[Definition, classification and epidemiology of spondyloarthritis]. / Définition, classification et épidémiologie des spondyloarthrites.

Definition, classification and epidemiology of spondyloarthritis. This group of inflammatory rheumatic diseases is characterized by an axial and/or peripheral tropism for enthesis, a genetic pattern, extra articular manifestations (uveitis, psoriasis, MICI) without any auto antibodies. The phenotypic classification separate axial and peripheral forms. Classification criteria have been published by the ASAS group. Prevalence is between 0.20% in South East Asia and 1.61% in Northern Arctic communities.

Définition, classification et épidémiologie des spondyloarthrites. Ce groupe de rhumatismes inflammatoires a en commun une topographie axiale et/ou périphérique avec une atteinte préférentielle de l'enthèse, un terrain génétique (HLA-B27 notamment), des manifestations extra-articulaires (uvéite, psoriasis, entérocolopathie), et une absence d'auto-anticorps. La classification phénotypique actuellement utilisée sépare plutôt les spondyloarthrites à prédominance axiale de celles à prédominance périphérique. Les critères de classification actuels sont ceux de l'Assessment of SpondyloArthritis international Society. Leur prévalence est de 0,20 % en Asie du Sud- Est à 1,61 % dans les communautés du nord de l'Arctique.

[Rheumatic fever].

This lecture-style paper highlights all major problems pertinent to rheumatic fever Definition of acute RF and chronic rheumatic heart disease is proposed and desirability of the use of these terms in clinical practice is explained. Present-day epidemiology of RF is described with reference to marked differences in its prevalence in developed and developing countries. Modern classification of acute RF is described as adopted by the Russian Association of Rheumatologists and recommended for the use in Russian medical facilities. Discussion of etiological issues is focused on such virulence factors as beta-hemolytic streptococcus A and genetic predisposition confirming hereditary nature of RE Its clinical features are described along with laboratory and instrumental methods applied for its diagnostics. Large and small diagnostic criteria of RF are considered. Special attention is given to the treatment of RF and its complications (antibiotic, pathogenetic, and drug therapy). Its primary and secondary prophylaxis is discussed in detail, preparations for the purpose are listed (with doses and duration of application). In conclusion, criteria for the efficacy of therapy are presented along with indications for hospitalization and emergency treatment.

[Activity of lipid peroxidation processes in children with rheumatic fever].

Pathogenic mechanism of acute and chronic inflammation is connected to the increased production of superoxide anion, hydrogen peroxide, and other free radicals. Clinical role of lipid peroxidation (LPO) processes was studied in 38 patients in the age from 3 to 15 years old with different variants of Rheumatic Fever (RF). We have investigated the relationship between malonidialdehide (MDA) and RF. We measured the levels of MDA in the plasma in patients with acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD). Our study revealed that the levels of MDA in patients with ARF are significantly higher than in patients with CRHD. These levels were also significantly higher in patients with history of disease for up to 2 years, than in patients with history longer than 2 years. Thus, the measurement of MDA in the plasma could be used as a laboratory test for relation of active state of rheumatic fever.

Rheumatic fever: the relationship between clinical manifestations and laboratory tests.

OBJECTIVES: To determine the relationship between the severity of clinical features of rheumatic fever (RF), and antistreptolysin O titre (ASOT) and/or erythrocyte sedimentation rate (ESR). METHODS: Clinical and laboratory data from 102 children with RF who had been admitted at a university hospital in Tehran between 1992 and 2002 were reviewed retrospectively. In order to categorize the severity of clinical manifestations of disease, patients were divided into three groups. Those with arthritis alone were defined as group A, carditis with or without arthritis as group B and carditis (with or without arthritis) with congestive heart failure as group C. RESULTS: Thirty-one cases were enrolled in group A, 39 in group B, and 32 in group C. We didn't find a significant relationship between the severity of clinical presentation of disease and ASOT (P = 0.89) and ESR (P = 0.24). Seventy-two patients presented with first attack and 30 had recurrences. The frequency of congestive heart failure (CHF) in first attacks was 31.2%vs 68.8% in recurrences (P < 0.0001). No Significant relationship was found between the number of involved valves and ASOT (P = 0.4) or ESR (P = 0.8). CONCLUSION: Variable clinical presentation of disease and increasing intensity of cardiac involvement is not related to the ASOT or ESR levels.

Descrição dos indicadores sociais em adolescentes portadores de febre reumática / Description of the social markers in adolescents with rheumatic fever

Objetivo: Esta pesquisa objetivou conhecer a realidade socioeconômica em que vivem os adolescentes portadores de febre reumática em tratamento no Instituto Nacional de Cardiologia Laranjeiras (INCL), a fim de estabelecer indicadores para planejar a ação interdisciplinar no atendimetno ao paciente e sua família.Métodos: A partir de um corte transversal, foram entrevistados 120 pacientes portadores de febre reumática em acompanhamento no Ambulatório de Adolescentes do Serviço de Cardiologia Pediátrica, entre junho de 2003 e fevereiro de 2004. Foi aplicado um questionário com o objetivo de coletar e analisar dados como: nível de escolaridade, situação profissional, condições de moradia, renda familiar, número de coabitantes, dificuldades para adesão ao tratamento, prevalência de cirurgias cardíacas e uso da medicação. Este dado foi propositalmente levantado e utilizado para avaliar o número de pacientes que não fazem uso correto da penicilina benzatina e orientar o risco das recidivas de febre reumática.Resultados: Foi observada uma distribuição igual da população estudada em relação ao sexo. A faixa etária variou de 9 a 26 anos. Na população do estudo, 33 por cento não frequentam escola e 28 por cento trabalham. Em relação às condições de moradia, 12,5 por cento não contam com saneametno, e 16,5 por cento têm saneamento parcial, residindo em 4,5 cômodos em média por residência. Quanto ao número de coabitantes, 56,47 por cento residem com 4 ou mais pessoas e 43,53 por cento com 3 ou menos. A renda familiar declarada foi de 1 salário mínimo para 18,1 por cento, enquanto 4,7 por cento sobrevivem da solidariedade humana sem nenhuma remuneração. A média do tempo gasto no deslocamento até o hospital foi de 2 horas e o custo médio com passagens de RS10,40. Cerca de 30 por cento dos entrevistados afirmam não fazer uso correto da medicação. Quanto ao nível de escolaridade dos responsáveis, 14,2 por cento são analfabetos e 46 por cento não completaram o ensino fundamental.Conclusão: Estes dados indicam a premência de serem realizadas ações educativas envolvendo equipes interdisciplinares, para que seja possível a médio prazo minimizar a incidência de recidivas por irregularidade da profilaxia secundária e tornar possível a conquista da cidadania, diminuindo a exclusão social

[Present-day classification and nomenclature of rheumatic fever]. / Sovremennaia klassifikatsiia i nomenklatura revmaticheskoi likhoradki.

The paper presents a new classification of rheumatic fever, which has been adopted by the Plenary Session of the Association of Rheumatologists of Russia in May 2003. This classification envisages the abandonment of the term "rheumatism" in its former interpretation. The term "acute rheumatic fever" (ARF) appears to be more justified since it makes a physician elucidate its association with Group A streptococcal infection of the throat and prescribe antibiotics for eradication of this infection in its acute period (primary prophylaxis) and for prevention of repeated attacks (secondary prophylaxis). The current interpretation of the clinical syndromes/symptoms and laboratory parameters that enter into diagnostic criteria for ARF is presented. There are 2 types of outcome of the disease. In case of recovery, we are dealing with the complete regression of the clinical symptomatology of ARF, normalized laboratory parameters and no residual changes. Chronic rheumatic diseases of the heart are considered to mean a disease characterized by a cardiac valvular lesion as postinflammatory marginal fibrosis of valvular leaflets or cardiac abnormality (failure and/or stenosis) developed after prior ARF. Emphasis is laid on the significance of evidence of Group A streptococcal infection that precedes the development of the disease. Examples of clinical diagnosis in accordance with the terminology of the International Classification of Diseases, the 10th edition, are given in the paper.

Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease.

OBJECTIVE: To determine the prevalence of subclinical synovitis using ultrasound (US) imaging of both painful and asymptomatic joints, in patients with early (<12 months), untreated oligoarthritis (6 joints). Of the 826 asymptomatic (non-painful) joints scanned, 13% (107/826) had US detected synovitis. CONCLUSION: Sonography detected more synovitis than clinical examination in patients with oligoarthritis. In almost two thirds of patients there was evidence of subclinical disease while one third could be reclassified as polyarticular. These findings suggest that a definition of oligoarthritis based purely on clinical findings may be inappropriate, which may have important implications for disease management.

[Jaccoud's arthropathy]. / Ob artropatii Zhakku.

Jaccoud's arthropathy is a variant of deforming arthropathy affecting primarily hands. The author presents literature data and analysis of 28 original cases of valvular disease combined with chronic arthritis. Though these cases were diagnosed as Jaccoud's arthropathy, only one of them met Bywaters' criteria. This female patient is described. Jaccoud's arthropathy is suggested to arise due to connective tissue dysplasia resulting in soft tissue impairment in different rheumatic and nonrheumatic diseases. A working classification and additional criteria for postrheumatic Jaccoud's arthropathy are proposed.

The classification of subjects with joint complaints on incomplete biochemical and haematological datasets.

We performed a retrospective study on 163 subjects suffering from rheumatic fever (16), rheumatoid arthritis (36), lupus erythematosus (17), gout (21), arthrosis (50) and osteomyelitis (23). The number of variables evaluated was 39. These were all of a general biochemical and haematological nature. A feature reduction resulted in sixteen variables that matched well with those known from the literature. Linear discriminant analysis yielded poor results in classifying the six disease categories (with 18 variables 61.8%). A reduction to three disease categories improved the classification results remarkably. This, and the excellent discriminating power between patients and the reference group, shows that the selected variables are illustrative only for general clinical pictures, such as infection, and not for the desired differential diagnosis.