Classification and nomenclature of rheumatism

Along with the most common and characteristic localization and clinical-anatomical forms of rheumatism and there are numerous other options for this disease. This fact together with a variety of traditional items of rheumatism in different countries explains why until recently, there was created a generally accepted classification and nomenclature of disease. Adopted in 1956, the all-Union Antirheumatic Committee and supplemented and refined A. I. Nesterov at the Symposium on the classification and nomenclature of rheumatism in 1964 (Moscow) classification and nomenclature of rheumatism have the following structure (table. 1). These classification, nomenclature and diagnostic criteria require some explanation. In the adopted all-Union Antirheumatic Committee in 1956 working classification of rheumatism in the section of clinical-anatomic definitions were given the division of acute rheumatic heart disease (a) and return (b). However in practical activities of doctor rheumatic heart disease occurs in two main clinical-anatomical variants of rheumatic heart disease in primary and return that is purely practical importance and provided in the new version of classification and nomenclature. The term "acute rheumatic heart disease" (a) the previous classification was related not to the form of rheumatic heart disease, and to his course, as reflected in the column "the nature of the course" the new classification. The division of rheumatic heart disease in primary and return not only make a significant refinement in the diagnosis of rheumatic heart failure, but is well guides the doctor energetic Bartiromo primary therapy of rheumatic heart disease, which, as shown by a large clinical experience, it is possible, necessary and promising. However, doctors are known not so rare forms undisputed rheumatism, when rheumatic fever or chorea is not accompanied by clinically established by the symptoms of rheumatic heart disease, heart disease, etc., In such cases, in accordance with the requirements of the International statistical classification of diseases and injuries (1955) Symposium on the classification recommended to use the definition of "rheumatism without apparent change of heart", which was reflected in the new version of the classification under the letter "b".
Compared with the classification of 1956 in the new version in the section "Clinical-anatomical characteristics of the defeats of other organs and systems" for polyarthritis delivered serosity (pleurisy, peritonitis, abdominal syndrome), being closer to the arthritis symptoms allergies, inflammatory syndrome. After rheumatic lesions of the Central nervous system (chorea, encephalitis and other) delivered neuropsychiatric disorders as genetically associated with rheumatic affection of the Central nervous system. In the column "the nature of the course" the notion of a protracted course the addition of the word "sluggish", i.e. satino-sluggish pace. However, the Commission considered it important to warn the doctors from overly broad use of the term in order to avoid unjustified reduction attention to subacute, continuously retidiviruuschem and especially the latent period of rheumatic heart disease. Under sluggish protracted, or satino-sluggish, over mean rheumatic heart disease with distinct signs of rheumatic heart failure occurring, however, Stagno, slowly, persistently, often with incomplete clinical picture of the disease. Meanwhile, the term "latent rheumatic heart disease" refers also active rheumatic process, but flowing latent, hidden, with fuzzy disease symptoms, manifested primarily in the process of dynamic observation and treatment of the patient. The most significant amendments and additions to the previous classification 1956 made in the 1st column on the classification, in which there is a requirement for the phase-detection of rheumatic process is active or inactive. In force since 1956 Soviet classification split rheumatism in active and inactive phase very favorably differed from all well-known foreign classifications, where this distinction was not required. However, the accumulated experience deeper clinical, laboratory, clinical and instrumental study of the rheumatic process, and comparing its performance with the results of pathomorphological control (according to biopsy ears left atrium when commissurotomy) prompted the Soviet experts (A. I. Nesterov, 1964) to put forward the requirement to define three levels of activity of rheumatic process. This requirement strongly emphasized also by the problems of differentiated methods of treatment depending on the degree of activity of rheumatic process (see below).

Table 1. Classification and nomenclature of rheumatism *
Phase Clinical-anatomical characteristics of the lesions The nature of the course Functional characteristics of blood circulation
heart other systems and organs
Active (activity I, XI, III degree) A. Rheumatic heart disease primary
B. Rheumatic heart disease return**
Without blemish valves
The sin of valves (what)
Polyarthritis. Serosity (pleurisy, peritonitis, abdominal syndrome). Chorea. Encephalitis. Meningoencephalitis. Cerebral vasculitis. Neuropsychiatric disorders. Vasculitis. Nephrite. Hepatitis, Pneumonia. Skin lesions. Iritis. Iridocyclitis. Thyroiditis Acute.
Continuously relapsing
H0 - no circulatory failure

H1 - circulatory failure I of a degree

H2 - circulatory insufficiency of II degree

H3 - circulatory failure III extent
century Rheumatism without apparent change of heart
Inactive A. Myocardiosclerosis rheumatic
B. Heart disease (what)
Impacts and residual effects transferred extracardiac defeats  
* Adopted by the Symposium on the report of A. I. Nesterov (December, 1964, Moscow).
** Whenever possible, you should specify a leading localization destruction (infarction, endocardium, pericardium; pancarditis, coronary) and specify the number of attacks.