Differential diagnosis of rheumatic fever

Rheumatism must be differentiated from consilierilor syndrome, infectious nonspecific (evolutionary) polyarthritis, syndrome, primary tuberculosis, septic endocarditis, neurocirculatory asthenia, thyrotoxicosis and rare forms collagen diseases.
Unlike rheumatic fever and rheumatic heart disease, when consilierilor syndrome there are no clear signs of inflammation of the heart muscle, valves, Vice positive effect of Antirheumatic therapy and there is a clear effect of energetic antibacterial therapy or tonsillectomy.
Unlike syndrome, primary tuberculosis, rheumatism are no indications of an epidemiological link between illness and TB infection (contact with TB patients), on the availability of primary TB infection focus (in the lungs, lymphatic system) and Mycobacterium tuberculosis, there is no characteristic curve diagnostic tests (Pirke, Mantoux test) in the presence of high titers of streptococcal antibody and antigen in the blood, there is a positive response to Antirheumatic treatment and negative - specific and characteristic signs of organ rheumatic disease (rheumatic heart disease, heart disease and others).
For distinguishing rheumatism from non-infectious arthritis with success can be used table diagnostic criteria for these two diseases (table. 2).

Table 2. Criteria for differential diagnosis of rheumatic and infectious nonspecific polyarthritis
Symptoms Rheumatic polyarthritis Infectious nonspecific polyarthritis
Stiffness in the morning No Characteristic, is celebrated almost in all patients
The signs of inflammation in the joints Expressed brightly only in the acute phase of the disease There is almost always. May not be present in the final phases of the disease
Pain Only in the period of acute, subacute polyarthritis; can be arthralgia Always significant. Weaken in remission and in the final phase of the disease
Infringement of function of joints Only in the acute phase of arthritis Expressed as always. Progressing with the development of the disease
The disease Relatively rare recurrent attacks of rheumatic polyarthritis Clearly progressive, with remissions and relapses
Disturbance of trophism of muscles, skin Expressed little Pronounced at the beginning of the disease, progressing with the development of the disease
X-rays of the joints May be the extension of the joint space when vpotnye acute arthritis Early in the disease osteoporosis, changes of the joint space, at the later stages of the disease - ankylosis, signs of deforming arthritis
The impact of salicylates and piramidon (amidopirina) Expressed, fast Little is expressed primarily in the acute, the initial phase of the disease
The heart damage Characteristically, almost constantly Mainly in the form of cardiomyopathy, uncharacteristically
The dysproteinemia, hypergammaglobulinemia, and accelerated ROHE Expressed in the acute phase of the disease Characteristic at all stages of the disease and in all its forms
Leukocytosis Expressed Expressed in acute and subacute forms, may be with exacerbations of chronic forms (and the stage) of the disease
The Reaction Of Valera-Rose In most patients negative Positive in 70-80% of cases
C-reactive protein Increased natural in the active phase of the disease Elevated in most patients is more often, and the title is the higher, the more active the process in joints
Strep body Their titles significantly increased in the active phase of rheumatoid arthritis The credits antistreptolysine-O, antistreptokinase, antigialuronidasy can be increased in some patients
Communication with infectious hearth Frequently expressed Often expressed
Body temperature High acute arthritis Increased in the acute phase of the illness, most patients is subfebrile long time

Subacute bacterial endocarditis is characterized by a combination of symptoms previously acquired rheumatic heart disease (usually in the form of failure of the aortic valve) and the overall picture of sepsis with relapsing fever, chills and torrential sweats; progressive weakness, loss of weight and analizarea, bacteraemia, enlargement of the spleen; symptoms of hemorrhagic vasculitis, sepsis thromboembolic complications from the spleen, liver, kidneys (focal jade), a drum with your fingers (see), as well as the positive formaleva breakdown. Is essential and a different effect from energetic Antirheumatic and antibacterial therapy. The doctor, however, should remember about possible layers septic process on unfinished rheumatic when the symptoms of these two separate diseases can be mixed and very close.
Neurocirculatory asthenia differs from rheumatism abundance of subjective symptoms of a General nature (unmotivated fatigue and sudden fatigue, depression, sweating, dizziness, palpitations, pain in the heart, a freeze, interruptions and others) in the presence of arterial hypotonia, cold sweatiest limbs, etc. and in the absence of objective signs of inflammation and symptoms of heart organohalogen.
An important diagnostic criteria hyperthyroidism and thyroid hearts are recognised, in addition to the characteristic clinical symptoms (enlarged thyroid gland, exophthalmia, unmotivated tachycardia, emaciation, a significant weakness), increasing metabolic rate and increased thyroid uptake of radioactive iodine (over 40%) within 24 hours).
When erythematosus and scleroderma characteristic symptoms of slow development of the defeat of the heart muscle and heart valve apparatus (the predominance of proliferation and sclerosis over inflammation) in the presence of other manifestations of these diseases (basal pulmonary sclerosis, expansion of the esophagus, articular syndrome, systemic scleroderma and plurilaterally disease in systemic lupus erythematosus).
"Rheumatoid carditis" is rare and well-differentiated on the background of the classic symptoms of infectious nonspecific polyarthritis.