Clinical classification of rheumatism

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Analysis of case histories of patients treated in the clinic of the Institute of rheumatism AMS of the USSR the large number of patients (children and adults)who are active phase of rheumatoid arthritis, allowed to create a comprehensive clinical characteristics provided by the classification of the variants of the disease (table. 4).

Table 4. The main characteristics of the variants of flow rheumatism
For The time response of rheumatic fever Clinical features of
Sharp Clear, sometimes violent start, rapid growth and rapid regression of symptoms without the tendency to relapse. The cycle of development of clinical manifestations attack on terms not exceed 2-3 months Clinically usually expressed inflammatory lesions with a predominance of exudative component of inflammation, with a bright thermal response and laboratory activity. Tends to palindromes, migration of inflammatory changes involving joints, heart, serous membranes, other organs and tissues, relatively quick and complete effect Antirheumatic therapy
Subacute Bright or moderately expressed initial manifestations of the disease. Compared with the sharp version more stretched in time the development of clinical symptoms (duration of attack 3 to 6 months) with a tendency to acute rheumatic process Smaller than in the acute period, the severity, and the mobility of the clinical symptoms in the presence of the maximum, but most of moderate activity rheumatic process, less of a tendency to involve multiple agencies, is not clear and rapid effect Antirheumatic therapy. Exudative component of inflammation detected clinically less clearly
Continuously relapsing Onset is usually acute, often against the background of already formed valvular heart disease. In the following long-term (>6 months) wavy over to the presence of pronounced exacerbations and incomplete remission In the period of exacerbation typical bright inflammatory manifestations with severe exudative component, the tendency to palindromes often involving all heart membranes, serous membranes, lungs, kidneys and other organs, sometimes joints (as the initial manifestation of relapse), fever, high or moderate laboratory activity, incomplete effect Antirheumatic therapy. Often detected progressive lesions with increase of functional disorders, the occurrence of thromboembolic and other complications
Lingering The development of clinical symptoms usually gradual, can sometimes be detected pronounced initial manifestations of the disease, only in later evolving into a protracted process. The course of chronic, monotone, without a clear remissions. The duration of the attack more than 6 months Mainly moneydrake form of rheumatism. This is usually return (at least primary) rheumatic heart disease with torpid course. Weak expression, reduced the nature of the inflammatory reaction in patients with the common dystrophic changes. The activity of the rheumatic process often minimal, less moderate to low mobility of clinical, electrocardiographic, radiological symptoms. The effect Antirheumatic therapy is weak, unstable
Latent Initial clinical manifestations of the disease may appear only in some cases. In these cases, rheumatic process evolves into a chronic, clinically and laboratory revealed no form By diagnostic methods latent rheumatism simultaneously is not detected. The diagnosis is established retrospectively on the basis of formation or progression of valvular heart disease, as well as in the surgical treatment blemish on the basis of data histomorphologically research. By M. A. Skvortsov (1937), latent rheumatism different from other variants of the disease in the presence of only productive component of inflammation (rheumatoid granuloma) in the absence of nonspecific exudative reactions