Rheumatoid arthritis

Rheumatic arthritis is the most common manifestation of rheumatic fever (RL) present in 75% of patients with the first attack. In adolescents of the older age group and adults, joint damage is often the only primary criterion for RL and is more severe than in children.

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Symptoms of rheumatoid arthritis

Articular manifestations of rheumatic fever can vary from arthralgia to arthritis, which occurs with painful contracture. In the classic untreated case, arthritis affects several joints quickly and consistently, each for a short time, so the term "migratory" is widely used to describe polyarthritis in ORL.

The most commonly affected are the large joints of the lower extremities (knee and ankle), less often - the elbow, wrist, shoulder and hip, and the small joints of the hands, feet and neck are very rarely involved. Rheumatoid arthritis is usually characterized by acute development, accompanied by a sharp pain, hyperemia of the skin over the affected joints and their swelling. Pain in the joints is more palpable than the objective signs of inflammation, and almost always short-lived. Radiography of the joint can detect a small effusion, but more often it is not informative. The synovial fluid is sterile, marked by its pronounced leukocytosis and a large amount of protein.

In a typical case, each joint remains inflamed no more than 1-2 weeks, and completely rheumatoid arthritis is resolved within a month even in the absence of treatment. The natural course of polyarthritis in acute rheumatic fever changes when used in routine practice of salicylates and other non-steroidal anti-inflammatory drugs (NSAIDs). In the treatment, rheumatoid arthritis is resolved more quickly in the joints already involved and does not migrate to new joints, so at present ORL is more often described as an oligoartritic lesion. Monoarthritis is also possible, their frequency rises when anti-inflammatory treatment is initiated at an early stage, before the clinical picture of ARF is fully developed. According to large studies, the frequency of monoarthritis in ORL varies from 4 to 17%. In some cases, additive in nature, rather than typical migrating rheumatoid arthritis, is observed when inflammatory phenomena in another joint appear against the background of a persistent lesion of one joint. The frequency of prolonged additive flow increases in adult patients with RL. There is evidence that the harder the rheumatoid arthritis is, the less severe rheumatic carditis is, and on the contrary, arthritis, unlike carditis, is completely cured and does not lead to any pathological or functional consequences.

After a streptococcal infection, some patients develop arthropathy (called "post-streptococcal arthritis"), which has clinical differences from rheumatoid arthritis. Post-streptococcal arthritis develops after a relatively shorter latent period (7-10 days) than during a typical RL, is characterized by persistent long-term course (from 6 weeks to 6-12 months), non-migratory character and frequent recurrence, frequent involvement of small joints in the process, presence of lesions of periarticular structures (tendinitis, fasciitis), poor sensitivity to NSAID and sap therapy, and neither lats nor, and is not associated with other large criteria of RL. It remains unclear whether it is a form of reactive (postinfection) arthritis, other than true RL. In some of the patients, initially regarded as part of post-streptococcal arthritis, later, in the long-term prospective observation, RBS manifestation was found, which makes it impossible to consider them outside the RL structure. Currently, WHO experts recommend that cases of post-streptococcal arthritis should be attributed to ORL if they meet the criteria of T. Jones, and mandatory to conduct such patients with anti-stenococcal prophylaxis according to the usual for RL regimen.

Diagnosis of rheumatoid arthritis

In the case when rheumatoid arthritis is not accompanied by other large criteria of rheumatic fever, differential diagnosis with a large number of nosologies is required to establish the diagnosis, requiring additional examination, and in some cases, prospective observation. Most often differential diagnosis of rheumatoid arthritis has to be carried out with reactive (postinfection) and infectious (bacterial) arthritis of various genesis, viral arthritis, acute gouty arthritis. Rarely, diagnostic difficulties arise when juvenile idiopathic arthritis, arthritis with systemic lupus erythematosus, Lyme disease, which at first may resemble rheumatic fever, are excluded.

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Treatment of rheumatoid arthritis

Treatment of rheumatoid arthritis is based on the use of NSAIDs (salicylates). Usually, drugs of this group will stop the symptoms of arthritis in the first 12 hours. If the fast effect does not occur, then it is necessary to doubt that the polyarthritis is caused by RL. NSAIDs are given within 4-6 weeks, canceled gradually.

Prognosis for rheumatoid arthritis

Rheumatoid arthritis, in contrast to rheumatic heart disease, is completely cured and does not lead to any pathological or functional consequences. The only possible exception is the chronic post-treatment arthritis of Joccoid. This rare condition is not a true synovitis, but rather a periarticular fibrosis of metacarpophalangeal joints. It usually develops in patients with severe RBC, but is not associated with RL.