Diagnosis of rheumatism

3. Increase in permeability of capillaries.

The presence of two basic criteria or one basic and two additional ones is sufficient for the diagnosis of rheumatism.

Of course, with rheumatism, as with any other disease, many auxiliary research methods are used that not only help in the formulation of the correct diagnosis, but rather are aimed at assessing the general state of the organism and the degree of damage to various organs and systems. This is primarily a clinical blood test, in which, depending on the severity of the process, anemia( a decrease in hemoglobin and the number of red blood cells), leukocytosis( an increase in the number of leukocytes), indicative of the severity of the inflammatory process, an increase in ESR.In the general analysis of urine with rheumatic damage of the kidneys, proteinuria( excretion of protein with urine), hematuria( appearance of erythrocytes in urine) is detected.

Compulsory examination includes heart monitoring - measurement of heart rate and blood pressure. To determine the state of the heart muscle, electrocardiography is prescribed, which judges the nutrition of the heart muscle, its functional capabilities, and the presence and nature of cardiac rhythm disturbances. Phonocardiography - a method that allows you to clarify the auscultation( listening) of the heart and, consequently, the nature of heart murmurs. This helps to correctly recognize heart defects. Echocardiography is a method of investigation that is important in the course of a rheumatic process with severe damage to the heart muscle and the development of heart failure. In this case, the echocardiogram shows signs of a decrease in the contractility of the heart and the expansion of its cavities. In the presence of pericarditis Echocardiography allows you to estimate the amount of fluid in the heart bag.

Radiography of the chest helps to establish lung damage;ultrasound diagnosis determines the condition of the liver, kidneys, thyroid.

Differential diagnosis

The diagnosis of rheumatic fever with its classical course is quite easy, especially if there are already typical complications from the heart. But in order to successfully treat the disease, as well as to correctly and timely prevent complications and exacerbations, it is important to establish the correct diagnosis at the earliest possible stages, when the symptomatology is still little expressed and has a so-called general character. It is difficult to timely diagnose also inactive forms of rheumatism, therefore in modern medicine in the diagnosis of rheumatism errors are allowed. Differential diagnosis of rheumatism in the early stages of the disease is based on the detection of polyarthritis and carditis.

Rheumatoid arthritis must be differentiated from reactive arthritis, primarily arthritis in infectious diseases - salmonellosis, pseudotuberculosis, yersiniosis, respiratory viral infections, etc. for arthritis in infectious diseases are also characterized by "volatility" of pain, but at the same time, the pain more. Resistant. As a rule, there is a clear connection with catarrhal phenomena from the side of the nasopharynx or with violations of the intestinal function, either or even accompanied by it. To clarify the diagnosis, a blood test is done to identify antibodies to antigens of salmonella, pseudotuberculosis, iersiniosis.

Polyartralgia must be differentiated with rheumatoid arthritis. For rheumatoid arthritis, the involvement of other joints, including small ones, is often symmetrical. Unlike rheumatoid arthritis, rheumatic polyarthritis has a migratory nature. Rheumatic polyarthritis is well amenable to therapy with nonsteroidal anti-inflammatory drugs, carditis early joins it, a high content of anti-streptococcal antibodies is detected in the blood. When diagnosing rheumatoid arthritis, the diagnostic criterion is the determination of a rheumatoid factor in the blood.

C manifestations of arthritis may start a disease, as hemorrhagic vasculitis, and nature of pain in the joints when it is the same as rheumatism. To establish the correct diagnosis helps the appearance of characteristic rashes on the skin, abdominal pain and subsequently damage to the kidneys.

Most often rheumatic heart disease has to be differentiated with numerous non-rheumatic myocarditis( viral, bacterial, etc.).For non-rheumatic myocarditis is characterized by a clear chronological association with viral infections or stress, and myocarditis develops almost immediately after the effect of the provoking factor. Such a myocarditis, as a rule, happens in the middle and old age, in contrast to rheumatism, which is considered a disease of adolescents and young people. Articular syndrome with non-rheumatic carditis is absent;In contrast to rheumatic lesions, the patient complains of discomfort or pain in the heart area.

Rheumatic carditis should be distinguished from functional cardiopathy in vegetative-vascular dystonia. Such patients often complain of pain in the region of the heart, palpitations, interruptions, a sense of "fading" of the heart, "stopping", that is, manifestations that are not characteristic of rheumatic carditis. In this case, there is usually a discrepancy between the abundance and brightness of subjective sensations and scanty laboratory data. Anti-inflammatory and corticosteroid therapy not only does not improve the condition, but even worsen it. And, on the contrary, the appointment of sedatives and antispasmodics give a positive effect.

With developing heart disease, especially aortic, recurrent rheumatic carditis should be distinguished from infective septic endocarditis. This complication develops immediately after the bacterial infection - a purulent infection, an infected injury, etc.

Be Healthy!