Medical recruitment examination medical basic information: what are the hazards of rheumatism?

the main pathological changes of rheumatism occur in collagen fibers of connective tissue, and all organs of the whole body can be involved, but the lesions in the heart, blood vessels and serosa are the most obvious. The characteristic pathological change of rheumatism is rheumatism corpuscle, that is, Aschoff corpuscle, which is significant for the diagnosis of rheumatism. The development process of the disease is long and can be divided into three stages:

1. Deterioration and exudation stage: it is the early change of rheumatism. In the heart, serosa, joints, skin and other pathological sites, it shows mucinous degeneration of connective tissue matrix and collagen-cellulose necrosis. At the same time, in the process of serous cellulose exudation, a small number of lymphocytes, plasma cells and monocytes infiltrated. This stage of the lesion can last for 1 month.

2. Proliferative stage or granulomatous stage: The characteristic of this stage is that on the basis of deterioration and exudation, there are characteristic granulomatous lesions in myocardial stroma, endocardium and subcutaneous connective tissue, which are called rheumatic corpuscles or Aschoff corpuscles. Rheumatoid corpuscles are composed of groups of rheumatic cells and a small number of lymphocytes and plasma cells gathered in cellulose-like necrosis foci. Rheumatoid cells are transformed from proliferating macrophages after phagocytosis of cellulose-like necrotic substances. Rheumatoid cells, also known as Schouw cells, can last for 2~3 months.

3. Fibrosis stage or hardening stage: the necrotic tissue in Aschoff corpuscle is gradually absorbed, and the rheumatic cells are transformed into fibroblasts, so that the rheumatic corpuscle is gradually fibrosed, and finally a small spindle scar is formed. This stage of the lesion can last for 2~3 months.

the whole course of the disease is 4~6 months. Due to the recurrent nature of rheumatic diseases, the coexistence of old and new diseases can often be seen in the affected organs and tissues. The pathological changes continue to progress repeatedly, and fibrotic scars can be formed continuously, destroying tissue structure and affecting organ function.

2. organ changes of rheumatism

1. rheumatic heart disease

heart diseases caused by rheumatism can be manifested as rheumatic endocarditis, rheumatic myocarditis and rheumatic epicarditis. If the lesion involves the whole layer of heart tissue, it is called rheumatic carditis or rheumatic carditis. Among children with rheumatism, 6%~8% have clinical manifestations of carditis.

2. Rheumatoid arthritis

About 75% patients with rheumatic fever develop rheumatoid arthritis in the early stage of the disease. The most common invasion is knee, ankle, shoulder, wrist, elbow and other major joints, which are wandering and recurrent. There are redness, heat, pain and dysfunction in the joints. There is serous fluid and fibrin exudation in the joint cavity, the diseased synovium is congested and swollen, and atypical Aschoff corpuscles can be seen in the adjacent soft tissues. After the acute phase, the exudate is easily absorbed completely, generally leaving no sequelae.

3. Skin lesions

In acute rheumatism, annular erythema and subcutaneous nodules appear on the skin, which is of diagnostic significance.

4. Rheumatic arteritis

Rheumatic polyarteritis can involve both large and small arteries, especially small arteries,

5. Rheumatic encephalopathy

is more common in children aged 5-12 years, with more girls. The main pathological changes are rheumatic arteritis and subcortical encephalitis of the brain.