Treatment of rheumatoid arthritis is carried out by a rheumatologist, since the functional state of patients under medical supervision is better, and the use of modern methods of pharmacotherapy for rheumatoid arthritis requires special knowledge. It is necessary to inform patients about the nature of the disease and the side effects of the medications used. If appropriate symptoms appear, the patient should immediately stop taking the drug and consult a doctor.
When choosing treatment, it is necessary to take into account risk factors for poor prognosis and the length of the period between the onset of symptoms and the start of DMARDs.
Poor prognosis factors that necessitate more active treatment include the following:
- Seropositivity for RF and anti-CCL antibodies at the onset of the disease.
- High inflammatory activity.
- Involvement of many joints in the pathological process.
- Development of extra-articular manifestations.
- Increase in ESR and CRP level.
- Detection of certain HLA DR alleles (0101, 0401, 0404/0408, 1402).
- Detection of erosions in the joints at the onset of the disease.
- Young or old age of onset of the disease.
- Poor socio-economic living conditions.
If the disease lasts more than 6 months, treatment should be more active. When risk factors for poor prognosis are identified, methotrexate (initial dose 7.5 mg/week) with a rapid (over about 3 months) dose increase to 20–25 mg/week is considered the choice.
The effectiveness of treatment of rheumatoid arthritis is assessed using standardized indices, such as improvement criteria of the American College of Rheumatology, dynamics of the DAS28 index (every 3 months recommendations of the European League Against Rheumatism), patient functional ability (HAQ) (every 6 months), progression of joint destruction according to data radiography using the Sharpe or Larsen methods (every year).
Currently, treatment for rheumatoid arthritis is considered effective if it achieves clinical improvement of at least ACR70 or remission.
To assess improvement according to the American College of Rheumatology criteria, the following must be considered.
The number of painful joints (the severity of synovitis is determined by counting the number of painful and the number of painful and swollen joints).
- The number of swollen joints (the severity of synovitis is determined by counting the number of painful and the number of painful and swollen joints).
- General activity (according to the doctor).
- General activity (according to the patient) (the patient evaluates activity on a visual analogue scale with extreme points: “complete absence of activity” and “maximum possible activity”),
- Joint pain.
- Disability Index (HAQ).
- Changes in ESR, CRP level.
ACR20, ACR50, ACR70 indicate a 20, 50 and 70% improvement in at least five of the seven indicators listed (improvement in the first two is considered mandatory).
Characteristics of remission in rheumatoid arthritis
According to the criteria of the American College of Rheumatology (clinical remission: persistence of five of the six following signs for at least 2 months).
- Morning stiffness less than 15 minutes.
- No discomfort.
- No joint pain.
- No joint pain when moving.
- No joint swelling.
- ESR less than 50 mm/h in women and
According to the criteria of the European League Against Rheumatism.
- The DAS28 index value is less than 2.6.
According to FDA criteria.
- Clinical remission according to the criteria of the American College of Rheumatology and the absence of progression of joint destruction according to radiological signs (according to the Larsen or Sharp index) for 6 months without taking DMARDs (remission).
- Clinical remission according to the criteria of the American College of Rheumatology and the absence of progression of joint destruction according to radiological signs (according to the Larsen or Sharp index) for 6 months during treatment with DMARDs (complete clinical remission).
- Improvement in ACR70 levels over at least 6 subsequent months (clinical effect).
- The activity of inflammation usually correlates with the development of joint destruction, however, in some patients during treatment with standard DMARDs, progression of the erosive process in the joints is observed even with low inflammatory activity, and even during the period of clinical remission.
Indications for hospitalization
Patients are hospitalized in the rheumatology department in the following cases.
- To clarify the diagnosis and assess the prognosis.
- To select DMARDs at the beginning and throughout the course of the disease.
- During exacerbation of RA.
- With the development of severe systemic manifestations of RA.
- If an intercurrent illness, septic arthritis or other severe complications of the disease or drug therapy occur.
What are the goals of treatment for rheumatoid arthritis?
- Suppression of arthritis symptoms and extra-articular manifestations.
- Prevention of destruction, dysfunction and deformation of joints.
- Maintaining (improving) the quality of life of patients.
- Achieving remission of the disease.
- Reducing the risk of developing comorbid diseases.
- Increased life expectancy (to population level).
Non-drug treatment of rheumatoid arthritis
The treatment of rheumatoid arthritis is based on a multidisciplinary approach, based on the use of non-pharmacological and pharmacological methods, and the involvement of specialists from other medical specialties (orthopedists, physiotherapists, cardiologists, neurologists, psychologists, etc.).
In the absence of serious joint deformities, patients continue to work, but significant physical activity is contraindicated for them. Patients should avoid factors that could potentially provoke an exacerbation of the disease (intercurrent infections, stress, etc.). It is recommended to stop smoking and limit alcohol intake.
Maintaining an ideal body weight helps reduce stress on joints and reduces the risk of death and osteoporosis. To do this, you need to follow a balanced diet, including foods high in polyunsaturated fatty acids (fish oil, olive oil), fruits, and vegetables. Eating these foods potentially reduces inflammation.
Patient education programs (changing physical activity patterns) are important. Exercise therapy, special exercises (1-2 times a week) aimed at strengthening muscle strength, physiotherapeutic methods (for moderate RA activity). Orthopedic methods are aimed at preventing and correcting typical joint deformities and instability of the cervical spine.
Spa treatment of rheumatoid arthritis is recommended only for patients with minimal RA activity or in remission.
Throughout the entire period of the disease, active prevention and treatment of concomitant diseases, primarily cardiovascular pathology, is necessary.
It should be especially emphasized that non-drug treatment of rheumatoid arthritis has a moderate and short-term effect. The effect on disease progression has not been proven. The described measures increase the effectiveness of symptomatic therapy and help in the correction of persistent joint deformities.
Drug treatment of rheumatoid arthritis
Recent decades have been marked by significant progress in deciphering the pathogenetic mechanisms of RA development. It is no coincidence that this disease is considered as a unique model of chronic inflammatory diseases in humans. The study of RA is acquiring general medical significance, since it creates the prerequisites for improving the pharmacotherapy of many other human diseases (atherosclerosis, type 2 diabetes mellitus, osteoporosis), the development of which is also associated with chronic inflammation.
A fundamentally new direction in drug treatment of rheumatoid arthritis was the formation of the concept of a “window of opportunity.” The window of opportunity is the period of time at the onset of the disease when treatment with DMARDs has the maximum anti-inflammatory and anti-destructive effect and improves the prognosis.
It was found that patients who started receiving DMARDs early do not experience an increase in the risk of premature death, unlike RA patients who did not receive DMARDs. The prognosis for patients with severe RA treated with DMARDs at the onset of the disease is the same as for patients with a more favorable course of the disease. It is noteworthy that treatment with DMARDs and, especially, TNF-α inhibitors can significantly reduce mortality from cardiovascular causes. and also slow down the development of osteoporosis, leading to skeletal bone fractures.
The following groups of drugs are used to treat rheumatoid arthritis.
- NNPV:
- non-selective;
- selective.
- Glucocorticosteroids.
- DMARDs.
- Synthetic drugs.
- Biological drugs.
The mainstay of treatment is drug therapy with DMARDs. Treatment of rheumatoid arthritis should begin as early as possible, preferably within the first 3 months from the onset of the disease. Therapy should be as active and flexible as possible, changing (if necessary) the treatment regimen depending on the dynamics of clinical symptoms and laboratory signs of inflammation. When choosing DMARDs, risk factors must be taken into account.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs have a direct anti-inflammatory effect.
The purpose of prescribing NSAIDs for RA is to relieve symptoms of the disease (pain, stiffness, swelling of the joints). NSAIDs do not affect the activity of inflammation and are not able to influence the course of the disease and the progression of joint destruction. Nevertheless, NSAIDs are considered the main treatment for the symptomatic treatment of RA and a first-line treatment when prescribed in combination with DMARDs.
Treatment of rheumatoid arthritis with NSAIDs must be combined with the prescription of DMARDs, since the incidence of remission with NSAID monotherapy is significantly lower than with treatment with any DMARD.
Glucocorticoids
The use of GCs in low doses (prednisolone
In rheumatoid arthritis, glucocorticosteroids should not be used as monotherapy. They must be used in combination with DMARDs. In the absence of special indications, the dose of glucocorticosteroid should not exceed 10 mg/day (in terms of prednisolone).
When prescribing GCs for RA, it should be remembered that their use leads to the development of a large number of side effects. Side effects are more often observed with inadequate use of drugs (long-term use of high doses). It should be borne in mind that some side effects (for example, severe damage to the gastrointestinal tract, penis and other organs) occur less frequently than with treatment with NSAIDs and NSAIDs. In addition, effective preventive measures have been developed to prevent some undesirable effects (eg, glucocorticoid osteoporosis).
Indications for prescribing low doses of GC.
- Suppression of joint inflammation before the onset of DMARDs (“bridge” therapy).
- Suppression of joint inflammation during exacerbation of the disease or the development of complications of DMARD treatment.
- Ineffectiveness of NSAIDs and DMARDs.
- Contraindications to the use of NSAIDs (for example, in elderly people with a history of peptic ulcers and (or) dysfunction).
- Achieving remission in some types of RA (for example, with seronegative RA in the elderly, resembling polymyalgia rheumatica).
Medium and high doses of GCs orally (15 mg per day or more, usually 30-40 mg per day in terms of prednisolone) are used to treat severe systemic manifestations of RA (effusion serositis, hemolytic anemia, cutaneous vasculitis, fever, etc.), as well as special forms of the disease (Felty's syndrome, Still's syndrome in adults). The duration of treatment is determined by the time required to suppress symptoms. The course is usually 4-6 weeks, after which the dose is gradually reduced and switched to treatment with low doses of GC.
Pulse therapy with GC is used in patients with severe systemic manifestations of RA. This method allows you to achieve rapid (within 24 hours), but short-term suppression of joint inflammation.
Since the positive effect of GC pulse therapy on the progression of joint destruction and prognosis has not been proven, their use (without special indications) is not recommended.
Local (intra-articular) administration of GC in combination with DMARDs effectively suppresses inflammation of the joints at the onset of the disease or during exacerbation of the process, but does not affect the progression of joint destruction. When carrying out local therapy, general recommendations should be followed.
Biological therapy
In patients with persistent and/or erosive arthritis, treatment of rheumatoid arthritis with DMARDs should be started as early as possible (within 3 months from the onset of symptoms), even if they do not formally meet the diagnostic criteria for RA (undifferentiated arthritis). Early treatment with DMARDs improves the patient's condition and slows down the progression of joint destruction. Late administration of DMARDs (3-6 months from the onset of the disease) reduces the effectiveness of ionotherapy. The longer the duration of the disease, the lower the effectiveness of DMARDs. In undifferentiated arthritis, the administration of methotrexate reduces the risk of transformation of the disease into definite RA, especially in patients whose blood has anti-CCP antibodies.
During treatment, it is necessary to carefully evaluate the dynamics of disease activity (DAS index) at least once every 3 months. Correct selection of DMARDs depending on disease activity significantly increases the effectiveness of treatment in early RA.
Taking DMARDs should be continued even if the disease activity decreases and remission is achieved, since drug withdrawal often leads to exacerbation and progression of destructive changes in the joints. Once remission is achieved, the dose of DMARDs can be reduced if there is no exacerbation.
The main drugs (first-line drugs) for the treatment of rheumatoid arthritis are methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine. Other DMARDs (azathioprine, cyclosporine, penicillamine, cyclophosphamide, chlorambucil) are rarely used, primarily due to side effects and the lack of reliable data on their effect on the progression of joint damage. Potential indications for their use include the ineffectiveness of other DMARDs or contraindications to their use.
The effectiveness and toxicity of DMARDs may be affected by other drugs. These interactions should be taken into account when administering treatment.
Women of childbearing potential taking DMARDs should use contraception and plan their pregnancy carefully as these drugs should be used with extreme caution during pregnancy and lactation
Combination treatment of rheumatoid arthritis with DMARDs
Three main treatment regimens are used.
- Monotherapy followed by the prescription of one or more DMARDs (for 8-12 weeks) while maintaining the activity of the process (step-up).
- Combination therapy followed by transfer to monotherapy (after 3-12 months) when the activity of the process is suppressed (step-down).
- Combination therapy throughout the entire period of the disease.
- Methotrexate is considered the main drug in combination therapy.
Biological drugs
Despite the fact that treatment with standard DMARDs in the most effective and tolerable doses starting from the earliest period of the disease can improve the immediate (relief of symptoms) and long-term (reduced risk of disability) prognosis in many patients, the results of treatment of RA are generally unsatisfactory. Treatment of rheumatoid arthritis with standard DMARDs has certain limitations and disadvantages. These include difficulties in predicting the effectiveness and toxicity of DMARDs, the rarity of achieving remission of the disease (even with early treatment), and the development of exacerbation after stopping medication. During treatment with DMARDs, joint destruction can progress, despite a decrease in the inflammatory activity of the disease and even the development of remission. These drugs often cause adverse reactions that limit the possibility of using these drugs in doses necessary to achieve a lasting clinical effect.
This is a serious incentive to improve approaches to pharmacotherapy of RA. New methods should be based on knowledge of the fundamental mechanisms of the development of rheumatoid inflammation and on modern medical technologies. The most significant achievement in rheumatology of the last decade is considered to be the introduction into clinical practice of a group of drugs united by the general term biological agents (“biologies”), or, more precisely, biological modifiers of the immune response. Unlike traditional DMARDs and GCs, which are characterized by nonspecific anti-inflammatory and/or immunosuppressive effects, biological agents have a more selective effect on the humoral and cellular components of the inflammatory cascade.
Currently, 3 registered drugs belonging to the class of biological agents are successfully used. These are TNF-a inhibitors (infliximab, adalimumab) and an inhibitor of B-cell activation (rituximab). They are characterized by all the beneficial properties inherent in DMARDs (suppression of inflammatory activity, inhibition of joint destruction, possible induction of remission), but the effect, as a rule, occurs much faster (within 4 weeks, and sometimes immediately after infusion) and is much more pronounced, in including in relation to inhibition of joint destruction.
The main indications for prescribing TNF-a inhibitors (infliximabn and adalimumab) are considered to be ineffectiveness (preservation of inflammatory activity) or intolerance to methotrexate (as well as leflunomide) at the most effective and tolerable dose. There is data, however, that requires further confirmation, on the effectiveness of combination therapy with infliximab and leflunomide in patients with insufficient effectiveness of ion therapy with leflunomide. It should be especially emphasized that, despite the fact that combination therapy with methotrexate and TNF-a inhibitors is highly effective (compared to standard DMARDs), this type of treatment does not help in more than 30% of patients, and only in 50% of cases can complete or partial remission be achieved . In addition, after completion of the course, patients with RA usually experience an exacerbation. All this taken together, as well as the fact that the use of TNF-a inhibitors can contribute to the development of severe side effects (tuberculosis, opportunistic infections and other diseases), served as the basis for the use of rituximab for the treatment of RA.
Treatment of rheumatoid arthritis depends to a certain extent on both the duration and stage of the disease, although the goals and general principles of therapy do not differ significantly.
At the early stage of the disease (the first 3-6 months from the onset of symptoms of arthritis), erosions are not detected in the joints (in most patients), and the likelihood of developing clinical remission is high. Often, patients do not meet sufficient criteria for RA, and the disease is classified as undifferentiated arthritis. It must be emphasized that in patients with undifferentiated arthritis, a high frequency (13-55%) of the development of spontaneous remissions (disappearance of symptoms without treatment) is observed. In this case, the development of spontaneous remission is associated with the absence of anti-CCP antibodies. At the same time, in patients with reliable early RA, spontaneous remissions are rarely observed (in 10% of cases), and anti-CCP antibodies are also not detected in this group of patients. As already noted, the administration of methotrexate to patients with anti-CCP-positive undifferentiated arthritis significantly reduces the risk of its transformation into definite RA. There is evidence that in patients with early RA, when markers of an unfavorable prognosis are identified, it is advisable to begin treatment with combination therapy with methotrexate and inflixnmab.
The advanced stage is usually observed when the disease lasts more than 12 months. In most cases, it is characterized by the typical clinical picture of RA, the gradual development of an erosive process in the joints and the progression of functional disorders.
The vast majority of patients require continuous treatment of rheumatoid arthritis with effective doses of DMARDs, even when disease activity is low. It is often necessary to change DMARDs and prescribe combination treatment for rheumatoid arthritis, including the use of biological agents. To prevent exacerbations, NSAIDs and GCs can be re-prescribed for systemic and local use.
Late-stage manifestations are usually observed when the disease lasts more than 5 years (sometimes less). The late stage of RA is characterized by significant destruction of small (radiological stage III-IV) and large joints with severe impairment of their functions and the development of complications (tunnel syndromes, aseptic bone necrosis, secondary amyloidosis). In this case, inflammatory activity may subside. Due to persistent joint deformation and mechanical pain, the role of orthotics and orthopedic methods in the treatment of RA at this stage is increasing. Patients should be regularly monitored for active detection of complications of the disease (in particular, secondary amyloidosis).
It is advisable to consider a patient resistant to treatment if treatment with at least two standard DMARDs at the maximum recommended doses (methotrexate 15-20 mg/week, sulfasalazine 2 g/day, leflunomide 20 mg/day) was ineffective (lack of 20 and 50% improvement according to the criteria of the American College of Rheumatology). Failure can be primary or secondary (occurring after a period of satisfactory response to therapy or when the drug is re-prescribed). To overcome resistance, low doses of GCs, combination therapy with standard DMARDs and biological agents are used, and in case of ineffectiveness or contraindications to their use, second-line DMARDs are used.
Treatment of Felty's syndrome
To assess the effectiveness of treatment for Felty syndrome, special criteria have been developed.
Criteria for good treatment effectiveness.
- An increase in the number of granulocytes to 2000/mm3 or more.
- Reduce the incidence of infectious complications by at least 50%.
- Reduce the incidence of skin ulcers by at least 50%.
The main drugs for the treatment of Felty's syndrome are parenteral gold salts; if methotrexate (leflunomide and cyclosporine) is ineffective. The tactics for their use are the same as for other forms of RA. Monotherapy with GC (more than 30 mg/day) leads only to temporary correction of granulocytopenia, which recurs after reducing the drug dose, and increases the risk of developing infectious complications. Patients with agranulocytosis are prescribed GC pulse therapy according to the usual regimen. Data were obtained on the rapid normalization of granulocyte levels with the use of granulocyte-macrophage or granulocyte colony-stimulating factors. However, their administration is accompanied by side effects (leukocytoclastic vasculitis, anemia, thrombocytopenia, bone pain) and exacerbations of RA. To reduce the risk of side effects, it is recommended to start treatment with a low dose of granulocyte-macrophage colony-stimulating factor (3 mcg/kg per day) in combination with a short course of glucocorticosteroids (prednisolone at a dose of 0.3-0.5 mg/kg). In case of severe neutropenia (less than 0.2x 109/l), treatment with granulocyte-macrophage colony-stimulating factor is carried out for a long time at the minimum effective dose required to maintain the number of neutrophils >1000/mm3.
Although splenectomy leads to rapid (within a few hours) correction of hematological disorders, it is currently recommended only in patients resistant to standard therapy. This is due to the fact that a quarter of patients experience recurrence of granulocytopenia, and 26-60% of patients experience recurrence of infectious complications.
Blood transfusion is not recommended except in cases of very severe anemia associated with cardiovascular risk. The effectiveness of epoetin beta (erythropoietin) has not been proven. It is recommended to be used only before surgery (if necessary).
Treatment of amyloidosis
There is evidence of certain clinical effectiveness of cyclophosphamide, chlorambucil, GC and especially infliximab.
Treatment of infectious complications
RA is characterized by an increased risk of developing infectious complications localized in the bones, joints, respiratory system and soft tissues. In addition, many drugs used to treat the disease (NSAIDs, DMARDs, and especially GCs) may increase the risk of developing infectious complications. This dictates the need for careful monitoring and active early treatment of infectious complications.
Risk factors for developing infections in RA are:
- elderly age;
- extra-articular manifestations;
- leukopenia;
- comorbid diseases, including chronic lung diseases and diabetes;
- GC treatment.
Patients with RA are very susceptible to developing septic arthritis. Features of septic arthritis in RA include damage to several joints and a typical course in patients receiving glucocorticosteroids.
Treatment of cardiovascular complications Patients with RA (including undifferentiated arthritis) have a higher risk of developing cardiovascular diseases (acute myocardial infarction, stroke), so they should undergo examination to assess the risk of this pathology.
Treatment of osteoporosis
Osteoporosis is a common complication of RA. Osteoporosis can be associated both with the inflammatory activity of the disease itself and impaired physical activity, and with treatment, primarily GC. Prevention of osteoporosis should be carried out in the following categories of patients:
- receiving GC;
- with a history of non-traumatic skeletal bone fractures;
- over 65 years old.
In patients with risk factors for osteoporosis and receiving GCs, BMD must be determined annually.
Bisphosphonates are considered the main drugs for the prevention and treatment of osteoporosis, including glucocorticoid osteoporosis. If you are intolerant to bisphosphonates, you can use strontium ranelag. Calcitonin (200 IU/day) is indicated for severe pain associated with vertebral compression fractures. All patients are prescribed combination therapy with calcium (1.5 mg/day) and cholecalciferol (vitamin D) (800 IU/day).
Surgical treatment of rheumatoid arthritis
Surgical treatment of rheumatoid arthritis is considered the main method for correcting functional disorders at a late stage of the disease. Use in the early stages of RA in the vast majority of cases is inappropriate due to the wide possibilities of drug therapy. In the advanced stage of the disease, the need for surgical treatment is determined individually when the indications are established.
Indications for surgery
- Nerve compression due to synovitis or tenosynovitis.
- Threatened or completed tendon rupture.
- Atlantoaxial subluxation, accompanied by the appearance of neurological symptoms.
- Deformations that make it difficult to perform simple daily activities.
- Severe ankylosis or dislocation of the lower jaw.
- The occurrence of bursitis, which impairs the patient’s ability to work, as well as rheumatic nodules, which tend to ulcerate.
Relative indications for surgery.
- Synovitis, tenosynovitis or bursitis resistant to drug therapy.
- Severe joint pain.
- Significant restriction of movement in the joint.
- Severe joint deformity.
Endoprosthetics is the main method of treatment for deformities of the hip and knee joints, as well as the joints of the fingers. Synovectomy (recently performed mainly in small joints) and tenosynovectomy are also used. Arthroscopic synovectomy is becoming increasingly widespread, but long-term results have not yet been studied. Bone resections and arthroplasty are performed (mainly used on table joints). Arthrodesis may be the method of choice for severe deformities of the ankle, first metatarsophalangeal and wrist joints.
What should a patient know about the treatment of rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease. It is characterized by the development of erosive arthritis and systemic damage to internal organs. Symptoms are usually persistent and progress steadily without treatment.
Drug therapy is considered the main treatment method for RA. This is the only way to slow down the development of the inflammatory process and maintain mobility in the joints. Other treatment methods: physiotherapy, diet, exercise therapy are of auxiliary value and are not able to have a significant impact on the course of the disease.
The treatment of RA is based on the use of DMARDs. These include a large number of drugs with different chemical structures and pharmacological properties, such as methotrexate, leflunomide, sulfasalazine, etc. They are united by the ability, to a greater or lesser extent and through various mechanisms, to suppress inflammation and (or) pathological activation of the immune system. A new method of treating RA is the use of so-called biological agents. Biological agents (not to be confused with dietary supplements) are protein molecules that selectively act on individual substances or groups of cells involved in the process of chronic inflammation. Biological drugs include infliximab, rituximab, adalimumab.
Treatment for rheumatoid arthritis usually begins with methotrexate or leflunomide. Biological agents (infliximab, adalimumab and rituximab) are usually added to these drugs when ionotherapy is insufficiently effective. GCs can provide a rapid anti-inflammatory effect. NSAIDs are an important component of RA treatment because they can reduce joint pain and stiffness. The most commonly used are diclofenac, nimesulide, meloxicam, ketoprofen, and celecoxib.
For rheumatoid arthritis, drug treatment can produce very good results, but requires careful monitoring. Monitoring should be carried out by a qualified rheumatologist and the patient himself. The patient must visit the doctor at least once every 3 months at the beginning of treatment. In addition to the examination, blood tests are prescribed, and an X-ray examination of the joints is performed annually to assess the course of the disease. Be aware of the treatment limitations associated with methotrexate and leflunomide therapy.
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Forecast
And the end of the 20th century. on average, about half of the patients lost their ability to work during the first 10 years; by the 15th year of the disease, approximately 80% of patients became disabled in groups I and II. In patients with RA, a decrease in life expectancy was observed compared to the general population by 5-10 years. The most common causes of death were cardiovascular diseases (stroke, acute myocardial infarction), the occurrence of which is associated with the intensive development of atherosclerosis and a tendency to thrombosis due to chronic immune inflammation. Deaths due to secondary amyloidosis were often observed. associated infections (pneumonia, soft tissue suppuration, etc.).
A common complication of viral damage to the body is arthritis due to influenza. The complex of symptoms of this disease includes myalgia - muscle pain and arthralgia - discomfort in the joints. Basically, an abnormal reaction of the body to a pathogen causes reactive arthritis. It does not occur in everyone, but as a complication, it can manifest itself in the form of inflammation of one or more joints already on the first day of influenza infection.
Why does arthritis get worse?
This pathological condition is associated with a restructuring of the immune system in response to a pathogenic agent - a virus. After the flu, unique immune complexes are formed, an allergic reaction occurs to the pathogen itself and to secondary bacterial infections, which, against the backdrop of a weakening of the body’s protective functions, join the underlying disease.
The mechanism for the development of arthritis in influenza is that on the articular surfaces covered with hyaline cartilage there are receptors similar to antibodies that appear in response to the pathogenic agent. Therefore, without recognizing strangers and their own, the cells of the defense system attack the musculoskeletal system. Faster and stronger immune aggression is directed against joints that are well supplied with blood. With the blood comes a greater number of warring immune complexes that perceive cartilage as foreign. Rheumatoid arthritis, which develops with streptococcal infection, has a similar mechanism.
Symptoms of arthritis with flu
One of the symptoms of arthritis is joint inflammation. Manifested by pain, swelling and dysfunction. Even in the initial (prodromal) period of influenza, weakness, stiffness of movements in the limbs, and minor muscle spasms appear. At the end of the first day of illness, in some cases, mono- or oligoarthritis occurs - acute inflammation of one or a pair of joints. Arthritis is rarely observed during the full-blown flu. After 1-2 weeks, immune complexes have time to form, affecting the articular surfaces, resulting in persistent inflammation, which can become chronic.
The diagnosis is confirmed by laboratory test data. With reactive influenza arthritis, the number of leukocytes, ESR, and C-reactive protein increase. Biochemical indicators indicate an increase in the concentration of seromucoid and sialic acids.
There will be no changes on x-ray for this pathology. In rare cases, when the process is severe, a narrowing of the joint space is formed, and the contours of the cartilage surfaces are deformed. Ultrasound shows a similar picture. Body temperature rises to 38 °C. Patients limp on the affected limbs, sparing them. When inflammation of the joint capsule occurs, the exudate that accumulates in the cavity stretches the capsule, which aggravates the situation by increasing pain.
How to treat arthritis?
The patient is advised to limit movements in the joints and minimize the load on them. It is recommended to eat plant foods rich in vitamins and mineral complexes, reduce the amount of sweets, and drink more fluids. Antiviral drugs that reduce the viral load and suppress inflammation have an effective effect: Tamiflu, Amizon, Remantadine. To relieve pain and relieve inflammation, the groups of drugs presented in the table are prescribed:
Physiotherapeutic methods
Treatment with ozokerite will help regulate peripheral blood circulation in the joints. Physiotherapy treatments include:
- Paraffin wraps. Method of long-term and uniform thermal exposure.
- Ozokerite applications. Compresses made from a substance containing paraffin, mineral oils and resins.
- Ultra-high frequency therapy (UHF). A treatment method that involves influencing the body with an ultra-high frequency electric field (40 MHz), which is supplied to the patient using capacitor electrode plates.
- Laser therapy. Physiotherapeutic method using infrared or red light radiation.
- Magnetotherapy. A type of treatment that involves the influence of static magnetic fields on joints at the molecular level.
- Phonophoresis. Method of simultaneous exposure to ultrasound and medications.
- Electrophoresis. Treatment with the combined influence of low current and voltage on the body (galvanization) and medications.
Why is arthritis dangerous?
Complications that occur after inflammation of the joints are classified into early and late. The first include phlegmon and panarthritis -
There are two main types of arthritis: inflammatory arthritis and degenerative arthritis.
Inflammatory arthritis is associated with inflammation of the membrane lining the joint from the inside:
- infectious (purulent) arthritis
- rheumatoid arthritis
- gout
Degenerative arthritis is associated with damage to articular cartilage:
- osteoarthritis
- traumatic arthritis
Arthritis that accompanies various diseases (flu, Lyme disease, etc.) is considered separately.
Suppurative arthritis
Purulent arthritis occurs when pathogens of a pyogenic infection penetrate the joint. Purulent arthritis is primary and secondary. observed in wounds. Secondary arthritis develops when an infection from adjacent tissue or blood enters the joint. Damage and destruction of cartilage is observed. Arthritis can lead to periarticular cellulitis. In this case, severe pain, high fever, and chills are observed.
Rheumatoid arthritis
Rheumatoid arthritis is a systemic disease affecting the joints like polyarthritis. The causes of rheumatoid arthritis have not yet been clarified. The role most often pointed to is streptococci, viruses and other microorganisms, as well as genetic factors. Damage to one’s own immune system plays a special role in the development of rheumatoid arthritis. The presence or absence of rheumatoid factor in the blood determines two forms of rheumatoid arthritis. The seropositive form of arthritis is more severe. The disease usually begins acutely, with morning stiffness, pain, and fever. First, one joint is often affected (monoarthritis), and after a few months other joints are involved in the process. Rheumatoid arthritis often affects the small joints of the hand and, less commonly, the spine. Rheumatoid arthritis is characterized by persistent pain that increases with movement and decreases at night. Arthritis is accompanied by muscle atrophy and the formation of rheumatoid nodules in the skin.
Arthritis due to influenza
Most patients with influenza have sensations of damage to muscles and joints. During the peak of the flu, joints are less likely to be affected. However, after 10-15 days the likelihood of arthritis increases. Arthritis due to influenza is usually allergic in nature and often becomes chronic.
Arthritis due to Lyme disease
Lyme disease is caused by spirochetes after a tick bite. Very often, at the first stage of the disease, neck stiffness appears, and after a few months the patient develops arthritis.
Infectious-allergic arthritis
Infectious-allergic arthritis begins acutely and develops as a result of increased sensitivity of the body to an infectious pathogen (streptococcus, staphylococcus). Infectious-allergic polyarthritis is more common in young women. There is a connection between the occurrence of arthritis and acute upper respiratory tract infection. 10 - 15 days after an acute infection, during the period of greatest allergization of the body, acute inflammation of the joints occurs. But if patients with acute respiratory diseases take anti-inflammatory drugs, the process in the joints is sluggish.
Polyarthritis
Non-infectious polyarthritis develops with systemic diseases - allergies, connective tissue diseases (lupus erythematosus, scleroderma), blood diseases and hemorrhagic diathesis, malignant tumors, diseases with deep metabolic disorders (uremia, gout), injuries.
I never thought that I would go to doctors so much in search of the cause of my ill health. By my specialty, I am a nurse, and I hoped that by rotating in a medical environment, I would be able to cope with any abnormalities in the body. But making my correct diagnosis proved difficult even for experienced doctors.
It all happened 2 years ago. For a year I was painfully ill. Periodically, the joints on my legs became inflamed to the point of being unable to stand on my feet, my ankles became swollen, and then pain appeared in my spine, and this pain spread throughout my body. My hands became swollen and began to go numb. The pain was concentrated in the left hand, 3 fingers on it went numb. I turned to a massage therapist, who often saved me from exacerbation of osteochondrosis, I thought that was the reason. But there was no effect from the massage.
I went to see a therapist, who prescribed tests for me and referred me to a cardiologist. The cardiologist, in turn, did not find any cardiological abnormalities and sent me to a surgeon. The surgeon goes back to the therapist. In the district consultation, I walked in circles, trying to find the cause of my condition. As a result, I was admitted to the cardiology department because my blood pressure had risen. There were no effects from treatment in the hospital.
Desperate, I even turned to an oncologist. My torment would have continued for a long time if one of the doctors had not advised me to go to a rheumatologist, which I did.
Finally, the rheumatologist made the correct diagnosis - rheumatoid arthritis. At this moment I was very worried about aching muscle pain. The joints of the feet and wrists were inflamed. There was constant pain in the joints, I could not even walk. The doctor prescribed treatment for 4 months, after which I felt better. Then life circumstances developed in such a way that there was no time to continue treatment for rheumatoid arthritis, and I felt so much better that I thought about healing. However, it turned out that this was my mistake, since rheumatoid arthritis is a chronic disease. If it appears once, you must always be on guard. The result of forgetting about my illness was a complication in the elbow and shoulder joints, the spine, with pain in which I now live constantly.
What is rheumatoid arthritis
Modern diagnostics can now easily identify rheumatoid arthritis in the early stages. However, in district consultations it is often suggested at the very last moment, when there is already deformation of the joints.
Rheumatoid arthritis is a systemic connective tissue disease. The disease is chronic, infectious-inflammatory in origin, which affects both peripheral small joints and large joints such as our spine. In addition, the destructive processes are so strong that the joints can cease to perform their function until they become completely immobile. Among other things, rheumatoid arthritis can be considered an autoimmune disease. That is, the body’s defense system perceives its cells as foreign. She reacts to her own cells, like viruses and bacteria, directing her aggression towards her own body.
For many years, both in our country and abroad, they have been looking for ways to combat rheumatoid arthritis. It can have an acute onset or proceed in a sluggish form. Has no seasonality, i.e. appearance can be expected at any time of the year. Rheumatoid arthritis cannot be infected.
What can cause rheumatoid arthritis?
- Injuries.
- Various infectious diseases (sore throat, acute respiratory infections, any viral diseases - for example, herpes, rubella, hepatitis).
- Decreased immunity, which is facilitated by acute and cumulative stress and depression.
Symptoms of rheumatoid arthritis
- The disease begins differently in each case. Rheumatoid arthritis can begin acutely or subacutely (when one or 2 joints suddenly swell).
- Appears joint pain, especially when walking. It may occur in the morning and especially in the evening.
- Often the joints become inflamed symmetrically. It happens that pain appears in one or another joint, while in the first it has stopped.
- Muscle pain in rheumatoid arthritis they are of a long-term aching nature. The patient often tries to rub the muscles with warming ointments, but the effect is insignificant.
- In the latent period of rheumatoid arthritis, it manifests itself severe fatigue, weakness, malaise. Stiffness in movements in the morning. A person can hardly clench his hand into a fist.
- May appear fever(presence of unmotivated jumps in body temperature).
- Sweating.
In later stages of rheumatoid arthritis appear:
Extra-articular lesions in rheumatoid arthritis
Rheumatoid arthritis is not only a joint disease. It affects connective tissue, that is, problems arise in all organs and systems where it is present. These include muscles in any organ and blood vessels. That is, the respiratory, cardiovascular system, and kidneys suffer.
It happens that doctors rarely pay attention to extra-articular lesions. It must be said that it is in vain, since very often these disorders are more serious for the patient than joint lesions.
Thus, with rheumatoid arthritis, one disorder is layered on top of another. It seems that the body is falling apart, which is not far from the truth. The problem is that people believe that these are different diseases. In fact, these are manifestations of the same disease - rheumatoid arthritis.
Why is rheumatoid arthritis so scary? secondary amyloidosis . Amyloid is a pathologically altered protein. When amyloid is deposited in various organs, it destroys them. The most serious complication is renal amyloidosis. Most often this leads to kidney failure.
Treatment of rheumatoid arthritis
Early treatment helps prevent the irreversible consequences of rheumatoid arthritis. Currently, there are many good drugs that are successfully used for arthritis. There is one important rule in the treatment of rheumatoid arthritis: if such a diagnosis is made, treatment and prevention of exacerbations must be constantly addressed, once every six months by contacting a rheumatologist.
Drug treatment is prescribed by a doctor and only by him.
Herbal medicine will help support the body with rheumatoid arthritis. Meeting with a competent herbalist greatly alleviated my condition. I am now sharing this information with you, dear readers.
Herbs for rheumatoid arthritis
Tinctures that are taken in a course of 21 days are very effective:
- Elecampane tincture 25%, 30 drops 3 times a day.
- Burdock tincture 20%, 30 drops 3 times a day.
- Baikal skullcap tincture 25%, 10 drops 3 times a day.
- Calamus tincture 20%, 20 drops 3 times a day
- Thyme tincture 10% 10 drops 3 times a day
Water extracts (infusions and decoctions) of lingonberry, lemon balm, St. John's wort, bearberry, string, orthosiphon, agrimony, sweet clover, astragalus, and elderberry support the body well. Separately, tansy can be distinguished, with infusions of which they take baths and take a 5% infusion orally. Tansy has immunomodulatory, antibacterial and anti-inflammatory effects. But we must not forget that tansy is poisonous, so it is important not to overdo it in doses.
Cranberry juice, lemon juice and tea with honey are useful.
Medicinal herbs are used to make infusions that are even more effective than the herbs individually. These preparations should have an anti-inflammatory effect and can be taken during hospital treatment.
For rheumatoid arthritis, many herbs are used that can be combined with each other in preparations:
- Meadowsweet (meadowsweet)- immunomodulator, reduces blood viscosity, cholesterol levels, improves blood circulation, antiviral and antibacterial agent.
- St. John's wort- a good antiseptic and at the same time a sedative, relieves pain.
- Knotweed (knotweed) grass- cleanses the kidneys.
- Birch leaves(especially May) - puts the kidneys in order, cleanses the body.
- Stinging nettle(mayleaf) is a source of vitamins, affects blood circulation, relieves inflammation, but all infusions with nettle should be used on the day of production, because become toxic when stored.
- Ledum shoots is a potent remedy, so a minimal amount is added to preparations. Ledum is a strong analgesic component.
- White willow bark contains aspirin. Shavings of this bark can even replace cardiomagnyl or aspirin-cardio.
- Wormwood, herb- cleanses the body, in particular the liver, restores normal metabolism. This is a very important component, since many drugs used for arthritis have a very aggressive effect on the liver. In this case, wormwood acts as a detoxifying component, i.e. removes poisons.
- Also effective for rheumatoid arthritis juniper fruits in the form of a decoction sage, strawberry herb, silverweed (gurley).
- Has a good anti-inflammatory effect creeping wheatgrass (cat grass roots).
- Licorice naked acts as a hormone-like agent. Burdock is useful for rheumatoid arthritis both in the form of infusion and tincture. Forest geranium (joint, cinquefoil - not to be confused with cinquefoil!) is used in tinctures. But cinquefoil is a powerful anti-inflammatory agent and is widely used to make dietary supplements and ointments for arthritis.
- Among other things, plants containing vitamins are very useful (rose hips, mountain ash, buckwheat, wild strawberries, creeping clover). These plants are good to add to preparations for rheumatoid arthritis.
- Can be used pine needles and heather. A little about heather: it calms the nervous system, relieves inflammation, heals the kidneys, and relieves pain.
- Usage horse chestnut in the form of a tincture for rubbing has long been used for rheumatoid arthritis.
It must be said that Chinese medicine, unlike European medicine, considers rheumatoid arthritis to be a treatable disease. For this, an extract of mountain ants is used, which is designed to regulate the immune system in case of autoimmune disorders, and a mushroom called cordyceps.
In conclusion from the author
If you have a suspicion of rheumatoid arthritis, if you feel that you are not suffering from the flu, but you have a fever, pain in the joints, your heart is acting up, your blood pressure is rising, you should definitely consult a specialist. From my own experience, I was convinced that the rheumatologist should be one of the first doctors to visit, and not the last, as in my case. Delay leads to the fact that we waste the time that is needed to stop rheumatoid arthritis in the initial stage, and not lead to its more complex manifestations and complications.
Nature has given us a large number of remedies that can support the body with rheumatoid arthritis and protect against the negative effects of drug therapy, which cannot be avoided. We must not forget about the disease “rheumatoid arthritis,” as happened to me; we must try to use all means for rehabilitation in order to prevent further destruction of joints and other organs. And, of course, you shouldn’t give up and be lazy about brewing all this and accepting it in a disciplined manner.
I wish everyone who is faced with the same illness as me to relentlessly act in preventing complications and exacerbations of rheumatoid arthritis.
Good health!
Honey. sister Lyudmila Karpova, Vladimir
Arthritis – this is inflammation of the joint. With arthritis, pain is observed when moving or lifting heavy objects, the joint loses mobility, swells, changes shape, and the skin over the joint turns red.
Main symptoms of arthritis:
Pain and swelling in the joints.
Morning stiffness in the joints of the hands.
Weakness, fatigue.
Increased body temperature.
Losing weight.
Types of Arthritis
There are two types of arthritis:
Inflammatory arthritis.
Degenerative arthritis.
Inflammatory arthritis is associated with inflammation of the membrane lining the joint from the inside:
Infectious (purulent) arthritis
Rheumatoid arthritis
Gout
Degenerative arthritis is associated with damage to articular cartilage:
Osteoarthritis
Traumatic arthritis
Suppurative arthritis occurs when pathogens of a pyogenic infection penetrate into the joint. Purulent arthritis is primary and secondary. Primary arthritis occurs in wounds. Secondary arthritis develops when an infection from adjacent tissue or blood enters the joint. Damage and destruction of cartilage is observed. Arthritis can lead to periarticular cellulitis. In this case, severe pain, high fever, and chills are observed.
Rheumatoid arthritis- a systemic disease with joint damage such as polyarthritis.
The causes of rheumatoid arthritis have not yet been clarified. The role most often pointed to is streptococci, viruses and other microorganisms, as well as genetic factors.
Damage to one’s own immune system plays a special role in the development of rheumatoid arthritis. The presence or absence of rheumatoid factor in the blood determines two forms of rheumatoid arthritis.
The seropositive form of arthritis is more severe. The disease usually begins acutely, with morning stiffness, pain, and fever. First, one joint is often affected (monoarthritis), and after a few months other joints are involved in the process.
Rheumatoid arthritis often affects the small joints of the hand. Rheumatoid arthritis is characterized by persistent pain that increases with movement and decreases at night. Arthritis is accompanied by muscle atrophy and the formation of rheumatoid nodules in the skin.
Arthritis due to influenza
Most patients with influenza have sensations of damage to muscles and joints. During the peak of the flu, joints are less likely to be affected. However, after 10-15 days the likelihood of arthritis increases. Arthritis due to influenza is usually allergic in nature and often becomes chronic.
Lyme disease caused by spirochetes after a tick bite. Very often, at the first stage of the disease, neck stiffness appears, and after a few months the patient develops arthritis.
Infectious-allergic arthritis begins acutely, develops as a result of increased sensitivity of the body to an infectious pathogen (streptococcus, staphylococcus).
Infectious-allergic polyarthritis is more common in young women. There is a connection between the occurrence of arthritis and acute upper respiratory tract infection. 10 - 15 days after an acute infection, during the period of greatest allergization of the body, acute inflammation of the joints occurs. But if patients with acute respiratory diseases take anti-inflammatory drugs, the process in the joints is sluggish.
Polyarthritis
Non-infectious polyarthritis develops with systemic diseases - allergies, connective tissue diseases (lupus erythematosus, scleroderma), blood diseases and hemorrhagic diathesis, malignant tumors, diseases with deep metabolic disorders (uremia, gout), injuries.
Inflammation of periarticular tissues in arthritis
With periarthritis, bursitis, tendinitis and some other arthritis, the joint capsules, tendons, and ligaments become inflamed. The causes of these diseases are mechanical overload due to flat feet, professional and sports overload, spinal curvature, and injuries. Periarthritis often affects the shoulder and hip joints.
Arthritis treatment
The duration of arthritis is 1-2 months. However, in some patients it persists for a longer period.
Recurrence of arthritis is possible after repeated acute infection or hypothermia. Under the influence of anti-inflammatory therapy, the shape and size of the joints are normalized, and function is restored.
Therapy is carried out with non-hormonal anti-inflammatory drugs: brufen, flugalin, naproxen, butadione, indomethacin, voltaren.
Desensitizing therapy - suprastin, diphenhydramine. Additionally, ultraviolet irradiation, vitamins, and low-carbohydrate foods are recommended. The disappearance of arthritis must be confirmed clinically and radiologically. Typically, long-term treatment is required, followed by observation by a rheumatologist, regular laboratory (2-4 times a year) and radiological (1-2 times a year) monitoring of the activity of inflammation for many years.
Several groups of anti-inflammatory drugs have been developed and successfully used to combat arthritis. In acute cases, they can be administered by injection directly into the site of inflammation. Restoring joint mobility and muscle elasticity is achieved using special gymnastics and massage techniques. A course of treatment with chondroprotectors is carried out, stimulating the restoration of joint cartilage.
Non-pharmacological treatments for arthritis include:
Reducing the load on joints: reducing body weight; selection of orthopedic shoes with soft soles and fixed heels, use of instep supports, knee pads, and canes when walking.
Therapeutic exercises, which should be carried out in a sitting position, lying down or in water (i.e. without static loads) and should not cause increased pain in the joints. Exercises on bent knees and squats are completely excluded. Swimming lessons are recommended.
Physiotherapeutic treatment: thermal procedures, ultrasound, magnetic therapy, laser therapy, acupuncture, hydrotherapy, massage, electrical pulse stimulation of muscles. Any physiotherapeutic procedures are carried out in the absence of contraindications.
Getting rid of bad habits: quitting smoking, excessive consumption of coffee drinks.
Pharmacological treatments for arthritis:
Local therapy: use of non-steroidal anti-inflammatory creams, ointments or gels; intra-articular or periarticular administration of glucocorticosteroids.
For moderate joint pain, simple painkillers (paracetamol) are used; if their effect is insufficient, non-steroidal anti-inflammatory drugs are prescribed.
Currently, much attention in the treatment of arthritis is paid to drugs that can eliminate not only pain, but also prevent, slow down or reverse the development of pathological processes occurring in the joints during arthritis. Such drugs are called chondroprotectors, i.e. drugs that protect cartilage. They are able to stimulate the synthesis of the main substance of cartilage and at the same time inhibit the production of an enzyme that destroys cartilage. Thus, chondroprotectors enhance regenerative processes and suppress destructive processes in cartilage. When prescribed, pain is often significantly reduced, range of motion increases, and joint function is restored. Chondroprotectors are well tolerated and very rarely cause side effects.
Surgical treatment (joint replacement), which is used only for the most advanced forms of arthritis.
Treatment of rheumatoid arthritis
Rheumatoid arthritis cannot be completely cured. Modern treatment methods are aimed at reducing inflammation, improving joint function and preventing disability in patients. Early initiation of treatment improves prognosis. Optimal treatment includes not only drug therapy, but also exercise therapy, lifestyle changes and other measures. There are two types of drugs used in the treatment of rheumatoid arthritis: anti-inflammatory or fast-acting “first-line” drugs and slow-acting “second-line” drugs (also called disease-modifying or disease-modifying drugs). The first group of drugs includes aspirin and hormones (corticosteroids), which relieve inflammation and reduce pain. Basic drugs (for example, methotrexate) cause remission and prevent or slow down joint destruction, but are not anti-inflammatory drugs. Surgical treatment is used to correct severe joint deformities.
Treatment of reactive arthritis
General hygienic measures for the prevention of intestinal infections, the use of condoms to reduce the risk of infection with genitourinary chlamydia and other sexually transmitted diseases.
Treatment of infectious arthritis
Infectious arthritis usually requires several days of hospital treatment, followed by medications and physical therapy sessions over several weeks or months.
Treatment of arthrosis
Gymnastics 2-3 times a week for 15 minutes.
Periodic preventive treatment of arthrosis 1-2 times a year (chondroprotectors, physiotherapy, manual therapy, massage).
Gentle exercise regimen and balanced nutrition.
Treatment of infectious-allergic arthritis
Antimicrobial, anti-inflammatory and desensitizing drugs are used. Before prescribing antibiotics to a patient with arthritis, their tolerance is determined. It is advisable to carry out balneological treatment (sea, hydrogen sulfide, radon baths) after treating arthritis.
Treatment of periarthritis
Treatment of periarthritis, bursitis, and tendinitis takes 1-3 months. The pain can be relieved within a week. If periarthritis is advanced (6 months or more without proper treatment), a limitation of joint mobility of 10-20% often remains. After the acute symptoms of periarthritis have been relieved, preventive courses are required 1-2 times a year (chondroprotectors, physiotherapy, massage).
Treatment of complications of arthritis
Sepsis is a common complication of arthritis. Late complications include fistulas, ankylosis, dislocations, arthrosis, and limb deformities. Treatment for complications of arthritis depends on the duration of the disease. Suppurative arthritis should be treated promptly. For purulent arthritis, the inflammatory fluid is sucked out and the joint is washed with an isotonic sodium chloride solution, and antibiotics are prescribed. The limb must be immobilized.
Alternative remedies for treating arthritis:
Place a piece of camphor the size of 1/4 of a piece of refined sugar into a 200-gram bottle. Fill 1/3 of the bottle with turpentine, 1/3 with sunflower oil, 1/3 with wine alcohol. Let it brew for 3 days. Rub dry into the area of the sore joint at night and tie as a compress.
Apply celandine juice generously to the affected joints, after a few days the pain decreases. The more juice you apply to the joints, the more active the treatment.
1 tsp. pour celandine with 1 cup of boiling water, leave for 1 hour. Drink 50 g 3 times a day 15 minutes before meals for 1-2 months.
1 tbsp. l. woodlice herbs (medium chickweed) pour 1 cup of boiling water. Leave, covered, for 4 hours, strain. Take 1/4 cup 4 times a day before meals.
1 tbsp. l. fresh purslane herb pour 1 glass of cold water. Boil for 10 minutes after boiling. Leave, covered, for 2 hours, strain. Take 1-2 tbsp. l. 3-4 times a day.
Infuse 20 g of horse chestnut flowers in 0.5 liters of alcohol or vodka for 2 weeks. Use the tincture as a rub.
Take 50 g of mullein flowers (bear's ear) and leave for 2 weeks in 0.5 liters of vodka or 70% alcohol. This tincture can be used for rubbing as a pain reliever.
3 tsp. Boil the rhizomes and roots of yellow gentian for 20 minutes, add 3 glasses of water. Leave, covered, for 2 hours, strain. Take 1/2 cup 3-4 times a day before meals for arthritis of various origins.
Pour 1 glass of walnut partitions with 0.5 liters of vodka and leave for 18 days. Take 2-3 times a day for a month.
