Indicators three degrees of activity of rheumatic process

I. Rheumatism (rheumatic heart disease) with a maximum activity (the activity of III degree; synonym acute rheumatism, continuously recurrent). A. Clinical symptomatology (syndrome):
a) pancarditis;
b) acute or subacute diffuse myocarditis;
C) sub-acute rheumatic carditis with severe circulatory insufficiency, stubbornly resistant to treatment;
g) subacute or continuous recurrent rheumatic heart disease in combination with symptoms of acute or subacute polyarthritis, pleurisy, peritonitis, rheumatic pneumonia, nephritis, hepatitis, subcutaneous rheumatic nodules, erythema annulare;
d) horei with severe manifestations of activity.
B. the Growing increase in the size of the heart, lowering of the myocardium contractile function, pleuropericardial adhesions (according to the data of x-ray examination), subject to the reverse development under the influence of active Antirheumatic therapy.
Century Clear electrocardiographic symptoms (violations of rhythm and conduction), characterized by an explicit dynamics and reverse development under the influence of treatment.
, Changes in blood system: neutrophilic leucocytosis is above 10 000; ROE - above 30 mm; C-reactive protein - 3-4 plus and above; fibrinogene - higher than 0,9-1,0%; Alfa-two-globulins is above 17%; gamma-globulin - 23-25%; seromucoid blood - above 0,8-2,0%; DFA (difenilamina sample) - above 0,350-0,500.
D. Serological indicators: credits antistreptolysine-0 (asle-0), antistreptokinase (VDR), antistreptokinase above the norm by 2-3 times.
E. Increased capillary permeability of II-III degree (if there is no other possible causes for this).
II. Rheumatism (rheumatic heart disease) with moderate activity (the activity of the II degree; synonym rheumatism subacute)
A. Clinical symptomatology (syndrome):
a) sub-acute rheumatic carditis in combination with circulatory I, I-II degree, slowly treatable;
b) subacute or continuous recurrent rheumatic heart disease in combination with will podostram polyarthritis, fibrinous pleurisy, peritonitis, jade, erythema annulare;
in) subacute polyarthritis;
g) rheumatic horei.
B. Radiographically installed increase in the size of the heart, pleuropericardial spikes exposed to the opposite development under the influence of active Antirheumatic therapy.
B. Electrocardiographic symptoms (lengthening of the interval, P - Q, rhythm disturbance), the symptoms of coronaria, disorders of coronary circulation, characterized by dynamism and disappearance under the influence Antirheumatic therapy.
, Changes in blood system: neutrophilic leucocytosis within 8 000-10 000; acceleration ROE in the range of 20-30 mm; C-reactive protein - 1-3 plus; increased globulins in the range of 11.5-16% for Alfa-two-globulins and 21-23% for gamma-globulin; DFA - within 0,250-0,300; seromucoid - within 0,3-0,8%
D. Serological tests: increased titers of streptococcal antibodies, primarily SLA-0 and the LRA, in 1,5-2 times versus the norm.
E. Increased capillary permeability of the II degree (if there is no other possible causes of this).
III. Rheumatism with minimal activity (the activity of the I degree)
A. Clinical symptoms:
a) satino-sluggish current or latent rheumatism (rheumatic heart disease) with preserved or reduced work capacity; with recurrent rheumatic heart disease in the background of previously developed heart disease may be blood circulation insufficiency of the different degree, as a rule, difficult active cardiac therapy;
b) satino-sluggish or latent rheumatic heart disease in combination with rheumatic chorea, encephalitis, vasculitis, moreover, subcutaneous rheumatic nodules, erythema annulare, persistent artralgia;
in) rheumatic horei.
B. Radiographically in primary outpatient rheumatic heart disease is normal or slightly increased the size of the heart; pleuropericardial adhesions, difficult subject reverse development under the influence of active Antirheumatic therapy. In recurrent revmocardit against the background of developing heart disease x-ray picture may be different, but, as a rule, extension and change of configuration of the cardiac shadow, sometimes with pleuropericardial spikes, which, although with difficulty, but amenable to reduction under the influence of active therapy.
B. On the ECG can be found too cardiosclerosis (postmyocardial), coronaria and violations of coronary circulation; various types of arrhythmias, which are difficult Antirheumatic therapy. Electrocardiographic symptoms are usually not eloquent, but stubborn in the sense of dynamics when conducting Antirheumatic treatment.
, Changes in blood system usually small and uncertain: ROE or slightly faster (if not circulatory failure), or normal, or even slowed down (circulatory failure); C-reactive protein or missing, or is found within one plus; the number globulin fractions (mainly gamma globulin) slightly increased or within high standards; DFA within high standards; seromucoid in normal or reduced.
D. Serological indicators or within a high rate, or slightly raised. Important dynamics of these indicators in the course of the disease and regardless of intercurrent infections. Low titers streptococcal antibodies may be associated with suppression (depletion) immunological reactivity and do not reflect the true state. Periodic increases titles, the more gradual increase of credits in the absence of infection, can serve as an indirect confirmation of the activity of rheumatic process.


E. Increased capillary permeability within the I degree (if there is no other possible causes for this).
These figures represent a synthesis of clinical-anatomic characteristics or symptoms of the disease, data of x-ray, ECG, phonocardiographic examination of the patient, conventional studies of blood, biochemical and serological studies and determination of capillary permeability. Dominant in the determination of the activity is recognized clinical-anatomical characteristics of the disease and its dynamics in the process of medical observation and treatment. Indicators of activity of rheumatic fever should not be considered as a kind of mathematical formula that gives unconditionally exact solution of this complex, mainly clinical tasks. The proposed scheme poses a doctor essentially the same tasks as the classification of the stages of circulatory failure by N. D. Strazhesko and C. X. Vasilenko. Especially difficult task stands before the physician in determining the nature of the process in rheumatoid arthritis with minimal activity, such as recurrent latent rheumatic heart disease with heart failure. A key to achieving the objective of these conditions should recognize thorough analysis and synthesis of the results of the dynamic study of the entire clinical picture of the disease and all laboratory of its indicators.
As for the diagnosis of rheumatic fever, there can be helpful, according to European and American specialists, diagnostic criteria Jelly-Jones (D. Jones, 1944) with some additions. (Criteria 6 and 7 in the main and 6 and 7 in the proposed A. I. Nesterov).
Criteria Jelly - Jones. I. Basic: 1) carditis; 2) polyarthritis; 3) chorea; 4) noduli rheumatici; 5) erythema annulare; 6) "rheumatic history"; 7) proof ex juvantibus.
II. Additional: 1) fever; 2) artralgia (not arthritis!); 3) leucocytosis; 4) lengthening of the interval P - Q; 5) the preceding streptococcal infection;
6) serological and biochemical indices of blood; 7) the increased capillary permeability; 8) other symptoms (fatigue, nasal bleeding, abdominal pain - abdominal syndrome and others).
For reliable nosological diagnosis of rheumatoid arthritis need a combination of 2-3 main and several additional criteria Jelly - Jones. However, considering possible to use in practical work with the modified criteria Jelly - Jones, it should be emphasized that this scheme, though it is recognized as a solid basis for the diagnosis of rheumatic fever, is still only scheme which cannot take into account all variety of clinical manifestations of this disease and therefore can not replace clinical thinking and experience of the doctor. Because she is regarded only as a valuable diagnostic tool, helping the doctor purposefully to summarize the most important manifestations of the disease.