Ph.D. Khanov AG
Rheumatology is one of the dynamically developing therapeutic medicines now due to the emergence of a large group of pharmacological drugs, including GEBA (genetically engineered biological agents), which allows to carry out pathogenetic treatment. At the same time, in other brunches of therapeutic medicine, there are processes associated with the reorientation of therapeutic approaches to surgical ones (such as in cardiology). In this case, cardiology seems to become subordinate to cardiac surgery, when it is assigned to the selection of patients, preoperative preparation and postoperative rehabilitation. In other branches of medicine (neurology), there are no specific drugs though there are excellent topical diagnostic capabilities, even with a physical examination. Simultaneously, the diagnostic search of the neurologist is cuffed by the orientation on CT and MRT data. Nephrology is in a “difficult” situation, having now the possiblity to “transfer” patients to chronic hemodialysis, if a certain stage of CRF (chronic renal failure) is reached. In gastroenterology, the antiviral therapy is developing more rapidly, with a “modest” percentage of genetic engineering therapy. Pulmonology is traditionally focused on antibacterial therapy. Allergology is improving, while the immunological examinations are becoming more expensive, their results are difficult to correct with a modern set of medicines. The achievements of conservative treatment of a number of diseases in hematology are impressive, but if pathology is serious, doctors are striving for bone marrow transplantation if the state or a patient can afford it. In endocrinology, a breakthrough in conservative treatment of diabetes is expected, while there are difficulties in its routine diagnosis (according to epidemiological studies in our country, about 10 million patients have not been diagnosed yet). Alongside with the increase of life expectancy, the number of diabetic patients with chronic renal failure, cardiac complications, diabetic foot and amputations have increased, which are still considered to be endocrinologic. It is reasonable to send them to specialize doctors, when organ damage corrective therapy of violations of carbohydrate metabolism is already ineffective. Effective medicare is impossible without solving the problems of access to medical care in different parts of our vast country. It is clear that all patients do not need high-tech care. There are enough patients for general therapy. In the light of the latest trends in the division of nosological forms of diseases into complexity coefficients, the question arises, who and where will treat unprofitable diseases? A paradoxical situation is being developed in osteoporosis rheumatology. The arsenal of diagnostic means and treatment allows to defeat osteoporosis today, like it was done with rickets. A state program is needed for it, but at the moment it has not been started, soa low coefficient of complexity makes the osteoporosis patient unattractive for the hospital. At the same time, it is not noticed that the severity of the outcomes and consequences of osteoporosis requires much more medical expenses (orthopedic operations, prolonged care for “bed” patients).
The rheumatologic patient is difficult to cure. The point is not to support the patient with basic drugs, but to prepare him for medical care and avoid fatal complications. Rheumatic diseases are polysyndromic. A modern rheumatologic patient is comorbid. So, according to our data, the hospitalized patient has got 2.6 comorbidities on average. The index of comorbidity in RA is 4.6 per 1 male patient and 2.6 per 1 female patient. The lowest comorbidity index was observed with both M and F (1.8-2.0) for ReA. Cardiology pathology occupies a special place among concomitant diseases. Namely it makes the rheumatologist be in a “tonus” because of the danger of developing fast-flowing and fatal complications. For 3 years, we studied the concomitant pathology of rheumatologic patients during the treatment in the rheumatologic department of the hospital. There is a great percent of cardiologic pathology. Thus, 32.4% of women have the pathology of CVS (AH-17%, CHF -7.7%, CHD-5.8%, myocardiosclerosis 1.9%), 42.8% of men have the pathology of CVS (AH 16.1 %, CHF -12.2%, CHD -9.4%, atherosclerosis of the aorta-5.1%).
Rheumatology is a division of internal illnesses, which studies a group of diseases characterized by affection of connective tissue, internal organs and joints.
Cardiology is a division of internal illnesses that studies the etiology, pathogenesis and clinical manifestations of diseases of the cardiovascular system.
We propose the following definition of rheumatologic cardiology:
Rheumatologic cardiology (RC) is a section of rheumatology that studies the features of the cardiovascular system lesion in illnesses of the musculoskeletal system and connective tissue with the development of recommendations for the prevention and treatment of cardiac syndromes against the background of chronic inflammation of various species in rheumatic diseases.
It is clear that at this stage, the selection of the concept of rheumatologic cardiology is organizational, to highlight the features of treatment of CVS pathology in RC, as well as to develop “ready solutions” for typical clinical situations. Rheumatologic cardiology (RC) can become an independent section of medicine when decoding the role of inflammation in the pathology of CVS and the emergence of specific drugs.
An approximate set of topics for rheumatologic cardiology:
Differential treatment of heart defects with intracardiac hemodynamics.
Arterial hypertension in main rheumatologic diseases
Chronic heart failure in main rheumatologic diseases
Thrombosis and embolism in rheumatologic practice
Myocardial infarction in rheumatologic patients
Сoronary artery disease in rheumatologic patients
Chronic heart failure in rheumatologic patients
Myocarditis of rheumatologic patients
Myocardiosclerosis and myocardial dystrophy of rheumatologic patients
Lipidemic therapyfor rheumatologic diseases
Risk factors for fatal diseases and complications of rheumatologic patients
We invite authors to creative cooperation.