Mandatory health insurance(compulsory medical insurance) on the territory of Russia is legally available to all citizens Russian Federation, as well as to other persons, in the manner established by the legislation of the Russian Federation.
Any citizen of Russia has the right to free medical services provided for by the compulsory medical insurance program and determined by the Program of State Guarantees for the provision of free medical care to citizens of the Russian Federation. medical care.
This Program is reviewed annually, and the list of services in it may change from year to year. The program is approved by the relevant Decree of the Government of the Russian Federation.
Questions and answers:
Question:
I am 68 years old, group 2 disabled. I have had gout for 25 years. During another exacerbation, I was denied a call to a rheumatologist at home. How to get a visit to a rheumatologist?
Answer:
Considering the length of the disease, it can be assumed that recommendations for therapy ( drug therapy, correction of diet, lifestyle, movement mode, etc.) you have. If there are no such recommendations, then the local general practitioner provides primary care for acute gouty arthritis and routinely organizes a consultation with a rheumatologist to develop an algorithm for treatment measures.
Question:
In our district clinic I don’t have a rheumatologist, but all my joints hurt. What to do?
Answer:
It is necessary to contact a general practitioner for an initial examination, followed by a referral to a rheumatologist at a consultative and diagnostic center, a city rheumatology center or the Institute of Rheumatology. The level of treatment (regional or federal) is determined by expediency.
There should be no problems with referral to a rheumatologist at the above institutions.
SQ
July 13, 2019 at 01:12Nh. Please tell me if
ANA is positive,
Antinuclear factor at the cellular level for hep-2 below 1:160 type of glow no,
At the inspiration of double-helix 1.92. Compliments of component C3 c4 within the ref. Values. General analysis
Leukocytes 6.36
Hemoglobin 140
Platelets 221
Red blood cells 4.96
RF less less than 20(up to 30)
SRP less than 0.2 (norm up to 5)
Asl-o 66(up to 200)
Using these analyses, can you determine SLE?
1 reply receivedCrunches in the joints
Elena, 23 years old, female
July 11, 2019 at 10:34 amHello, for about half a year now I have been experiencing crunches in different joints, covering all groups.
It first started after a visit to the dentist. It all started with pain in the muscles all over my body, sharp shooting pains in different parts, the neurologist said that I had intercostal neuralgia, everything went away after treatment, but the crunching continued, about 20-30 times an hour or even more, with mobility it crunches less than when I'm motionless. A week ago my leg hurt, I couldn’t walk, it seemed to give way with a sharp pain, an hour passed, I raised my leg horizontally with a bent knee, and heard crunching sounds, I raised the click and lowered the click, yesterday I checked again, everything was intact. I did exercises that didn’t help, today I got shots in my legs and arms again. What could it be? Could there be an infection? I noticed my boyfriend also had crunches, but less frequent. I think this may not be related. Could I have become infected with something at the dentist? I have a sedentary job and spend a lot of time sitting. What to do and where to go?
I drink 3-4 cups of coffee a day, I heard that coffee dehydrates, and when dehydrated, joint fluid may disappear, or maybe this has some other effect?
1 reply receivedIncreasing the dose
Olga, 25 years old, female
July 02, 2019 at 10:18 pmGood day. Please tell me, I have been diagnosed with SLE since 2015, I take ¾ tablets of prednisolone. 0.75% of the tablet. My rheumatologist wants to increase the dose to 4 tablets per day! ESR 51.ANF 1:20480, ACCP<7., циркулир. Иммун. Комплексы 657. Сдавала ещё кучу анализов. Просто подскажите, такое увеличение дозы, это нормально? Бывало не принимала плаквинил вечером. Хотят госпитализацию
1 reply receivedHello.
You provided too little information to draw any conclusions. Attach scans or photos of forms with the results of the examination and the rheumatologist's report as attachments to the question.
My child’s knee is swollen, what should I do?
Anastasia, 4 years old, female
June 28, 2019 at 12:41 pmHello, my 4 year old child had an acute respiratory infection in March after her knee became swollen. Doctors said that this is a complication and this often happens in children. We were not prescribed any examination. Now the knee is swollen, but it does not hurt or bother me. Please tell me what should we do? Thank you in advance
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Your child most likely has reactive arthritis. It is necessary to consult a pediatric rheumatologist for examination, diagnosis, examination and treatment.
Anf 1:160
Alexandra, 30 years old, female
June 18, 2019 at 6:22 pmGood afternoon After severe stress, I have been worried about dry mouth and eyes for more than a year. The dryness became less while taking antidepressants. I took tests several times over the course of a year. ESR is normal, RF is negative, AT to ENA is negative, the kit component is normal.
In June 2018, ANF is less than 1:160, in November 2018, 1:160 is a fine-granular type of luminescence, in June 2019, 1:160 is a cytoplasmic type of luminescence. On the eve of the test, I took omez and de-nol.
Strangely enough, within a year I had pyelonephritis and pneumonia. Immediately after rotavirus. Although before this I didn’t even have bronchitis or cystitis. The joints do not swell. No one in the family suffered from animmune diseases. Recently we discovered cardia insufficiency and erosion in the esophagus. Can I rule out an autoimmune process?
1 reply receivedVasculitis
Maria, 3 years old, male
June 02, 2019 at 03:49 pmHello, my 3.4-year-old son was diagnosed with vasculitis, a skin rash and swollen legs, now the obvious signs have passed, we are on bed rest, diet, the main medicine is heparin, he has been in the hospital for the second week. We suspect that the illness occurred after suffering from an acute respiratory infection.
Tell me, how do they continue to live with her? Now in life this is our diagnosis, should we be afraid of SARS so that it doesn’t happen again? Or can this be cured?
Is it possible for a child to play sports, he loves hockey very much, he has already signed up for the section, took half a year, loves training and is bored, I don’t know what to answer him, will we come back again or is sport not about us now?
Allergist, Immunologist, Pediatrician, Children's allergist
Hello.
All your questions can be answered only by knowing the exact final diagnosis and having information about the results of the examination and treatment, so it is better to contact your child’s attending physician or a specialist who will observe the child on an outpatient basis with all questions.
Juvenile idiopathic arthritis
Evgeniy, 33 years old, male
May 30, 2019 at 00:26My 2-year-old daughter, a month ago, was unable to stand on her right leg in the morning. The surgeon diagnosed reactive arthritis and prescribed Nimulid. At first the pain disappeared, but on the fifth day it returned. We contacted a rheumatologist and continued taking Nimulid. After 14 days, Nimulid was replaced with diclofenac, the pain in the morning went away, but within an hour the child was limping. Ultrasound shows slight signs of improvement. Today I was diagnosed with Juvenile Rheumatoid Artiritis. Knee, ankle, hip and phalangeal joints are affected. Hospitalization and a course of methotrixate were prescribed. ROE analyzes - 3.srb -8.1, RF - 0.3. I would like to hear your opinion. Tell me what tests still need to be taken to clarify the diagnosis and determine a treatment regimen? If you can, can you recommend a clinic in Russia? Thank you very much in advance for your answer.
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
The information provided is not sufficient to draw any conclusions. In St. Petersburg, the issues of rheumatological pathology in children are dealt with by the specialized departments of the St. Petersburg State Pediatric University (3 P.O. SPbSPMU) and the department of the Children's City Hospital No. 2 of Mary Magdalene.
Analysis transcript
Olga, 37 years old, female
May 06, 2019 at 11:11 amHello, please help me find out the result of a biochemical analysis for a 1 year 11 month old child. Result of rheumatoid factor<20, результат срб 0.6
Hidden files (1)
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Both indicators are within normal limits. In connection with what exactly these two indicators were taken? To exclude rheumatological pathology, the results of these tests alone are not enough.
HLA b27 positive result in a child
Yana, 32 years old, male
April 23, 2019 at 10:32 amHello.
The child has a positive result for HLA b27, the child is 6 years old, I would like to hear recommendations on lifestyle, observation and further diagnosis, etc.
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Why was this research carried out?
The child should be regularly monitored by a pediatric rheumatologist.
General recommendations: sleep in the correct body position, sufficient physical activity, timely sanitation of foci of chronic infection (chronic tonsillitis, sinusitis, caries, etc.), constant exercise therapy, hardening procedures.
Other recommendations depend on the diagnosis and its manifestations.
What could it be
Yulia, 30 years old, male
April 20, 2019 at 01:15 pmHello, please help! We don't have specialists! For a week now I (a girl) of 30 years have been tormented by joint pain. It all started abruptly with pain in all joints, then both ankle joints began to swell, the temperature has remained for a week at 37, 37.2, 37.5, 38. A large painful red spot appeared on the ankle. And higher up, incomprehensible red bumps began to appear under the skin. Passed rheumofactor aslo 318 units<200. С реактивный белок 56 мл<5.0. Ревматоидный фактор<20<30. Сдавала биохимию но результаты у врача.сказала идёт резкий воспалительный процесс артрита. Пью два антибиотика Амоксициллин и Азитромицин.ибупрофее,немесил.ничего не помогает отёки всё больше.Я ещё кормлю ребёнка грудью. Скажите может это быть артрит с отрицательным ревмофактором?
Hidden files (1)
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Rheumatoid arthritis can be seronegative, i.e. without characteristic markers of the inflammatory process in the blood. Considering the complaints, it is impossible to do without consulting a rheumatologist.
Compatibility
Nadezhda, 37 years old, female
April 20, 2019 at 01:01 pmHello. The gynecologist prescribed metronidazole and polygynax. I take methylprednisolone and painkillers. Tell me, are these medications compatible?
1 reply receivedRheumatoid arthritis
Utah, 65 years old, female
April 01, 2019 at 11:50 pmI was diagnosed in 2016 rheumatoid arthritis"and methotrexate was prescribed. I accept. But now I don’t have any pain at all, my joints don’t bother me, is it possible to stop taking methotrexate? I’ve already tried to do this a little, but at the moment I haven’t taken it for a month and I feel fine. My doctor said that I shouldn’t interrupt. I would like to know the opinion of other specialists. Thank you.
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Methotrexate is a basic therapy drug. If you do not follow a regular schedule for taking the drug, you risk exacerbation of the disease. Stop unnecessary experiments on yourself.
lupus erythematosus
Alena, 26 years old, female
February 28, 2019 at 9:16 pmHello. I have lupus erythematosus, it doesn’t seem to be systemic, only the skin of my hands is affected. Now the disease has almost gone to sleep and has begun to reduce the dosage of medications. I'm interested in this question: will I have to take medications for the rest of my life or can I take breaks from taking them.
Is it possible to drink wine on holidays, and if so, what is the best way to proceed? Skip the dose for a few days or take the pills as usual?
I’m worried about the consequences and have given up alcohol altogether while I’m undergoing treatment and started to wonder about this issue.
Allergist, Immunologist, Pediatrician, Children's allergist
Hello.
To answer your question, you need to know what medications you are taking and in what dosages. It is also not entirely clear - did you decide to reduce the dose on your own or was this the decision of your attending physician?
Allergy to a drug
Asya, 66 years old, female
February 09, 2019 at 08:05 pmHello! I have osteoarthritis affecting my fingers. After the doctor prescribed the drug Teraflex Advance, an adverse reaction appeared - allergic rhinitis. Should I continue treatment (10 days, 2 capsules 3 times a day) or abandon this drug?
1 reply receivedSlideron tablets
Zhanar, 50 years old, female
February 08, 2019 at 05:06Assigned Slideron 4
Which group does it belong to: pain relievers or treatments?
Can it be used for a long time?
Appointed for three months
1 reply receivedDentist-therapist, Periodontist
Hello, Zhanar. This is a hormonal glucocorticoid drug. It has a powerful anti-inflammatory effect without affecting the cause of inflammation. Those. This is a symptomatic remedy.
Arthritis
Tolganay, 26 years old, female
February 07, 2019 at 10:07 amGood afternoon, I am 26 years old, diagnosed with rheumatoid arthritis, I have been taking injections and tablets for 2 years now. Now I want apitherapy or physical treatment (Milta device), which treatment is the best to help?
1 reply receivedAllergist, Immunologist, Pediatrician, Children's allergist
Hello.
Basic (main, permanent) therapy for rheumatoid arthritis consists of regularly taking medications (tablets, droppers, injections). Apitherapy and physiotherapy are auxiliary and have not proven their effectiveness, but are not the main methods of treating your diagnosis.
Hemorrhagic vasculitis and lymphadenitis
Nikolay, 47 years old, male
February 06, 2019 at 08:44 pmHello.
There were pinpoint hemorrhagic rashes on the skin of the lower legs and feet along the front surface, which persisted for more than two months.
Complete blood count and coagulogram are normal.
Other test results:
ANF less than 1:160 (negative)
ASL-o less than 50
Immunoglobulin A 4.96 (normal 0.63-4.84)
Only immunoglobulin A is abnormal
Based on this, the rheumatologist makes a diagnosis: hemorrhagic vasculitis, probably the cutaneous form. and prescribes treatment:
Take Ascorutin 1 t/3 times a day for 1 month.
Curantil 75 mg No. 40, 1 tablet 1 time per day in the evening for up to 3 months.
After ascorutin, start taking Trental 400 (400 mg) 1 tablet in the morning for 2 months.
3 weeks after the start of treatment, swelling of the gums of the lower jaw, swelling of the neck and supraclavicular muscle appeared on the left side. From the side of the swollen gums I periodically felt the taste of blood. Blood was visible in the saliva when spitting. I did an ultrasound and went to the oncology clinic and was diagnosed with submandibular lymphadenitis. During this period, a general blood test and temperature were normal.
I had an appointment with a dentist and an ENT doctor. They did not find reasons for lymphadenitis in their profile.
On the advice of a therapist, I stopped taking medications prescribed by a rheumatologist, except for ascorutin.
3 months have passed. The hemorrhagic rashes have disappeared, but moderate swelling of the neck and gums remains on the left side and
The taste of blood is occasionally felt.
I did another ultrasound.
Here are the results:
On the left, in the mandibular region, there is an oval-shaped l/u with an expanded cortical layer of 11*6 mm, with blood flow;
At the angle of the jaw, there is a hypoechoic lymph node of oval shape, with a blood flow of 21*7 mm.
On the left, along the back surface of the neck, there is a chain of oval-shaped hypoechoic lymph nodes,
In the lower third of the neck along the posterior surface there is a hypoechoic lymph node of an oval shape with hypervascularization, a supraclavicular lymph node on the left of normal structure 7*3 mm, oval shape.
The therapist said that the lymph nodes were enlarged, but she saw no reason for concern.
How valid is the diagnosis and treatment regimen proposed by the rheumatologist and could taking chimes cause lymphadenitis? What to do?
1 reply receivedIn our network of clinics, appointments are conducted by rheumatologists with many years of experience. If you need emergency assistance, consultation or preventive examination, you can contact the centers on Belorusskaya, Kursk or Tula. We provide our patients with a wide range of services in this area: diagnostics, effective treatment, removal of synovial fluid, injections, blockade of the periarticular area, therapeutic and diagnostic puncture.
Who might need a rheumatologist?
It is a deep misconception that only elderly people may need the help of a rheumatologist. Often young people also need examination and competent consultation from a specialist.
Contact your doctor if you have:
- there is body stiffness in the morning
- pain in joints and spine
- swelling in the joint area
- fingertips go numb
- there are cases of diseases in blood relatives of rheumatoid arthritis, lupus erythematosus, scleroderma and vasculitis
We treat:
OsteoarthritisOsteoporosis
Rheumatoid arthritis
Gouty arthritis
Reactive arthritis
Ankylosing spondylitis (Bechterew's disease)
Psoriarthritis
Systemic lupus erythematosus
Systemic scleroderma
Raynaud's phenomenon
Polymyalgia rheumatica
Polymyositis, dermatomyositis
Erythema nodosum
At an appointment with a rheumatologist
At the initial consultation, a rheumatologist performs an examination, registers complaints, and makes a preliminary diagnosis. If necessary, the patient undergoes additional tests - x-rays, clinical and biochemical blood tests, markers of osteoporosis. The development of a treatment regimen includes drug therapy, as well as therapeutic and preventive measures. Intra-articular injections, physiotherapy, and magnetic therapy may be prescribed.
Sometimes the treatment of rheumatological diseases is long, the patient requires a significant amount of endurance and patience, he needs to follow preventive measures and fall in love with a healthy lifestyle. Doctors at our clinics practice an individual approach to the management of each patient. And if you need the help of a qualified rheumatologist, you can be sure that you will be provided not only with effective treatment, but also with sincere care and psychological support!
