Wissler’s subsepsis — Fanconi. Since there are known cases of complete cure of children after one or several periods of the acute course, the management of patients differs somewhat from the therapy of the articular-visceral forms of YUHA. In these cases, it is necessary to try to remove activity with the use of NSAIDs and hormonal drugs, without resorting to immunosuppression methods. It may be justified to use increased doses of hormonal drugs (up to 4–5 mg / kg) in short courses according to an intermittent pattern.
In principle, similar approaches can be recommended and when drug therapy RA adults.
Of the methods of drug therapy, it is also necessary to stop the possibility of local use of drugs by directly introducing them into the joint cavity. Intra-articular administration of glucocorticoids is most common, hydrocortisone is more common (the drug is injected into large joints by 100–125 mg, on average, by 50–75 mg, into small ones by 25 mg, the interval depends on the effect, but less 5 days). Recently, it has been considered more effective to administer durant preparations of glucocorticoids, the best of which is Kenalog, at the rate of 10–20 mg per large joint. The benefits of the drug are associated with a long-lasting effect, which allows the interval between punctures to be increased to 2–8 weeks.A possible modification of local administration is the simultaneous use of glucocorticoids and cyclophosphane or gold preparations (chemical synovectomy). The local application of the preparations described above is usually used for mono-, oligoarthricular lesions.
An extremely important place in the treatment of UHA and RA belongs to the methods of physical rehabilitation. It is well known that the absence of active movements in the joints, and especially immobilization, very quickly leads to their functional impairments, which are subsequently extremely difficult to eliminate. Healing physical therapy and massage should be used from the first day of the patient’s stay in the hospital, despite the pain syndrome. The question is only in the amount of these procedures. When expressed pain contractures can be re
Intermittent immobilization with gypsum langet or plastic tires, used only in hours from breathing patient or at night, is recommended. As the local inflammatory phenomena subside, the pain reaction and contracture decrease, every 1-2 weeks a new splint (splint) is made at an even greater angle of painless extension. As the process subsides and the motor activity of the patient expands, physical therapy is carried out with stress and resistance. An integral part of the complex treatment and rehabilitation of patients is the use of physiotherapeutic procedures. The extent of these treatment methods largely depends on the capacity of the medical institution and the adherence of medical specialists to certain methods of exposure. Probably, two directions in the treatment of UHA and RA can be considered more correct. The first of these is associated with a decrease in the inflammatory response and relates primarily to the acute exudative phase of the locomotor system and the second, associated with the antiproliferative resorption effect of physiotherapy methods. In the active phase of articular lesions, such procedures as the UHF electric field, ultraviolet irradiation in erythemal doses can be recommended. Phenophoresis with hydrocortisone, analgin has well proven itself. Recently, the use of dimethyl sulfoxide (Dimexidum) has become widespread both independently, in the form of applications of a 50% solution, and in combination with analgin or hydrocortisone.
For resorptional therapy (mainly for subacute), the following may be recommended: thermal procedures (dry heat, paraffin, etc.), ultrasound therapy, phonophoresis with drugs that improve microcirculation (heparin, nicotinic acid, etc.), application of Dimexidum alone or: in combination with heparin.
There is no doubt that along with the above methods of treatment of UHA and RA, there are a number of others, but they are not generally accepted and the indications for their use have not yet been determined.