The physical examination found that the anti-chain "O" high, how to do?

Don't want to miss Jiemei's push? Poke the blue word "medical rheumatism and nephropathy channel" to pay attention to us and click the "··" menu in the upper right corner and select "set as star" to resist "O" high. Is it rheumatoid arthritis or rheumatic heart disease? Many physical examination patients with anti streptolysin "O" test (hereinafter referred to as "anti-o") high test sheet to the rheumatology clinic, worried that they have rheumatoid arthritis or rheumatic heart disease.however, is anti-o high necessarily due to rheumatoid arthritis or rheumatic heart disease? Of course not! What is anti-o? Anti "O" is an antibody produced by the body with streptolysin O as antigen.by measuring the anti-o titer in serum, we can judge whether the patient has group a hemolytic streptococcus infection, which can be used as one of the auxiliary diagnostic methods of group a hemolytic streptococcal infectious diseases, and its existence and content can reflect the severity of infection.the anti-o titer began to increase about one week after group A streptococcus infection, reached the peak at 3-6 weeks, and lasted for several months. When the infection decreased, the anti-o value decreased and returned to the normal value within 6 months. If the anti-o titer did not decrease, it indicated that there might be recurrent infection or chronic infection.the antibody titer increased gradually, which was of great significance for diagnosis. The antibody titer decreased gradually, indicating the remission of the disease.anti-o test can only confirm that the patient has group a hemolytic streptococcus infection in the near future, but can not indicate whether there is autoimmune reaction induced by group a hemolytic streptococcus infection in the body.2 the cause of the increase of anti-o was that the anti-o was significantly increased in patients with rheumatoid arthritis, but it was also increased in patients with acute glomerulonephritis, erythema nodosum, scarlet fever and acute tonsillitis, and a few patients with hepatitis, connective tissue disease, tuberculosis and multiple myeloma could also increase the anti-o.because group A streptococcus is very common in nature, people have a lot of contact opportunities, and normal people also have low titer antibodies. Only when the titer is & gt; 200iu / ml, can it be considered as diagnostic significance.3 do you have rheumatoid arthritis? Rheumatoid arthritis is a kind of systemic connective tissue inflammation, which mainly involves joints, heart, skin and subcutaneous tissue after infection with group B hemolytic streptococcus in throat.at present, the most widely used diagnostic criteria for rheumatoid arthritis is the criteria revised by the American Heart Association in 1992. The standard is divided into three main contents: cardiac inflammation, polyarthritis, chorea, erythema annularis and subcutaneous nodules.the secondary manifestations included joint pain, fever, ESR and increased C-reactive protein. ECG indicated that the P-R interval was prolonged.Third, there is evidence of precursor streptococcal infection, such as throat swab culture or rapid Streptococcus antigen test positive, Streptococcus antibody titer increased.if there is evidence of precursor streptococcal infection, and there are two major manifestations, or one major manifestation plus two secondary manifestations, it is highly suggestive of acute rheumatoid arthritis.therefore, if the anti-o is found to be high, the patient should be evaluated for joint pain, erythema annularis, subcutaneous nodules, fever and chorea symptoms, and then combined with the results of laboratory tests such as erythrocyte sedimentation rate, C-reactive protein, myocardial enzymes, cardiac color Doppler ultrasound and electrocardiogram.for atypical or mild rheumatoid arthritis, the symptoms of carditis, such as palpitation, shortness of breath, dizziness, fatigue and low fever, should be carefully examined. Combined with echocardiography, electrocardiogram and myocardial nuclide examination, attention should be paid to the differentiation and exclusion of rheumatoid arthritis, reactive arthritis, tuberculosis, allergic arthritis (Poncet's disease), subacute infective endocarditis and viral carditis And other diseases.4 how to treat rheumatoid arthritis? The treatment of rheumatoid arthritis includes eliminating streptococcus infection, eliminating the cause of rheumatoid arthritis, controlling clinical symptoms and dealing with various complications, so as to improve the physical quality and quality of life of patients, and prolong their life span.pay attention to keep warm and avoid damp and cold. Patients with carditis should stay in bed and rest in the acute stage, and recover after 3-4 weeks of disease control.in the early stage of acute arthritis, you should also stay in bed and start to exercise after ESR and body temperature are normal.long acting penicillin benzathine penicillin is the first choice to eliminate streptococcal infection foci. Non steroidal anti-inflammatory drugs are preferred for simple joint involvement. Acetylsalicylic acid (aspirin) is commonly used. Glucocorticoid prednisone is generally used for the treatment of patients with carditis.therefore, whether anti-o is high or not has rheumatoid arthritis and whether treatment is needed depends on the individual.some people have increased anti-o, but they have not manifested as carditis, polyarthritis, chorea, erythema annularis, subcutaneous nodules, fever, sore throat, erythrocyte sedimentation rate and increased C-reactive protein, which can not be considered as rheumatoid arthritis, but can only indicate that they have a history of hemolytic streptococcus infection or tonsillitis, pharyngitis, scarlet fever and other diseases recently.however, the etiology of rheumatoid arthritis is indeed related to streptococcal infection, so the specific diagnosis and treatment should be based on clinical symptoms and laboratory examination when the anti-o level increases in the active stage of rheumatoid arthritis.References: [1]. Huang Feng. Jones standard for the diagnosis of rheumatic fever, revised in 1992 [J]. Journal of American Medical Association: Chinese version, 1993, 012 (003): 141-146. [2]. Han Yanyan, sun Jinghui. Progress in diagnosis and treatment of rheumatic fever [J]. Journal of Clinical Pediatrics, 2012. [3]. Zong Wenna (review), Yang Xiaohui (review), Lu Xinzheng (reviser). Expert consensus on prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis [J]. Progress in cardiovascular disease, 2009