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Rheumatic Heart Disease I: Introduction01:23

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Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
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Genome-wide association studies or GWAS are used to identify whether common SNPs are associated with certain diseases. Suppose specific SNPs are more frequently observed in individuals with a particular disease than those without the disease. In that case, those SNPs are said to be associated with the disease. Chi-square analysis is performed to check the probability of the allele likely to be associated with the disease.
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Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

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The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Several cytokine receptors have tightly bound Janus kinase or JAK proteins attached at their cytosolic tail. Small signaling molecules such as cytokines, growth hormones, or prolactins bind to the cytokine receptors and initiate their dimerization. The dimerization brings the cytosolic JAKs together that trans-phosphorylate and activates each other. The activated JAKs now phosphorylate cytosolic tails of the cytokine receptors, which serve as binding sites for adaptor proteins such as  SH2...
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Established rheumatoid arthritis - Redefining the concept.

Katerina Chatzidionysiou1, George E Fragoulis2

  • 1Department of Medicine, Solna, Karolinska Institute. Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden.

Best Practice & Research. Clinical Rheumatology
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Summary

Defining established rheumatoid arthritis (RA) is crucial for research. We propose defining established RA from the time of clinical diagnosis, regardless of symptom duration or damage, to differentiate it from early or undifferentiated arthritis.

Keywords:
Early rheumatoid arthritisEstablished RARheumatoid arthritisWindow of opportunity

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Area of Science:

  • Rheumatology
  • Immunopathology
  • Clinical Research

Background:

  • Research in rheumatoid arthritis (RA) increasingly focuses on early disease stages.
  • Clear definitions for early and established RA are essential for understanding immunopathology.
  • Established RA is associated with chronic inflammation, joint damage, and comorbidities.

Purpose of the Study:

  • To propose a clear definition for established rheumatoid arthritis.
  • To differentiate established RA from undifferentiated arthritis (UA) or RA risk.
  • To facilitate research into early RA and its immunopathological mechanisms.

Main Methods:

  • Review of current RA research focus and definitions.
  • Analysis of limitations in chronological and radiological definitions for RA.
  • Proposal of a new definition for established RA based on clinical diagnosis.

Main Results:

  • Chronological and radiological definitions lack precision in differentiating RA disease states.
  • Patient heterogeneity in RA progression complicates existing definitions.
  • A proposed definition of established RA is based on the point of definite clinical diagnosis.

Conclusions:

  • A precise definition of established RA is needed, independent of symptom duration or irreversible damage.
  • The proposed definition distinguishes established RA from earlier stages like UA or RA risk.
  • This definition aims to improve the focus and clarity of RA research.