Internal illnesses. Rheumatism (Sokolsky-Buyo disease) (etiology, pathogenesis, clinical picture, diagnosis) (most important)

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Internal illnesses. Rheumatism (Sokolsky-Buyo disease) (etiology, pathogenesis, clinical picture, diagnosis) (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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9. RHEUMATISM (SOKOLSKY-BUYO DISEASE) (ETIOLOGY, PATHOGENESIS, CLINIC, DIAGNOSIS)

Rheumatism is a systemic toxic-immunological inflammatory disease of connective tissue with a predominant localization of the process in the cardiovascular system.

Etiology. The disease is caused by group A beta-hemolytic streptococcus.

Pathogenesis. Released streptococcal antigens (streptolysin-O, streptokinase, streptohyaluronidase) lead to the development of the acute phase of inflammation by cellular exudation and phagocytosis. Chronic inflammation gradually develops with the transfer of activity to immune mechanisms, collagen formation with the formation of fibrosis processes.

Classification. According to Nesterov A.I. (1990), the following are taken into account:

1) the phase of the disease (active or inactive, specifying the degree of activity of the process - minimal, medium, high);

2) clinical and anatomical characteristics of damage to the heart and other organs;

3) the nature of the course of the disease (acute, subacute, protracted, continuously relapsing, latent);

4) the state of blood circulation (0, I, Na, Nb, III degree of violations).

Clinic. The first period of pre-rheumatism lasts 2-4 weeks from the end of streptococcal infection to the onset of manifestations of the disease. Appear: malaise, fatigue, loss of appetite, palpitations, tingling in the joints, hyperhidrosis, pallor of the skin.

The second represents a rheumatic attack. Fever appears with syndromes of damage to the joints, heart (primary rheumatic heart disease) and other organs.

The third period of clinical manifestations. There is recurrent rheumatic heart disease with progressive heart damage, the formation of complex heart defects.

Primary rheumatic heart disease. Inflammation of all membranes of the heart (pancarditis) is possible, the endocardium and myocardium are most often affected. There is tachycardia, rarely bradycardia. The borders of the heart are normal or moderately enlarged. Auscultation muffled I tone, soft systolic murmur at the apex (associated with myocarditis). Sometimes a third tone may appear.

Diagnostic criteria for rheumatism according to Kisel-Jones.

Major criteria: carditis, polyarthritis, chorea, annular erythema, subcutaneous rheumatic nodules. Minor criteria: previous rheumatism, arthralgia, fever, increased ESR, increased C-reactive protein, leukocytosis, prolongation of the PQ interval on the ECG, increased titer of anti-streptococcal antibodies in the blood, detection of streptococcal antigen.

If two major and one or two minor criteria are present, the diagnosis is considered reliable; if one major and two minor criteria are present, the diagnosis is considered probable.

Diagnostic research. Diagnostic value is the study of a complete blood count (hypochromic anemia, leukocytosis with a shift to the left, an increase in ESR), a biochemical blood test (the appearance of C-reactive protein, an increase in fibrinogen, dysproteinemia, a2-hyperglobulinemia, an increase in the content of hap2 toglobin, ceruloplasmin, acid phosphatase ).

An immunological study is being carried out to determine the increase in the titer of antibodies ASH, ASL-O, ASA, myocardial antibodies.

ECG determines various rhythm disturbances, conduction, Doppler echocardiography determines structural changes.

Author: Myshkina A.K.

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