Rheumatic arthritis

Rheumatic arthritis is the most common manifestation of rheumatic fever (RF), present in 75% of patients at the first attack. In older adolescents and adults, joint involvement is often the only major symptom of RF and is more severe than in children.

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Symptoms of Rheumatoid Arthritis

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

Most often, large joints of the lower extremities (knees and ankles) are affected, less often - elbows, wrists, shoulders and hips, and small joints of the hands, feet and neck are involved extremely rarely. Rheumatoid arthritis is usually characterized by acute development, accompanied by severe pain, hyperemia of the skin over the affected joints and their swelling. Joint pain is more noticeable than objective signs of inflammation, and is almost always short-lived. X-ray of the joint may reveal a small effusion, but is often uninformative. Synovial fluid is sterile, its pronounced leukocytosis and a large amount of protein are noted.

Typically, each joint remains inflamed for no more than 1-2 weeks, and rheumatoid arthritis completely resolves within a month even without treatment. The natural history of polyarthritis in acute rheumatic fever changes with the routine use of salicylates and other nonsteroidal anti-inflammatory drugs (NSAIDs). With treatment, rheumatoid arthritis resolves more quickly in the already involved joints and does not migrate to new joints, so oligoarthritic lesions are now more often described in ARF. Monoarthritis is also possible, their frequency increases when anti-inflammatory treatment is started at an early stage, before the clinical picture of ARF has fully developed. According to large studies, the incidence of monoarthritis in ARF varies from 4 to 17%. In some cases, additive in nature, rather than typical, migratory rheumatoid arthritis is observed, when, against the background of persistent damage to one joint, inflammatory phenomena appear in another joint. The frequency of prolonged additive course increases in adult patients with RL. There is evidence that the more severe the rheumatic arthritis, the less serious the consequences of rheumatic carditis, and vice versa, arthritis, unlike carditis, is completely curable and does not lead to any pathological or functional consequences.

After a streptococcal infection, some patients develop arthropathy (called "poststreptococcal arthritis"), which has clinical differences from rheumatoid arthritis. Poststreptococcal arthritis develops after a relatively shorter latent period (7-10 days) than in typical rheumatoid arthritis, is characterized by a persistent long-term course (from 6 weeks to 6-12 months), non-migrating nature and frequent relapses, frequent involvement of small joints in the process, the presence of lesions of periarticular structures (tendinitis, fasciitis), poor sensitivity to NSAIDs and glanders and nilatram, and is not associated with other major criteria of rheumatoid arthritis. It remains unclear whether it is a form of reactive (postinfectious) arthritis different from true rheumatoid arthritis. In some patients initially assessed within the framework of post-streptococcal arthritis, manifestations of RBS were later detected during long-term prospective observation, which does not allow considering them outside the structure of RL. Currently, WHO experts recommend classifying cases of post-streptococcal arthritis as ARF if they meet the criteria of T. Jones, and mandatory antistreptococcal prophylaxis for such patients according to the usual regimen for RL.

Diagnosis of rheumatoid arthritis

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

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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 relieve arthritis symptoms in the first 12 hours. If there is no quick effect, then it is necessary to doubt that polyarthritis is caused by rheumatoid arthritis. NSAIDs are given for 4-6 weeks, and are gradually discontinued.

Prognosis for rheumatoid arthritis

Rheumatic arthritis, unlike rheumatic carditis, is completely curable and does not lead to any pathological or functional sequelae. The only possible exception is chronic postrheumatic arthritis Joccoid. This rare condition is not a true synovitis but rather a periarticular fibrosis of the metacarpophalangeal joints. It usually develops in patients with severe RHD but is not associated with RL.