Clinical classification of rheumatism

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Despite the lack of tochnosti concepts, selection of three degrees activity was a serious impetus for further in-depth study of clinical and pathogenetic aspects of the disease and proved fruitful for further progress of rheumatology as a whole. Establishing the degree of activity was an important criterion for the individualization of therapy, assess their effectiveness, identify disability of the patient, to develop a differentiated approach to medical and sanatorium treatment.
Clinical and laboratory characteristics highlighted in the classification of degrees of activity of rheumatic process is presented in table 3.
As it is seen from table. 3, III (maximum), the degree of activity of rheumatic fever is characterized by the most striking clinical and laboratory manifestations of the disease caused severe exudative (non-specific) component of connective tissue inflammation in the joints, heart, and other organs. This clinically detected symptoms of acute arthritis, diffuse myocarditis, pancarditis, serositis different localization, clear electrocardiographic symptoms of chronic inflammatory lesions, acute-phase high and laboratory indicators of inflammation, high titers protiwastmaticescoe antibodies. Morphologically revealed palindromes rheumatic lesions in the area of primary localization common exudative inflammation with severe edema and disorganization of the connective tissue swelling, pyroninophilia, proliferation of endothelial endocardial and blood vessels.

Table 3. Clinical and laboratory characteristics of degrees of activity of rheumatic process
The degree of activity Clinical criteria Electrocardiographic, phonocardiographic and x-ray symptoms Laboratory indices
III (maximum) Bright General and local manifestations of the disease to the presence of fever, a predominance of exudative component of inflammation in the affected organs (acute arthritis, diffuse myocarditis, pancarditis, serosity, rheumatic pneumonia and other). Found different severity exudative inflammation with one or the other predominant localization Depending on preferential localization of rheumatic process can be detected bright, moderate or weak symptoms inflammation of the membranes of the heart, lungs, pleura High rates of inflammatory and immunological activity. In the blood, usually neutrophilic leucocytosis, ESR 40 mm per hour and up, C-reactive protein 3-4 plus a corresponding increase in the level of fibrinogen, seromucoid, hexoses, indicator DFA-reaction, the content of the A2-globulin. High titers SLA, VDR, AU
II (moderate) Moderate clinical symptoms of rheumatic fever with moderate fever or without it, without the Express exudative component of inflammation in the affected organs, less than in the III degrees of activity, the tendency to a multiple of their involvement in the inflammatory process Symptoms, reflects the presence of pericardial pericarditis, acute diffuse myocarditis, pleurisy, no. ECG, FCG and x-ray signs of carditis expressed moderately or poorly depending on preferential localization inflammatory lesions of organs) Acute-phase laboratory signs of activity of rheumatic processes moderate. The same applies to the indicators protiwastmaticescoe immunity. Leukocytosis, may be missing, ESR 20-40 mm per hour. Accordingly moderately increased and other laboratory findings
I (minimal) Clinical symptoms of active rheumatoid process is weak, sometimes hardly detectable. There are almost no signs of exudative component of inflammation in tissues and organs. Mainly monocistronic the nature of the inflammatory lesions Symptoms of inflammatory lesions of the heart, including the dynamics of ECG, FCG and x-ray changes, expressed weakly. There is no indication exudative inflammation in the lungs and serosa Laboratory symptoms, reflecting the activity of rheumatic process, the state of immunological reactivity of the organism, or not deviate from the normal or minimally elevated