Clinical classification of rheumatism

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Clinical and temporal characteristics of individual variants of flow rheumatism help identify significant differences in the state of reactivity of the relevant groups of patients, in determining which plays an important role bought, apparently, and constitutional qualities protective and compensatory organism systems. Thus, according to the clinic of the Institute of rheumatism AMS of the USSR, women suffer from rheumatism more often than men, acute options characterized predominantly young age and prevail in males. A comparison of primary and recurrent rheumatic fever has allowed to establish that the potential for recurrence, prolonged course of the disease more characteristic of women. This is determined by their significant prevalence in the group of patients with recurrent rheumatic fever (a ratio of 1 : 5 during return and 1 : 1,3 in primary).
Undoubtedly, it is also about specific pathogenetic differences. At the Institute of rheumatism AMS of the USSR in the clinical and morphological studies (I. Century sparrows and others, 1965; Century, Orlovskaya, I. Century Vorobiev, 1967; N. N. Gritsman, 1971, 1973) found that a typical acute and continuous retidiviruuschem the flow of rheumatism maximum clinical activity is detected a number of characteristic morphological traits. To them we should refer tendency to multiple involvement in the process of shells and heart valve with development of acute exudative myocarditis, pericarditis, valvulitis. Show marked and widespread manifestations of non-specific exudative inflammatory component of inflammation and disorganization of the connective tissue, accompanied by a sharp swelling stroma attack, swelling, pyroninophilia, proliferation of endothelial endocardial and vessels, vasculitis. This identifies signs of high functional activity as cell ashoff-talalaevsky granulomas, and unrelated cellular components of the connective tissue. Myocardial damage often manifests itself only moderate dystrophy. In contrast, the trend towards multiple simultaneous involvement in the process of shells and heart valve disappears when characterized by moderate or minimal clinical activity protracted period of rheumatic process. Nonspecific exudative component of inflammation, phenomena muhidnova and fibrinoidnogo swelling are not found only a small number of mostly involutive form ashoff-talalaevsky granulomas. In this clinical group, along with weak intensity of the inflammatory reaction important clinical significance of deep circulation disorders, degenerative changes in muscle fibers until the occurrence necrobiosis and MOLISA. According to Mr.. N. Grisman (1973), developing acute, such metabolic necrosis may play a significant role in the mechanism of the lethality of the disease.
Clinical symptoms of rheumatism suggests that there are two types of rheumatic inflammation in the heart muscle when different variants of flow and a variety of disease activity characterize themselves and others of its localization. So typical of acute, subacute and continuously-retidiviruuschem for the rheumatic process pronounced and widespread exudative component of inflammation clearly prevails not only when pancarditis, but when polyarthritis, different localization of zeroith, acute rheumatic lesions parenchymatous organs, skin, nervous and vascular systems. Functional disorders significant, but because of the lack of apparent dystrophy they bystroprokhodaschee. On the contrary, in protracted and latent variants with different localization process characterized by deficient, sluggish during inflammatory reactions involving more pronounced and persistent dystrophic component in the tissues of the affected organs.