Rheumatism

In the section on modern level presents basic information on the etiology, pathogenesis, clinic and treatment of rheumatism. Great attention is paid to the modern classification of diseases, highlighting the degree of activity of rheumatic process. For the first time presents the clinical-laboratory ground variants of flow rheumatism, with the latest characterized the main clinical forms of the disease, as well as a differentiated approach to treatment and preventive measures. The principles syndromic diagnosis in rheumatology. Discussed the current treatment Antirheumatic means and prophylaxis of rheumatic fever, see a detailed analysis adopted in the USSR the system of staging treatment of disease.
Designed for physicians.

Table of contents

Chapter I. The etiology and pathogenesis of rheumatic fever
Chapter II. Clinical pathomorphology
Chapter III. Clinical classification
Chapter IV. Clinic for rheumatism
   General rheumatism syndrome
   Rheumatic polyarthritis
   Rheumatic carditis
   Rheumatoid arthritis of the lungs and pleura
   Kidney rheumatism
   The abdominal organs, rheumatism
   Rheumatism of the nervous system
   Rheumatism, skin and subcutaneous connective tissue
Chapter V. Diagnostic criteria
Chapter VI. Treatment and prevention
   Etiotropic therapy
   Anti-inflammatory therapy
   Adverse reactions when conducting Antirheumatic therapy
   The system of staging treatment of rheumatism
   Prevention
Literature

Rheumatism relates to the same group of internal diseases, treatment and prevention which marked significant progress, accompanied by a widespread decline in primary morbidity, mortality, and lengthening of active longevity.
However, it would be a mistake to think that the problem of struggle against rheumatism lost General medical value, and rheumatism no interest to the scientific and practical cardio-rheumatology. First of all remains actual tactics control streptococcal infection, the lack of which can lead again to the primary outbreaks of acute rheumatism, observed rarely and now in the so-called closed groups.
Changing clinical picture of rheumatism: much more often began to be observed low manifestation of the clinical form of the disease, early detection are often very difficult. Again attracted attention to the problem of latent rheumatism extensive epidemiological studies have revealed a large number of persons with established without history of rheumatic heart disease, as well as the progress of cardiac surgery, which allows to detect latent rheumatism when histomorphological research on remote operations ears of the heart. Changing the appearance of clinical and laboratory signs of the illness made it necessary to improve methods of diagnostics and detection of rheumatic activity, searches the most informative laboratory tests. These questions in modern rheumatology be resolved through in-depth study of streptococcal infections and reactivity protective systems sick person, including immune, identify the forms of implementation of family-genetic predisposition to rheumatism.
In the modern view rheumatism - systemic inflammatory disease of connective tissue with predominant localization process in the cardiovascular system, developing in predisposed to it persons, mainly young age (7-15 years), due to infection β gemoliticeski streptococcal group A.
This definition reflects the multifaceted problems of rheumatism in medicine. First, a close relationship with streptococcal infection, which allows to consider the kind of rheumatism clinical option streptococcal infection (A. I. Nesterov, 1973). Secondly, system affection of connective tissue, not banal infectious and immune (allergic inflammation; development of autoimmune phenomena in chronic variants of flow (prolonged and continuous recurrent) determine rheumatism as a disease from a group of inflammatory along with diffuse disease connective tissue, rheumatoid arthritis and other related arthritis (disease of connective tissue with immune disorders, A. I. Strukova). Third, the outcomes of rheumatic heart disease in cardiosclerosis and rheumatic valvulitis in the heart bring rheumatism with cardiology, especially in terms of learning and correction of hemodynamic disturbances, problems of heart failure and arrhythmias. And, finally, the development of systemic vasculitis, first of all cerebral (neurotraumatism), makes the disease is a neurological problem. All this allows to include rheumatism in the category of diseases having a General medical value, requiring an integrated approach to further his study of fundamental and applied questions.
So, what is the place of rheumatism in modern medicine? It is still not precisely determined, despite sufficient certainty etiology and pathogenesis, which is the basis for rational science-based classifications.
According to the working classification of diseases of joints and cartilage tissues of the musculoskeletal apparatus, discussed at the all-Union Congress of rheumatologists (January, 1971), rheumatic fever is the basic forms of diseases of joints and spine, namely to arthritis. On the other hand, in accordance with the Statistical classification of diseases and causes of death (VIII revision, 1966), rheumatism and acquired heart diseases belong to the class of diseases of the cardiovascular system. Neither the first classification nor the second does not suggest that currently, rheumatism found appropriate essence of this pathology place.
Popular a few years ago the concept of collagen diseases, to which he was assigned and rheumatism (A. I. Nesterov, I. A. Sigidin, 1966), more than others reflected the true place of rheumatism in pathology, and doctors still there is an opinion about rheumatism as collagen diseases (collagenosis). However, collagen disease is now the concept of only historical, from this terminology is refused and the author of it, Klemperer, when it became obvious that the pathological process at "collagen diseases" applies to all components of the connective tissue, not only of collagen fibers. In recent years the term "collagen disease is more widespread was the concept of diffuse disease connective tissue". This group of diseases related systemic lupus erythematosus, systemic scleroderma, dermatomyositis and syndrome Shegrena; A. I. Strukov (1975) proposed to call this group of diseases diseases of connective tissue with immune disorders. Note several important factors related to changes in the epidemiology of rheumatic fever in recent years: it is primarily a reduction in the incidence of acute primary rheumatism, stabilization of distribution and constant decrease mortality from rheumatic heart disease.
According to Y. A. Goryaeva et al. (1977), reflecting the dynamic monitoring of the chosen population, from 1961 to 1969, the prevalence of rheumatic fever decreased from 37.4± 1,54 to 32.5±1.47 per 1000 population.. on 1000 population primary morbidity of acute rheumatism decreased in 2 times - from 0.77 to 0.36, and with the inclusion of low manifestation forms - from 1.5 to 0.98. Significantly reduced the number of patients with newly diagnosed rheumatoid arthritis - with 35-56 to 8.7-19,2%. Decreased number of persons with active rheumatoid arthritis - from 38.2 of + 2 to 14.6±1.5%, the authors connected with the effectiveness of prophylactic medical examination of all patients with rheumatism. No less convincing and data, S. Kozlov et al. (1977) on reduction of mortality from rheumatism in Yaroslavl - from 2.6% in 1968 to 1.6% in 1974, the same authors draw attention to the significant increase in the mean age of the dead: in 1960-1964, it reached 44,6 year, and in 1974 - 52.
At the Institute of rheumatism AMS of the USSR spend study (I. P. Annenkov and others, 1977) primary sickness rate in some Moscow districts. We found a decrease it in the period from 1970 to 1975 0.11 0.05, and among children - from 0.7 to 0.22 per 1,000 population.
Therefore, objectively assessing the success in the fight against rheumatism, it should be emphasized that in recent years has been some decline in primary incidence, prevalence and mortality from rheumatism, finds its confirmation in raising the age suffering from rheumatic heart diseases and in stabilizing the number of defects.
Methods and forms of struggle against rheumatism in our country was not formed at once, although primarily related to General social transformations that have taken place over 60 years of Soviet power, and with deep theoretical research in this area.
It must be emphasized that the theoretical and practical concept of the doctrine of rheumatism were formed over many years. Known for its great contribution to the creation of the doctrine of rheumatism, I. Sokolsky and Воuillaud, S. P. Botkin, and I. Zakharyin, Ashoff, B. I. talalaeva and M. A. Skvortsova, and in our days, A. I. Nesterov and A. I. Strukova and their numerous students.
S. P. Botkin was the first person in his lectures about acute articular rheumatism bound him with streptococcal infection, noticing frequent communication disease with scarlet fever, already drew attention to his appearance in families where there were other cases of rheumatism and heart disease. At the same time he noted the role of the environment in the development of the disease, believing that the person is in close relationship with the environment and in fact is part of it. The disease, according to C. P. Botkin, not that other, as a form of survival of man. Therefore, remembering S. P. Botkin, we would only like to emphasize that the present rheumatism etiologic link it with streptococcal infection, which is implemented in the rheumatism in special rheumatic predisposition to unconditional role massive streptococcal environment, adverse conditions of life, work, etc. and Hence future rheumatism treatment of streptococcal infections, specification of mechanisms of predisposition with allocation of risk factors, the improvement of the living environment.
For the past two decades clinic for rheumatism has undergone significant changes. Previously was a decrease sharp, manifest, forms and increased frequency, especially with the return revmocardit, chronic adversely current options is long and latent, at least - continuous-recurrent, when traditional diagnostic techniques uninformative, and classic anti-inflammatory and anti-infective therapy unable to significantly alter the current, and consequently, the forecast of illness. However, the change of clinical symptoms of rheumatism corresponds to the evolution of many infectious and infectious-allergic diseases with increased frequency low manifestation, as if primary chronic course. Apparently, not last role is played by the evolution of the organism, especially kokkov, under the influence of excessive and sometimes unwarranted use of antibiotics and sulfonamides with the development of resistance to the past or transformation into an L-shape under the influence first. In symbiosis microbe - people should not be underestimated changes reactivity of a person under the influence of constantly changing external environment.
Not surprisingly, the problem of modern rheumatism again diagnostics, and also development of such methods of treatment, which would allow not only to suppress inflammation, but also to stimulate the body's defenses.
Modern doctor has opportunities to actively fight this disease, as rheumatism. In-depth knowledge of the clinic of modern rheumatism, variants of its course, the ability to understand common and proper cardiac activity rheumatism can pick up an individual treatment complexes. No less important in essential change of prognosis of the disease have duration of treatment and the continuity of inpatient and outpatient care, the use of the sanatorium-resort treatment stage.
The task of the section is to acquaint the doctor with the most important achievements in the study of rheumatism, to equip it to further the fight against this insidious disease. The section describes current teaching of the etiology and pathogenesis of active rheumatism, the principles of its diagnosis, treatment and prevention. Special attention is paid to the differential diagnosis of major syndromes, diseases of rheumatic heart disease and arthritis. We are not concerned clinics and diagnostic formed heart disease as there is a book for practitioners in the series of "cardiovascular disease".