Download Acute rheumatic fever

Department faculty and hospital therapy of
medical faculty and department internal
diseases of medical prophylactic faculty.
Acute rheumatic fever
 Acute
rheumatic fever - a systemic
inflammatory disease of connective
tissue with a predominant localization of
the process in the cardiovascular
system, developing in connection with
acute infection, β-hemolytic
streptococcus group A, in adolescents,
ages 7-15.
Epidemiology
In most cases, the disease
begins in childhood and
adolescence (7-15 years).
Aetiology
 β-hemolytic
streptococcus
group A
Risk factors
 heredity
 dishormonal
violation
 social factors
 climatic factors
Pathogenesis

The development of ARF defined by direct toxic
damage to the components of myocardial
cardiotrophic enzymes β-hemolytic
streptococcus group A is particularly attach great
importance to the development of cellular and
harmonal immune responses to various antigens
AG streptococcus, leading to the synthesis of
anti streptococcal Ab cross-reacts with AG
infarction (the phenomenon of "molecular
mimicry" .)
Patomorphology
Stage 1 - mucoid swelling lasts 2 weeks.
Stage 2 - fibrinoid swelling lasts 1,5-2
months.
Stage 3 - the formation of AschoffTalalayev’s granulomas continues 1,5-2
months.
Stage 4 - fibrotic and sclerotic changes.
Clinic
Arthritis - a leading symptom of the disease
in two thirds of patients with first attack of
rheumatic fever. A characteristic feature of
it is migratory in nature. Pain in the joints
often leads to a substantial limitation in
their mobility. Take off at the same time
there is swelling of joints, and sometimes
redness of the skin over them.
Clinic (continuation)
Rheumatic heart disease - clinical carditis is
defined by myocarditis, endocarditis, or
pericarditis.
Signs of endocarditis: expanding the boundaries of
the heart, the appearance of cardiac noise,
disturbance of heart rhythm.
Signs of pericarditis: expanding the boundaries of
cardiac dullness, muted tones, noise, friction
pericardium.
Signs of myocarditis: tachycardia, conduction
disturbances and AV block (on ECG).
Clinic (continuation)
Annular erythema - pink, not itchy rash is
localized on the inner surface of the body
extremities and neck.
Subcutaneous nodules rheumatic - smaller
formations localized periarticular tissues at
sites of attachment of tendons over bony
prominences at the joints.
Clinic (continuation)
Chorea - involuntary jerking of the limbs
chaotic and mimic muscles, accompanied
by violation of the handwriting, slurred
speech and clumsiness.
Diagnostic criteria of rheumatic fever
(Kissel-Johns Nesterov)
1. The main criteria
1.1 carditis
1.2 polyarthritis
1.3 chorea
1.4 rheumatic nodules,
1.5 annular erythema
2. Additional criteria:
A. General:
2.1 improving the temperature
2.2 weakness, fatigue, irritability
2.3 pale skin
2.4 sweating
2.5 epistaxis
2.6 abdominal syndrome
B. Special (laboratory values​​)
1.
2.
3.
4.
leucocytosis (neutrophil)
dysproteinemia, increased ESR,
abnormal serum blood parameters:
increased ASO titers, ASA, ASG.
increased capillary permeability.
Working classification of Rheumatic fever
(Association of Rheumatologists RUSSIA, 2001)
Clinical syndromes
Main
More
Annular erythema
Rheumatic
heart disease rheumatic nodules
Aortalgia
primary
Abdominal
syndrome and etc.
serositis,
previous
streptococcal
infection
The
degree of
activity
3
2
1
Course
Outcome
(inactive
phase)
Acute
protract
ed
latent
Without
heart
disease
With heart
disease
Stage
0
I
IIа
IIб
III
Working classification of Rheumatic fever
(Association of Rheumatologists RUSSIA, 2001)
(continued)
Rheumatic heart disease
relapsing
- No heart disease
- Against heart disease
Arthritis
- Without the involvement of the
heart
- With the involvement of the heart
Chorea
- Without the involvement of the
heart
- With the involvement of the heart
For the first time detected
rheumatic heart disease
Classification and nomenclature of Acute rheumatic
fever (APP, 2003)
Clinical
variants
Acute
rheumatic
fever
Rerheumatic
fever
Клиник кўринишлари
Main
More
Carditis
arthritis
chorea
annular
erythema
rheumatic
nodules
Fever
arthralgia
abdominal
symptoms
serositis
Outcome
Recovery
Chronic
rheumatic
heart disease
With heart
disease
Without heart
disease
Stages
NC
SWR
NYHA
0
I
IIА
IIБ
III
0
I
II
III
IV
Differential diagnosis
Carditis:
1. infectious-allergic myocarditis
2. functional cardiopathy
4. bacterial endocarditis
5. cardiomyopathy
6. thyrotoxic myocardial
Differential diagnosis
(continuation)
Arthritis:







1. reactive arthritis
2. rheumatoid arthritis
3. Bechterew's disease
4. arthritis in hemorrhagic vasculitis
Carditis + arthritis:
1. SLE
2. MICs
3. rheumatoid arthritis
Treatment
1-phase - stationary.
2-step - in the clinic under the supervision
of cardiorheumatologist
3-step - Spa.
Prophylaxis
Primary - rehabilitation of chronic foci of
infection, hardening of the body.
Secondary - bicillin -3 bicillin -5
extentcillin.
Forecast
 Prognosis
is determined by the efficiency
of treatment of rheumatic heart disease, the
presence of valvular and their influence on
hemodynamics.