Compulsory medical insurance (CHI) on the territory of Russia is legally available to all citizens of the 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.

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, we can assume that you have recommendations for therapy (drug therapy, dietary correction, lifestyle, movement patterns, etc.). 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:

There is no rheumatologist in our district clinic, and 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.

A rheumatologist is a specialist who deals with diseases of an inflammatory and dystrophic nature. These pathologies affect joints and connective tissues. The Greek word rheuma, from which the specialty's name comes, literally means "substance that flows." This means that it is the joint fluid that causes certain inflammatory joint diseases.

What do rheumatologists do?

A rheumatologist deals with absolutely all inflammatory pathologies of the joints. Doctors in this specialty are involved in the prevention, diagnosis and treatment of diseases affecting:

• musculoskeletal system,
• heart,
• connective tissues (in this case, pathologies are called systemic),
• joints.

The category of rheumatic pathologies includes more than 100 very diverse diseases that a rheumatologist in Moscow deals with. They manifest themselves in inflammatory lesions:

• joints,
• spine,
• bones,
• muscles.

The most common diseases encountered by rheumatologists in Moscow are:

• osteoporosis,
• osteoarthritis or osteoarthritis,
• systemic lupus erythematosus,
• spondyloarthropathy,
• fibromyalgia,
• rheumatoid arthritis,
• gout, etc.

Two thirds of patients become disabled as a result of such diseases. Restriction in movement also leads to a loss of mental balance, so rheumatologists in Moscow often have to deal with completely lost people whose work and family life are collapsing. All this occurs against the background of constant pain during exacerbations of pathologies or chronic diseases.

What symptoms are referred to rheumatologists?

The main indications for visiting a rheumatologist are frequent sore throats and infectious diseases. It is especially important to see a specialist in Moscow if you have a hereditary history of joint diseases. You should definitely be examined by a rheumatologist if you experience:

• pain in the joints, neck, lower back;
• stiffness upon awakening;
• swelling in the joint area;
• crunching sound when moving;
• changes in joint configuration;
• repeated symptoms;
• chronic limitation of movement and so on.

In addition to general tests, rheumatologists in Moscow send patients for examination using radiography. Other diagnostic methods are also used, such as:

• densitometry, etc.

How to become a rheumatologist?

On a functional basis, the Department of Rheumatology of the FPDO is part of the MGMSU NUPC “Diseases of the Joints and Spine”. In addition, they offer training in the departments of rheumatology of such large metropolitan medical institutions as:

• MONIKI,
• RNIMU named after. N. I. Pirogova,
• RUDN University,
• MMA im. I. M. Sechenova,
• Institute of Traumatology and Orthopedics named after. N. N. Priorova,
• FPPOV First Moscow State Medical University named after. Sechenov,
• Institute GUN TsNIITO im. Priorov and other universities in Moscow.

Famous Moscow specialists

Scientists discovered the first traces of rheumatoid arthritis on the remains of Indian skeletons dating back to 4500 BC. e. The skeletons were discovered in Tennessee (USA), and the first handwritten document that contained a description of symptoms reminiscent of this disease dates back to the year 123. It was only in 1800 that Augustine-Jacob Landre-Beauvais gave the first clinical description of this pathology.

Russian scientists and doctors took an active part in the development of rheumatology. At the end of the 19th century, the Russian doctor Bekhterev, together with the French Strumpell and Pierre Marie, described ankylosing spondylitis. In 1908, Tregubov was the first to introduce oxygen into the cavity of a patient’s joint affected by tuberculosis. Doctor Sokolov began using oxygen administration for preventive purposes in the fight against post-traumatic joint contracture. Vessel, Baykulova and many others made a huge contribution to this direction.

If a patient is concerned about joints and musculoskeletal structures, it is advisable for him to consult a rheumatologist. Diagnostics will show the correct path for treating vasculitis, systemic lupus erythematosus, rheumatoid arthritis, rheumatism, muscle problems (including acquired heart disease) and connective tissues.

Primary is needed in case of severe swelling and pain in the joints of the legs, with an increase in body temperature for an unknown reason, with a change in skin color and increased goiter of the arms or legs, with the formation of subcutaneous nodes or “networks” on the surface of the skin. At the reception, the specialist examines the patient who has sought help. The rheumatologist is obliged to ask about his lifestyle, habits, previous illnesses, genetic pathologies and the presence of allergies. A highly specialized specialist will review the results of previous analyzes of the medical record. After analyzing the information received, the doctor will prescribe additional diagnostics and consultations with additional specialists.

As a rule, a rheumatologist is contacted if there is a suspicion of a rheumatic pathology or to prescribe or supplement the prescribed course of treatment. During the appointment, the specialist talks and examines the patient, draws up an individual technique taking into account the characteristics of the body and the results of laboratory and instrumental examinations. The attending physician will constantly keep his finger on the pulse in the management of each patient - adjusting treatment in time if necessary.

If your plans include a primary one, you should prepare for it in advance:

• donate blood for general laboratory analysis and other biochemical tests;
• submit urine for general analysis;
• undergo an ECG procedure;
• take x-rays of the affected joints.

Going to a rheumatologist is sometimes a real problem for elderly patients or for patients with musculoskeletal problems who, due to their health condition, cannot come to an appointment with a specialist at the clinic on their own. The capital's medical centers offer a relevant service for the population - a rheumatologist visiting a patient's home. Every year, joint diseases become younger, so not only older people, but also young people and able-bodied people of mature age require the help of this specialist. Increasingly, mothers bring their babies and their teenage children to a pediatric rheumatologist.

Indications for consultation with a rheumatologist

Modern medicine knows more than two hundred ailments associated with disorders of the joints and systemic disorders of the connective tissues of the musculoskeletal segments of the body.

For patients who feel restriction in the movements of the joints or spine, loud crunching of bones, swelling of the extremities, arthralgia, the appearance of subcutaneous nodes and a sharp change in skin tone, you should immediately consult a rheumatologist.

The specialist will study the medical history and diagnose the most considered diseases in his practice. Check the body for:

• arthritis caused by psoriasis or rheumatism;
• gout;
• deforming osteoarthritis;
• classical rheumatism;
• spondyloarthritis;
• systemic vasculitis;
• rheumatic lesions of soft connective tissues;
• Raynaud's, Reiter's, Sharp syndromes;
• diseases of the diffuse type that affect the connective tissue (SLE, dermatomysitis, scleroderma).

Dispensary registration of a patient who has been diagnosed with the above diseases guarantees frequent visits to a rheumatologist. The complexity of treating rheumatic diseases depends on the degree of metabolic problems, the number of inflammatory foci and degenerative changes in the spine and joints. Sometimes irreversible restructuring becomes an obstacle to the return of the body's former motor abilities. To avoid disability, try to promptly contact and undergo an examination of the musculoskeletal system by an experienced rheumatologist. Any changes in the functionality of the spine and limbs should not go unnoticed by a specialist.

Consultation: from accurate diagnosis to effective treatment

Primary will help you understand the true nature of your health complaints. Perhaps your relatives also suffered from similar illnesses and you will need a preventive course to “scare off” the disease. Rheumatic diseases are often caused by other diseases and bad habits. The doctor will advise you on how to change your usual lifestyle so as not to harm your body anymore.

The rheumatologist will draw up instructions for further treatment actions: from hardware and laboratory diagnostics to invasive procedures. Already at the first consultation, the specialist will express his concerns about the presence of a specific pathology. Prescribed blood tests will help clarify:

• to identify a rheumatoid cause;
• on DRR;
• on the amount of antibodies;
• on the concentration of immunoglobulins;
• to study complement levels.

You will also be recommended x-ray and ultrasound examination of diseased joints and skeletal bones. For a complete picture, you will need a CT scan of the joints of the limbs, scintigraphy, echocardiography, ECG and even a diagnostic puncture with biopsy and arthroscopy.

Rheumatic diseases are most often accompanied by involvement of internal organs, so prepare to visit other doctors:

• orthopedist;
• cardiologist;
• gynecologist;
• urologist;
• gastroenterologist;
• neurologist;
• endocrinologist;
• dermatologist.

After the nosological conclusion, the rheumatologist will prescribe detailed instructions for therapeutic therapy to the patient. Treatment of rheumatological diseases may require the use of various pharmacological medications, drugs for injection into joints, medications for various types of blockades (periarticular and para-arterial), general and local therapy.

The patient may also need extracorporeal hemocorrective procedures (including cascade filtration of blood plasma, photopheresis, plasmapheresis, and others) and local irradiation of diseased joints. If there is no relief and the joints continue to suffer from irreversible changes in bone and muscle tissue, the rheumatologist will consider the need for surgical intervention - a more radical technique.

At an appointment with a specialist, the patient learns in detail about the correct behavior for diseases of this type: the need to exclude causes that aggravate the development of the disease. The patient will have to limit himself from stressful experiences, cure infectious diseases, quit smoking and ensure that the limbs are always warm (to eliminate the risk of hypothermia). The patient needs to control his weight and perform a set of physical therapy exercises. The rheumatologist will select the optimal orthopedic accessories for the patient to prevent or correct problem areas of the joints and spine (splints, splints, corsets, arch supports, orthopedic shoes), and will issue a referral for treatment at a sanatorium.

A timely examination with consultation from a rheumatologist will preserve your physical strength, ability to work, social activity and a full life.

Consultation with a rheumatologist

Primary appointment (examination, consultation) with a rheumatologist

Repeated appointment (examination, consultation) with a rheumatologist

Exactly at the age of 15, my first period came. Immediately irregular, with a tendency to delay (the cycle varied from 21 to 60 days, a couple of times it was up to 100 days). Since my youth I had acne, very tall height, thinness (mother is 175 cm tall and tends to be overweight, father is 190 cm thin). At the age of 16-17, she underwent examination due to mitral valve prolapse. They referred me to various doctors, including a gynecologist and an endocrinologist. According to ultrasound at that time, multifollicular ovaries; according to tests, testosterone, DHEA-S, and 17-OH were increased. The gynecologist prescribed Dexamethasone 0.5 daily, the endocrinologist agreed with the prescription. Six months later, hormones were normal with Dexamethasone, but the cycle remained irregular (from 21 to about 50 days, but without a record delay of 100 days). The face gradually cleared up, but the skin and hair remained oily (my mother, with her ideal cycle of 28 days, also has oily skin and hair). Next, you are offered the choice of either OK, or continue taking Dexamethasone. Since I was still young (17-18 years old), I continued to take Dexamethasone 0.5, 1 tablet daily for about 4 years. The cycle remained irregular, ranging from 21 to about 50 days. There were no or very few rashes, the oiliness of the skin and hair remained, did not get better or lose weight. At the age of 21, she began to be sexually active and switched to Rigevidon. Took years recently, i.e. about 7-8 years. I took 2-3 breaks from taking it for up to six months. During this period after discontinuation, the cycle was always long, up to 50 days. When taking tests after discontinuing OCs and WITHOUT taking Dexamethasone, hormone tests were normal, except for progesterone, which I took like everyone else on day 21, with a cycle of 50 days. Progesterone was reduced. I took a break in 2017: the first cycle was 44 days, ovulation on the 32nd day according to ultrasound, the second cycle - 34 days, ovulation on the 20th day according to ultrasound, the third cycle - 42 days, ovulation presumably on the 30th day according to BT measurements, the fourth cycle - I took hormones of the first phase and those that can be taken on any day - everything is within the normal range, progesterone was reduced on day 21, according to ultrasound, multifollicular ovaries, a corpus luteum cyst is in question, on day 45 I took Duphaston for 10 days, after the arrival of menstruation I started taking Regividon again. Now, after two more years of taking the OC, I stopped it again for pregnancy. And ALWAYS, when consulting with a gynecologist, if there is a delay in taking the OK, I am prescribed Duphaston and prescribed to drink it every month according to the 17-26 scheme “to start my cycle” and “due to low progesterone.” When I say that I have been diagnosed with “AGS erased form,” they shrug their shoulders. An ultrasound does not diagnose PCOS, since the ovaries are not enlarged. Question: how to diagnose 100% AGS or VDC? Is it possible that due to age, hormones have returned to normal and there is no such diagnosis? Or did this norm turn out to be an accident? Is it possible and necessary to take Duphaston or its analogues during AGS? Is it possible to donate blood for hormones during menstruation if Duphaston is discontinued? And where to go and where to start if the cycle is very long and irregular and it’s difficult to find days for the necessary examinations? (((Thanks for the answer?