The clinical picture of rheumatoid arthritis

rheumatoid arthritis
Fig. 1. Rheumatoid arthritis of the right wrist.
erythema annulare
Fig. 2. Annular erythema

Symptoms of rheumatic fever is diverse and depends on preferential localization of inflammatory changes in the connective tissues of different organs. The disease develops more often in 1-2 weeks after a previous streptococcal infections (tonsillitis, pharyngitis, scarlet fever). The temperature rises up to subfebrile figures, headaches, "pulling" pain in the extremities, weakness, sweating, join the symptoms of the infection of internal organs, mainly heart. When developing rheumatic heart disease there is shortness of breath with a moderate physical activity, heart rate and unpleasant feelings in the heart area, there is a pale skin, tachycardia, muting tone of the heart, often heard systolic murmur; blood pressure decreases. The symptoms of myocarditis (see) are often attached symptoms of endocarditis (see), pericarditis (see) or of pancarditis (see). Less rheumatism begins with cardio-articular form, in which, along with rheumatic heart disease the symptoms of affection of joints (rheumatoid arthritis, acute rheumatic arthritis). Appear volatile pain, swelling and limited mobility, sometimes red skin over them. Often affects the joints of limbs (Fig. 1) (knee, shoulder, joints of hands and feet). At the same time increased temperature to 38-39°, there sweating, weakness. As a rule, for polyarthritis benign acute inflammatory effects in a few days subside, the joint deformation is not observed, their function is restored. Sometimes there are specific skin lesions: rheumatic subcutaneous nodules (noduli rheumatici) - dense, painless education in the magnitude of millet grain until beans, located mostly on the extensor surfaces of the joints, and erythema annulare (erythema anulare) - rash in the form of a pale pink rings, not rising above the skin, painless, appearing on the skin of the breast, abdomen, neck, cheeks (Fig. 2). Often when inflammation of the serous membranes (rheumatic serosity) develops pericarditis, rarely pleurisy, peritonitis; sometimes serous membranes are affected at the same time (polverosa). Perhaps the lungs (rheumatic pneumonia), kidneys (nephritis), liver, thyroid , etc. With the defeat of the nervous system are more common encephalitis, meningoencephalitis, chorea, rheumatoid vasculitis, thrombovascular, diencephalic syndrome, at least - epileptiform seizures. The duration of active rheumatic process 3-4 months, sometimes much more, especially with sluggish period.
Often rheumatism may be hidden (latent): there is a slight discomfort, weakness, minor joint pain, unpleasant feelings in the heart area. In these cases, rheumatism is recognized only later on the basis of the developed over time of heart disease. This form of disease called outpatient rheumatism.
For rheumatism most characteristic tendency to relapse (repeated attacks of rheumatic fever)caused by exposure to cold, physical and nervous overstrain of organism and layers of secondary infection. The symptomology of recurrence in many respects similar to the primary attack, but the signs of joint damage, serous membranes and other bodies are less pronounced than in the primary attack; prevalent symptoms of heart failure, often symptoms of circulatory failure, especially when the previously formed heart disease.

  • Diagnosis of rheumatic fever
  • Treatment and prophylaxis of rheumatic fever
  • Rheumatic fever in children