Clinical classification of rheumatism

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Legitimate expectation that for rheumatism is largely determined by the state of immunological reactivity, primarily against Streptococcus. In this connection, of interest is held in the Institute of rheumatism AMS of the USSR the comparison of the results of immunological research, indicators of nonspecific resistance in patients with different variants of the illness. In particular, found that high titers of streptococcal antibodies (including antibodies to intracellular soluble antigen Streptococcus group A), undergoes during treatment distinct positive dynamics, the most frequently found in acute and subacute disease. On the contrary, in chronic cases, the response to antigenic stimulation was much weaker (IV2-2 times), and was notable for the slow dynamics. Along marked with quantitative and qualitative differences in immune reactions. So, first established that unlike acute options with typical dominated the clinical picture of hypersensitivity reactions immediate type for chronic forms of rheumatic heart disease is more common manifestations of delayed Allergy and autoimmune processes. It is shown, for example, that the frequency detection as myocardial and connective tissue antibodies most high long and continuous recurrent course of rheumatism. The same direction was the results of a study of cross-reactive antigens Streptococcus cardiac antibodies determined by the method of indirect immunofluorescence on Zabriskie. Most constantly be detected in the long course of the disease and were not characteristic for its sharp options.
The predominant occurrence of autoimmune reactions in individuals with chronic rheumatic carditis, morphologically characterized by the marked dystrophic changes in the heart muscle, is consistent with observations, confirming the necessity of a number of conditions, including deep enough prior tissue damage, for the occurrence of autoimmune disorders. From this perspective, special attention is drawn to research that points to the inadequacy of protective mechanisms and due to it the big intensity of destructive processes in tissues in patients of this group.
The results of the study suggest that in patients with chronic rheumatism, together with the more pronounced than in acute options, and the potential for disease progression with signs of increasing myocardial degeneration, disability inflammatory reactions is the relative lack protiwastmaticescoe immunity, accompanied by the growth of autoimmune processes in relation to the tissues of the heart and connective tissue.
To find out the inadequacy of protective mechanisms can play a role violations of regulatory functions of the nervous, endocrine and enzyme systems. Found that one of the reasons peculiar to long and continuous retidiviruuschem to rheumatic heart disease violations of phagocytic activity of leukocytes is the change in the metabolism of these cells in the form of pronounced and sustained decline in activity of acid proteases. The violation of enzyme functions with a predominance of catabolic dystrophic processes in these cases of recurrent rheumatic point and other studies. It is established that decrease nonspecific resistance in chronic forms of the disease manifests itself in the inhibition of biosynthesis performs a protective function glycoproteins, lack of activation of the pentose-phosphate pathway of carbohydrate metabolism, decrease in plasma native RNA. In turn, the prevalence of destructive processes in patients with chronic rheumatism was pointing to the high activity of acid lysosomal hydrolases origin, rise of native DNA in blood plasma, increased concentration hydroxyproline and glycosaminoglycans in urine (C. A. Nasonova and others, 1973, 1975).