Clinical classification of rheumatism

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For centuries in the understanding of many physicians, the term "rheumatism" was a collective term to refer to the pathology of the musculoskeletal system. This is reflected in modern foreign terminology, such as French ("lupus rheumatoid arthritis", "sclerodermatitis rheumatism and others). In contrast, domestic rheumatic school with an inherent commitment to a holistic understanding of the disease strictly highlights from the group of rheumatic diseases true rheumatism (illness Sokolsky - Buyo), investing in this concept not only of acute episodes of acute rheumatic fever), but all the stages of the disease, with its tendency to relapse, the formation of valvular heart disease. An expression of this trend is, in particular, constant attention to the development and improvement of clinical classifications of rheumatism, which had always treated the priority tasks of the all-Union Antirheumatic Committee. Since 1934, the Committee had consistently approved four options classification of rheumatism, of which current (table. 2) adopted in December 1964, at the Symposium on operating the classification and nomenclature of rheumatism on the report of A. I. Nesterov.

Table 2. Classification and nomenclature of rheumatism
Phase of the disease Clinical-anatomical characteristics of the lesions The nature of the course The circulation
heart other systems and organs
Active Rheumatic heart disease primary without blemish valves Polyarthritis, serosity (pleurisy, peritonitis, abdominal syndrome) Acute, subacute H0
Activity I, II, III degree Rheumatic heart disease return with Vice valves (what) Chorea, encephalitis, encephalitis, cerebral vasculitis, neuropsychiatric disorders Prolonged, continuous, intermittent, latent HI
Rheumatism without apparent change of heart Vasculitis, nephritis, hepatitis, pneumonia, skin lesion, irit, iridotsyklit, thyroiditis   H -IIA
Inactive 1. Myocardiosclerosis rheumatic
2. Heart disease (what)
Impacts and residual effects transferred extracardiac defeats   HIII

Modern classification distinguishes two phases of rheumatism - active and inactive. It should be noted that until recently there is still the point of view of a progressing, sustained over time emerged rheumatic process, mainly based on expert opinion, which by the nature of its activities, see mostly chronic course options rheumatism with advanced defeat valvular heart muscles. However, the vast experience of internists, pediatricians and rheumatologists, having the ability is long to be seen not only advanced, but also the earliest forms of the disease, shows that rheumatism if properly organized system of therapeutic and preventive actions quite often ends up in complete recovery.
In the classification of 1964, at the suggestion of A. I. Nesterov was first implemented division of the active phase of the disease on three degrees of activity of rheumatic process. As the main constituent of the integral concept of "activity" means primarily inflammatory rheumatic process in organs and tissues in his clinical and laboratory display (A. I. Nesterov, 1964). However, the notion of "activity", as the concept of "disease", is not limited only by inflammation, but certainly includes elements and corruption, malnutrition, multidisciplinary protective and adaptive, including immune response of the organism. With this agreement the research results, confirming the existence of certain relationship between the degree of rheumatic process and height of the immune response against streptococcal antigen exposure, levels of immunoglobulins in the serum (, So holmogorova, 1977, and others). It is noteworthy that the research R. S. Karpov and other (1977), the most sensitive method for the detection of minimal activity, morphologically confirmed by histological examination of the ears of the heart, served not biochemical, and immunological tests (level cardiac antibodies, the rate of damage neutrophils extract infarction). Like others, all of these observations point to the need to further explore the issues of activity of rheumatic process is inseparable from the problems of pathogenesis of this disease.