Classification

1. Acute rheumatic fever

2. Rheumatic disease of heart (Rheumatic disease of heart – with defect or vice of heart, valvular heart disease).

The Jones Criteria for Rheumatic Fever, Updated 1992

A. Major Criteria:

1. Carditis

2. Polyarthritis

3. Chorea minor - hyperkinesia (abnormal movements of the extremities, the trunk, and the facial muscles).

4. Annular erhytema

5. Rheumatic subcutaneous nodule

B. Additional (minor) Criteria:

Fever

Pain in the joints

C-reactive increased

Increased the erythrocyte sedimentation rate

The minor criteria are nonspecific and may be present in many clinical conditions. To fulfill the Jones criteria, either two major criteria, or one major criterion and two minor criteria, plus evidence of an antecedent streptococcal infection are required. The latter may be provided by recovery of the organism on culture or by evidence of an immune response in one of the commonly measured group A streptococcal antigens (e.g. anti-streptolysin O, anti-deoxyribonuclease B, anti-hyaluronidase). Since the accurate diagnosis of rheumatic fever has future medical.

Clinical features

The clinical picture of rheumatism is quite varied and depends mostly on the localization of the inflammatory changes in connective tissues of various organs and on acuity of the rheumatic process. As a rule, the disease develops in 1-2 weeks after a streptococcal infection (e.g. tonsillitis, pharyngitis). Most patients develop subfebrile temperatures 3 weeks), new symptoms a heart. The patient complains of palpitation and intermissions the work of the heart, the feeling of heaviness or pain in the heart, and dyspnoea. Less frequently the onset of the disease is acute. Remitting temperature develops (38-39°C), which is accompanied by general asthenia, fatigue, and perspiration.

Heart affections may be the only clinical manifestation of rheumatism. On the other hand, practically all-rheumatic patients have their heart muscle affected rheumatic myocarditis. Rheumatic myocarditis is characterized by dyspnoea, the feeling of heaveness and pain in the heart, palpitation, and intermissions in the heart work. In addition, certain objective signs are found: enlargement of the heart, decrease heart sounds (especially the first sound); gallop rhythms develop in severe affection of the myocardium. A soft systolic murmur can he hear all the heart apex. It is associated with relative incompetence of the valve affection papillary muscles. The pulse of small and soft; tachycardia are frequent. Arterial pressure is usually decreased. Circulatory insufficiency rapidly develops in grave diffuse myocarditis. Myocardial cardiosclerosis develops in benign outcome of the disease.

Rheumatic myocarditis usually concurs with rheumatic endocarditis (rheumocarditis). Early endocarditis signs are not pronounced (symptoms of myocarditis prevail). Further development of the heart disease proves the presence of endocarditis. At earlier stages of endocarditis systolic murmurs are coarser than in myocarditis; the murmur becomes louder after exercise; in some cases it becomes "musical". Diastolic murmur may be heard as well. It is probably explained by deposition of thrombotic mass on the valve cusps, which produces turbulence in the blood flow as it passes from the atrium to the ventricle. These thrombotic deposits on the valves can leave their seat and become the cause of embolism or infarctions in various organs (e.g. the kidney or the spleen). The mitral valve is mostly affected on endocarditis. Next in incidence follows the aortic valve; the tricuspid valve is affected still less frequently. If early attacks of rheumatic endocarditis are treated timely, development of the valvular heart disease may be prevented.

In a grave course of rheumatism the affection of the myocardium and endocardium may combine with rheumatic pericarditis. Pericarditis may be dry or exudative.

Simultaneously (or several days later) the patient feels pain in the joints (mostly in large joints, such as the ankle, knee, shoulder, elbow joints, and in hands and feet). Affections of the joints are usually multiple and symmetric. The migrating character of pain is also characteristic: pain disappears in one joint and develops in others. Rheumatic polyarthritis is usually benign. Acute inflammation subsides in a few days, although dull pain in the joints may persist for a long time. Abatement of inflammation in the joints does not mean recovery because other organs become involved in the pathological process. The cardiovascular system is mostly involved, but the skin, lungs, liver, kidneys, and the nervous system may also be affected.

Examination of the patient with acute rheumatic fever reveals of skin (even at elevated temperature) and increased perspiration. In some patients, the skin of the chest, neck, abdomen and the face affected by annular erythema (pale-pink painless rings not elevating over the surrounding skin). In other cases nodular erythema develops: circumscribed indurated dark red foci on the skin varying in size from a pea to a plum; they are usually found on the lower limbs. In rare cases, rheumatic subcutaneous nodules (firm, painless formations varying in size) can be palpated, mostly on the extensor surfaces of the joints find along the course of tendons. Lungs are affected in very rare cases. This is specific rheumatic of pneumonia. Dry pleurisy or pleurisy with effusion are more common.

The nervous system often involved in rheumatism. This is due to either rheumatic vasculitis (attended by small hemorrhages or thrombosis of cerebral vessels) or inflammation of the brain and the spinal cord. Children would develop encephalitis with predominant localization in the subcortical nodes (chorea minor). It is manifested by emotional liability and hyperkinesia (abnormal movements of the extremities, the trunk, and the facial muscles).

The alimentary system is rarely affected. Acute pain in the abdomen (the abdominal syndrome) associated with rheumatic peritonitis (mostly in children) sometimes occurs. Affections of the kidneys also common. Protein or red blood cells can befound in the urine due to affections of the renal vessels and frequently.