The pathogenesis of rheumatic fever

On the basis of experimental studies and clinical observations, we can identify the following main stages of pathogenesis of rheumatic fever. 1. Strep, often tonsil infection (primary etiologic antigen). 2. Immunity to infection due to personal weakness protective mechanisms or adaptation reserves, because they will not offset the impact of primary antigenic stimulus and does not create stable immunity against infection beta haemolytic Streptococcus group A, as is the case with the majority of people are also exposed to this infection. 3. As a result of violation of immunity in connective tissue (primarily heart) there autoantigens, or secondary antigens, which cause the formation of pathogenic autoantibodies. The latter determine the depolymerization of the basic substance of connective tissue (capillary wall at maximum), which is accompanied by increasing its permeability. 4. The increased capillary permeability facilitates the diffusion of antibodies and other proteins of blood cells and enzymes in the tissues with the consistent formation of autoantibodies and the emergence of tissue giperergicakie inflammatory changes based on the reaction of the antigen-antibody. 5. The formation of proteins and antibodies due to a number not yet clear conditions (continued or repeated admission primary antigen, the emergence of haptens or influence parallelistic factors, violation of neurohumoral mechanisms of adaptation) leads to the development of chronic disease with progressive loss of connective tissue and with secondary disorders in the structure and function of parenchymatous organs and first of all hearts.
The scheme of the main links of the pathogenesis of rheumatic fever covers only some, the most studied of its elements. A number of important and principled sides of the pathogenesis of this disease and primarily intimate individual offset mechanism normal immune response to streptococcal infection (2-3% who underwent this infection) in the direction of allergic and autoimmune reactions remain unresolved and require further research. However, it can be considered indisputable that no matter how great is the native streptococcal antigen, i.e. the main etiological factors decisive role in the development of rheumatism its course and outcomes belong not so much to him, how many total individual immunological and argonodugovoy reactivity of human organism and the conditions of his existence in the environment. Undisputed is the fact this variability of reactivity: it is changing in several generations, and in the life of the individual as a result of interaction with external environmental factors, including with streptococcal environment. The development of rheumatic fever as autoimmune, autoimmune diseases are presented in the scheme of Politzer and Steffen (Fig. 1).

Fig. 1. Rheumatism as "autoaggression" (scheme of Politzer and Steffen).