT ARE YOUR RECOMMENDATIONS AND HOW SEVERE IS IT?

Sacroiliitis is an inflammation of the sacroiliac joint. Any inflammation requires treatment. Sacroiliitis treatment is a long process. The duration of treatment depends on:

  • the reasons that caused it;
  • the degree of activity;
  • genetic predisposition.

If untreated, a chronic process may develop. The rest of the identified changes are of a degenerative nature; treatment is also needed to restrain their progression.

PAIN IN FOOT, HEEL, ANKLE. Achilles is inflamed. ALL ANALYSIS IS OK. WHAT DO YOU ADVISE?

Normal tests do not yet indicate the absence of the disease. It is necessary to consult a rheumatologist to clarify the diagnosis and develop a treatment regimen.

CONSTANTLY ACHE MUSCLES OF THE LEGS, ARMS, BACK. THERE IS A FEELING OF TIRED, FATIGUE. HAS BEEN EXAMINED IN THE HOSPITAL. TESTS IN NORMALITY (IMMUNOBLOT, ENMG, INCLUDING NEEDLE OF THE LOWER LIMBS, TESTS FOR HORMONES, VITAMIN D, MAGNESIUM). PASSED DIAGNOSTICS: MRI of the BRAIN, ultrasound of the thyroid, abdominal organs, mammary glands, pelvic organs, joints. EVERYTHING IS OKAY. X-RAY OF THE LUNGS, NECK, CHEST AND LUMBAR REGIONS ALSO IN NORMAL. HELD A CONSULTATION OF NEUROLOGIST ROVDO SE IN YOUR CENTER. DIAGNOSIS: SOMATOFORM VEGETATIVE DYSFUNCTION. IS RHEUMATIC DISEASE EXCLUDED OR IS IT NECESSARY TO BE EXAMINED FURTHER?

Rheumatic muscle diseases are immune-inflammatory diseases. If you do not have inflammatory changes in the blood, immunological changes, primary muscular damage is excluded during needle ENMG, then such diseases (dermatomyositis and polymyositis) can be rejected. You have undergone a complete examination to exclude this pathology.

INFLAMMED NECK LYMPHONOSES (TO A GREATER EXTENT FROM THE RIGHT), CONSTANTLY PAINS THE KLAVO-SHOULDER JOINT ON THE RIGHT When the arms are bent and raised to the level of the head, the veins in the brushes begin to swell and the brushes themselves turn blue. C-REACTIVE PROTEIN AND RHEUMOFACTORS FOR BIOCHEMISTRY IN NORM. HAS TAKEN ANTINUCLEAR ANTIBODIES (ANA, IFT METHOD) - 1: 320 AND LACTATE DEHYDROGENASE (LDH) - 321. WHAT DOES THIS MEAN? CAN THE NECK LYMPHONIDES INFLAMMATE IN RHEUMATOID ARTHRITIS OF THE SHOULDERS? WHAT IS NECESSARY FOR THE INITIAL INSPECTION?

Lymph nodes can enlarge with various diseases, incl. and with rheumatoid arthritis. A complete blood count and consultation with a rheumatologist are required. From immunology, it is still necessary to perform antibodies to double-stranded DNA. If radiographs of the shoulder joint were taken, then they should be taken for an appointment.

IS IT POSSIBLE TO REMOVE THE LIQUID IN THE KNEES WITHOUT TABLETS?

If its a small amount, then you can.

UNCLE HAS BEEN SUFFERING FOR A VERY LONG TIME WITH A PAIN IN THE LEG THE LEG PRACTICALLY PULLS, BARRELS OUT OF THE MACHINE, SOMETIMES DOES NEVER FALL WITH SILENT MOVEMENT HELP ORIENTED TO WHICH DOCTOR AND WHICH DIAGNOSTICS SHOULD BE PASSED. HAVE TAKEN ANALYSIS, PERFORMED CT and ultrasound, CONSULTED A NEUROLOGIST, HAS BEEN Cured ALL IS USELESS. I AM ATTACHING THE RESULTS OF THE SURVEYS.

According to the presented examination results, the patient has stage 3 right-sided coxarthrosis. This can be the cause of severe pain and requires an orthopedic surgeon to resolve the issue of prosthetics of the right hip joint. In addition, there is neurological pathology. Apparently, the treatment is being carried out. If there is no effect against the background of the treatment of neurologists, then you should seek help from orthopedists about the hip joint.

WHAT ARE THE INDICATIONS FOR INCREASING THE DOSE OF METOTREXATE?

Methotrexate is the basic drug for the treatment of various diseases. The indication for increasing the dose is the activity of the disease process.

C-REACTIVE PROTEIN 84.3 MG / L; ESR 15. IN AUGUST HAS BEEN COVID-19. WHY DOES NOT PROTEIN REDUCE?

CRP is an indicator of the inflammatory process. It may remain for some time after the transferred infection. If you have any other inflammatory diseases, it can be a sign of their exacerbation. We must watch the dynamics of the blood test. In the absence of a decrease in its level, a detailed examination is required.

I AM 23 YEARS OLD. HOW TO MAINTAIN A HEALTHY LIFESTYLE IN BEKHTEREV'S DISEASE?

Bechterew's disease is a chronic inflammatory disease of the spine. In addition to drug treatment, the following are required: exercise therapy and swimming (to maintain the mobility of the spine); treatment of all foci of infection that can increase the activity of inflammation.

Benefit:

  • visit to the sauna;
  • massage;
  • spa treatment using mud therapy.


PREGNANCY 33 WEEKS. HEEL CONSTANTLY HURTS, WALKING HURTS. DO NOT HAND FINGER. INCREASED CRP, ESR 56, RF-NEGATIVE. A NEUROLOGIST RECOMMENDED TO CONTACT A RHEUMATOLOGIST.

Taking into account the pregnancy, to clarify the cause of the pain syndrome, it is necessary to perform an ultrasound of the heel region. There may be heel spurs, tendon inflammation. Until the diagnosis is clarified, local treatment can be used: ibufen gel, long cream, fastum gel in the form of compresses at night. Urinalysis is required. Pain in the heel can cause urinary tract infections.

MOTHER HAS 3 DEGREE OF ARTHOROSIS. IN THE NIGHT THE PAIN INCREASES. HOW CAN YOU HELP?

With arthrosis of the 3rd degree and the presence of night pain in the joint, first of all, it is necessary to limit the load. It is also necessary to take anti-inflammatory drugs. Administration of hyaluronic acid preparations may be considered, but the appropriateness of their administration is determined by radiographs. If pain persists, it is necessary to resolve the issue of joint prosthetics. Be sure to use a cane. The use of dietary supplements is unlikely to give any effect with the 3rd stage of arthrosis.

ANAMNESIS: CHRONIC TONZILLITIS, PAIN IN THE JOINT OF THE RIGHT HAND WHEN BROWNING BACK, IN THE PHALANGES OF THE INDICATIVE FINGERS, IN THE HIP JOINT. DO YOU NEED TO CONTACT A RHEUMATOLOGIST WITH SUCH COMPLAINTS? AND IF YES, WHAT TESTS TO GIVE BEFORE YOU ARE?

Yes, to a rheumatologist. Complete blood count, ASLO, CRP, RF and urinalysis are required.

HOW TO BE WITH PERMANENT BURSIT?

You need to know the cause of bursitis. It can be post-traumatic and inflammatory. Orthopedists deal with post-traumatic problems. As for inflammatory bursitis, it is necessary to consult a rheumatologist.

CAN REACTIVE ARTHRITIS GO WITHOUT SULFASALAZINE?

Yes, it can go away without sulfasalazine.

IN ANALYSIS RHEUMATOID FACTOR 60. SOMETIMES DOES NOT HAVE ANYNUMBER AND INDICATIVE FINGERS ON HANDS. IS THERE A REASON FOR ANXIETY? WHAT EXAMINATIONS SHOULD BE PASSED?

To exclude the onset of rheumatoid arthritis and Sjogren's disease, it is necessary to perform tests for immunological indicators: AntiCCP, SSA / Ro, SSB / La. If the joints hurt, then you need a consultation with a rheumatologist. An increase in rheumatoid factor can be in the pathology of the liver, thyroid gland.

I AM experiencing pain in the middle of the buttock. WHAT EXAMINATIONS TO PASS?

This pain may be due to an abnormality in the hip joint. In this case, an x-ray or MRI of the hip joints is necessary. Neurological pathology may be the cause. It is better to start with a doctor's examination, and there it is already determined what examinations are needed.

ACHE FOOT, HEEL, ANKLE, Achilles. ANALYSIS (SRB, RF, ESR, URIC ACID, ACCP, ASLO, LG G CHLAMIDIA) IN NORM. I TAKE SULF 2 G / DAY AND MEDROL. NO EFFECT. SORE 1.5 YEARS. WHAT DO YOU ADVISE?

The disease is long-term and serious treatment is carried out, therefore, any recommendations can be given only after examination and study of medical documentation. Normal tests can also be performed in the presence of a serious illness that requires prolonged treatment.

TWO WEEKS AGO THE BACK HAS BEEN PAIN, NOW THE PAIN "GIVES" INTO THE LEFT INTO AND IN THE LEFT FOOT. IN THE ANKLE THE PAIN IS UNBEELABLE. I TAKE PAINKILLERS. HOW TO TREAT?

Such pain can be a manifestation of sciatica, which requires consultation with a neurologist. In case of joint diseases, the pain should not be very strong and is determined only in the projection of the joint, and not throughout the leg.

JOINTS ON THE INDICATIVE FINGERS RECENTLY STARTED. WHAT CAN THIS BE, IS IT POSSIBLE TO CURE AND WHICH DOCTOR TO GO?

It is necessary to consult a rheumatologist. These joints can hurt in both arthritis and arthrosis.

GONARTHROSIS. TRABECULAR Edema of the medial condyle of the femur, tibia. DEGENERATIVE CHANGES OF THE FRONT HORN OF THE LATERAL MENISCUS. WORLD-SIGNS OF RUPTURE OF THE FRONT CROSS-LINE. SUPrapatellar bursitis. CHONDROMATOSIS. INTENDED FOR 2021 KNEE REPLACEMENT. NOW THE LEG FROM THE KNEE IS 2/3 INCREASED IN VOLUME. SEVERE PAIN. HOW TO TREAT AND WHICH DOCTOR TO CONTACT: THE INSPECTOR OR SURGEON? RECOGNIZED TRAMADOL, BUT DOESN'T HELP VERY MUCH.

You need to see an orthopedist. If the leg is swollen, there may be a ruptured popliteal bursitis (Baker's cyst).

WITH A CIRCULAR TURN OF THE FOOT, Clicks in the back of the hip. DURING SLEEP, PAINS IN THE BOTTOM OF THE BACK (IN THE Lying ON THE BACK), AND ON THE SIDE - STEPS. IS IT WORTH PASSING THE EXAMINATION?

To clarify the cause of the "click" in the hip joint, it is necessary to perform an x-ray of the hip joints. As for back pain, they are more often caused by neurological pathology. In this case, a consultation with a neurologist is indicated.

I AM 62 YEARS OLD. Rheumatoid arthritis was diagnosed. 9 YEARS OF DRINK METOTREXAT 12.5 MG PER WEEK, NIMESULID AND PERIODICALLY DONA. THERE IS NO DOCTOR WHO CAN CONTROL THE TREATMENT IN OUR TOWN. MAYBE THERE ARE MORE NEW DRUGS SUPPORTING THIS DISEASE OR DO I CONTINUE TO TAKE THESE DRUGS ONLY?

Methotrexate is the number one drug in the treatment of rheumatoid arthritis. If, against the background of taking it in such a dose, there is no pain syndrome, swelling of the joints, normal ESR and CRP, then there is no point in changing the drug. He is accepted while he is acting. However, it is necessary to monitor the performance of the liver. If the joints hurt, there are inflammatory changes in the analyzes, then this requires correction of the basic therapy. It is undesirable to take nimesulide together with methotrexate due to the same side effects on the liver. It is better to change nimesulide to meloxicam 15 mg per day or Aertal 100 mg 2 times a day.

WHEN LIFTING THE KNEES STRONGLY ROCK, BUT DO NOT HURT. DO I NEED TO TREAT?

If there is no pain, then treatment (as a rule) is not required. If the crunch is accompanied by pain, then you should see a doctor.

I HAVE READ THAT IN RHEUMATOID ARTHRITIS, TWO SIMILAR JOINTS START AT THE SAME TIME TO DISTURB, AND WITH A REACTIVE JOINT, ONE. BUT THERE WERE CASES WHEN BOTH JOINTS WERE ALSO AFFECTED BY THE REACTIVE (IF TALKING ABOUT THE KNEE). IS THERE ANY obvious difference between reactive arthritis and rheumatoid arthritis in the first stages?

Rheumatoid arthritis usually begins in the small joints of the hands. If only one knee joint hurts, then it is not rheumatoid arthritis.

WITH WHAT ANALYSIS DO YOU NEED TO GO FOR THE FIRST RECEPTION WITH GONARTHROSIS? WHAT IS NECESSARY TO PERFORM IMAGES, USES?

Complete blood count, CRP is required. Also a radiograph of the knee joints and, if possible, an ultrasound of the knee joints.

I HAVE ARTHROSIS OF 3 STAGES OF KNEE JOINT. DRINK NSAIDs, CHONDROPOTEKTORY. THERE IS A TEMPORARY IMPROVEMENT. WHAT DO YOU ADVISE?

Stage 3 arthrosis requires limiting the load. Development of joints is required. At this stage, hyaluronic acid preparations can be administered. If the pain is severe, then it is necessary to resolve the issue of joint prosthetics.

IS IT POSSIBLE TO DO SCANDINAVIAN WALKING WITH COXARTHROSIS?

If Nordic walking does not increase joint pain, then you can. If coxarthrosis is stage 3, then it is necessary to very carefully increase the load. If after exercise the pain intensifies, then you need to reduce the load.

COXARTROSIS 2 DEGREE. HOW SEVERE IS THIS? WHAT ARE YOUR RECOMMENDATIONS?

It is necessary to know the patient's age, clinical manifestations. Coxarthrosis of the 2nd degree requires dosing of the load, the development of joints and periodic administration of drugs to nourish the cartilage.

DONE OSTEODENSITOMETRY. WHAT TREATMENT IS NEEDED FOR THESE RESULTS (MEASUREMENT REPORT ATTACHED)? AND QUESTION ABOUT VITAMIN D TAKING THE ANALYSIS RESULT OF 13.99 NG / ML, WITH A REFERENT VALUE> 30 HOW OFTEN AND AT WHAT DOSAGE SHOULD I TAKE VITAMIN D?

Ultrasound densitometry was done here, it is screening. If there are changes (and they are here), X-ray osteodensitometry should be done. With the results, consult a rheumatologist. At the appointment, you must also take a blood test for ionized calcium, phosphorus. For vitamin D: take devit 50,000 IU, 1 tablet per week for up to 8 weeks, then 1 tablet per month.

We are grateful to Galina Gennadievna for the opportunity to get answers to exciting questions!

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