Rheumatism

Rheumatism (rheumatismus) - the total infectious and allergic disease characterized by inflammation of the connective tissue, mainly cardiovascular systems and joints, but also other organs. Arthritis refers to a group of collagen diseases.
Etiology. The causative agent of rheumatism is hemolytic Streptococcus, but the main role in the development of the disease plays the changed reactivity of the organism, its sensitivity to the re-introduction of Streptococcus, the so-called Allergy (see).
Pathogenesis. Rheumatism is not created stable immunity to hemolytic Streptococcus, on the contrary, when you hit Streptococcus in sensitized the body may experience a recurrence of the disease. In the development of rheumatism play an important role autoimmune processes (see Autoallergy). In response to the introduction of Streptococcus in the infected organism rheumatism are produced not only the normal protective antibodies (see), but pathological, the so-called autoimmune antigens and antibodies that are capable of hitting first of all connective tissue of the heart. Cooling, the overstrain of organism, layering secondary infections may cause the re-suspension of autoimmune antigens and antibodies and cause a relapse.
Pathological anatomy. The disease lies progressive systemic disorganization of the connective tissue.
Rheumatism allocate 4 phase disruption of connective tissue: molignee swelling, fibrinoidnogo change, Wegener, sclerosis. Molignee swelling is accompanied by surface disorganization of the connective tissue. Deeper defeat it occurs in the next phase - fibrinoidnogo changes or the emergence of fibrinoid. In response to these changes appears cell response and in the connective tissue of the heart are formed specific bundles - rheumatic granuloma of Asifa - talalaeva, which consist of histiocytes, lymphoid cells, white blood cells. Initially, along with cellular proliferation in granulomas retained elements of exuding wounds and tissue damage. Then the products disorganization of connective tissue dissolve, begins scarring granuloma, develops final phase of rheumatic process - sclerosis, which could arise in place fibrinogen changes. The duration of these phases of rheumatic process 4-6 months. When the recurrence of rheumatic fever in the field of old scars can again cause tissue destruction and subsequent outcome sclerosis. In addition, rheumatism may be nonspecific exudative reactions that occur in the pericardium, joints, less often in the pleura, peritoneum, the heart, blood vessels, and other Inflammatory changes infarction (see Myocarditis) may be focal (granulomatous) or diffuse (exudative). Rheumatism often affected connective tissue heart valves (see Endocarditis), it's their scarring and deformation, is developing heart disease.

Rheumatism (lat. rheumatismus, from the Greek. rheumatismos - leakage of liquid, pathological discharge; synonym: disease Sokolsky - Buyo, rheumatic fever, acute rheumatic arthritis, acute rheumatic arthritis and others) - the total infectious and allergic disease with inflammatory lesions of the system of connective tissue with predominant its localization in the cardiovascular system, and frequent involvement of other internal organs. Challenging the violation of the processes of immunogenesis and protein-enzyme metabolism with the development of autoimmune reactions resulting in the tendency to chronic retidiviruuschem course of the disease. Primary defeat of the system of connective tissue and the violation of the processes of immunogenesis and protein-enzyme metabolism are the main motives for inclusion rheumatism group collagen diseases.

Statistics and geographical distribution
According to statistics Scherf and Boyd (d Scherf, L. Boyd, 1958), rheumatism is cause of death from heart disease in 98% of cases in people age 20 and 80% - at the age of 30. Rheumatic fever mainly child's disease, a high incidence occurring at the age of 7-12 years of preschool children suffer from rheumatism much less frequently. However, over the last decade in several countries, including the USSR, was augmentation of R. in preschool age. Older people are sick fresh forms R. relatively rarely. Among adults R. common in women is almost 2 times more often than men.
The incidence of rheumatism in this or that country depends on the occurrence of difficult periods in the life of the peoples of these countries, affecting the level of sanitary-hygienic conditions, natural immunity and General reactivity of the broad masses of the population. During the great Patriotic war of 1941-1945, dramatically reduced the number fresh typical forms of rheumatic disease with a defeat of joints, serous membranes, endocardial and infarction, and in the postwar years was a gradual recovery of quantitative and qualitative indicators of the disease. However, currently most frequent clinical-anatomic shape R. with mild allergies, exudative manifestations of the disease (polyarthritis, acute carditis) and with the prevalence of subacute, low current and latent forms of rheumatic heart disease. This confirms the modern understanding of rheumatism as clinical and immunological problems.
Installed variations in the incidence of rheumatism, depending on the time of year and weather conditions. The high incidence R. and its recurrence falls on the period of seasonal increase of nasopharyngeal streptococcal infections (tonsillitis, acute exacerbation of chronic tonsillitis, sinusitis, sinusitis) or at least for the time of their disappearance or significant decrease. It would be a mistake to underestimate direct allergenic impact of such "rheumatogenic" factors as rapid or substantial cooling, draughts, prolonged exposure to damp cold air, stone cold floor, drenching feet and so on, They can play the role of auxiliary sensitizing or enabling factor in people already affected by streptococcal sensitization.


Epidemiology. Etiology
Marked the Semenovsky Bockenem, G. M. Malkov, V. I. Molchanov and other communication rheumatic fever with the previous sore throat or scarlet fever, strep which origin is firmly grounded, confirmed repeatedly and quite convincingly in numerous subsequent clinical and epidemiological observations (N. D. Strazhesko, A. N. Volovik, A. M. Korytskyy, E. C. Myasoedov, A. I. Nesterov). According to A. I. et al., the recurrence of diseases in people suffering from chronic tonsillitis, there are 2.5 times more often, and the formation of new heart defects in 3 times more frequently than in patients with rheumatic disease without chronic tonsillitis. Recently, the role of new or exacerbated chronic nasopharyngeal streptococcal infection for the development of relapses R. recognized as a methodological basis of billingovoy relapse prevention. Relatively frequent cases of so-called family rubles with more thorough studies tend to confirm the main role of intensive "streptococcal environment"than the value of particular genetic factors. This, of course, is not denied certain congenital weakness of the General adaptation mechanisms conducive to address the role of the family factor in the development of the disease. Other evidence etiological role of streptococcal infection in rheumatoid arthritis stem from microbiological and serological studies, clinical and morphological comparisons, the results of bicillin-drug prevention R. and experiments on creation of experimental model of the disease. Numerous microbiological studies indicate considerable frequency of streptococcal bacteremia during the initial acute phase of the disease (N. D. Strazhesko, E., Cashiers, Doctor of historical Sciences Cochinita-Stankaitiene and others)that does not occur in other diseases. The results of numerous works of domestic and foreign authors suggest much higher titers of streptococcal antibodies [antistreptolysine-O, antistreptokinase, antistreptokinase (C. I. Ioffe, V. N. Anokhin and others)] in the active phase of rheumatoid arthritis than in other streptococcal diseases; they are important, albeit indirect, evidence of the etiological role of Streptococcus when R. In the same sense allows to evaluate the role of streptococcal infections and the high frequency of detection in the blood and urine of patients R. streptococcal antigen.
Development of experimental rheumatology and experiments on the creation of experimental R. brought new evidence of streptococcal etiology R. So, if studies M. P. Konchalovsky, Klinge (F. Klinge), D. E. Alperna, such as talalaeva and others have confirmed the pathogenic role of allergies in rheumatoid arthritis, the experiments M. I. Andreeva al. (1963, 1964), A. A. Tustanovska al. (1961, 1963) and others emphasized the evident superiority of the models created when the number of antigenic stimuli Streptococcus in one form or another. The most convincing and already a direct proof of the etiological role of Streptococcus when R. should recognize the successful application of penicillin to prevent primary diseases, rheumatism and its recurrence.
Since studies of koberna (A. F. Coburn, 1931, 1932, 1935, 1949) and many other works (C. I. Ioffe, 1959, 1962) etiological role in R. recognized for beta-haemolytic streptococcal group A. the Main pathways of streptococcal infection among people confess: droplet infection, items of General use (not wiped a damp dining room and the tea utensils), dairy products, underwear and bed linen infected patients or bakterionositeli infected Streptococcus wounds, exfoliating epidermis in infectious eczema in children.
Some researchers believe that in the etiology of rheumatism, apart from Streptococcus, play a role, and other pathogens such as tubercle Bacillus (A. T. petraea), special virus R. (D. Zalessky, bpts Kushelev). To date, however, these authors was not so convincing evidence of viral etiology R., as it is made in respect of a strep infection.