Acute Rheumatism as a Familial Disease

Abstract

Five hundred families with rheumatic members were investigated ; this represented more than eight hundred rheumatic persons in the immediate family circles. This was necessarily largely a study of rheumatism as a familial disease, and it was felt that the value of such observations lay not only in the considerable number of families represented, but in the comparison by one observer of rheumatism in two widely differing communities.By the methods used it was hoped to show the relative importance of heredity and constitution contrasted with infectivity as factors in the occurrence of rheumatism.In the two clinics the methods of obtaining data were similar. The mother of every rheumatic child examined was questioned as to the occurrence of rheumatism in other members of the family, and asked to bring in the other children and, when possible, the father for exami¬ nation. By means of evening clinics and visits to the homes a large percentage of the "contacts" of rheumatic children were questioned and examined. The social conditions of the subjects at the two clinics were regarded as comparable.The manifestations regarded as rheumatism included acute rheu¬ matic fever, chorea, shifting joint pains without fever, and mitral stenosis. Hospital or clinic records, military hospital records and diag¬ noses made by outside physicians were accepted in most cases. The statements of parents were also accepted as evidence of rheumatism in relatives who were not available for examination (usually deceased or out of the country), if in such cases a physician had made a diagnosis of "inflammatory rheumatism with a leaking valve" or "St. Vitus' dance." Cases were omitted in which a systolic apical murmur, apparently organic, was unaccompanied by a history of rheumatism, although it was From the

Genetic Susceptibility to Acute Rheumatic Fever: A Systematic Review and Meta-Analysis of Twin Studies

“…Six studies published between 1933 and 1964 and contributing a total of 435 twin pairs were included in the analysis ( Table 2 ). [21] , [22] , [23] , [24] , [25] , [26] Two of the included datasets [21] , [22] were retrieved from Perry [18] and Honeyman [20] respectively, while another was reported as a conference abstract. [26] Where indicated by the authors, studies were conducted in North America [24] , [25] and Ireland.…”

“…[21] , [22] , [23] , [24] , [25] , [26] Two of the included datasets [21] , [22] were retrieved from Perry [18] and Honeyman [20] respectively, while another was reported as a conference abstract. [26] Where indicated by the authors, studies were conducted in North America [24] , [25] and Ireland. [23] One study [26] specifically focused on twins, while in the others, twin pairs formed part of larger cohorts.…”

“…Where indicated, the diagnosis of acute rheumatic fever was made either using the criteria of the Heart Committee of New York Tuberculosis and Health Association, Inc or the Jones Criteria ( Tables 2 and 3 ). [23] , [24] , [25] , [26] .…”

Further Observations on the Occurrence of Rheumatic Manifestations in the Families of Rheumatic Patients

“…Forty-three of the 96 rheumatic index cases had parents with a history of rheumatic disease. A study of Table I (2,3,4). 2 It should be noted that control families were selected without reference to the past history of rheumatic manifestations in the siblings of the index case so that it could happen that some of the siblings had been registered in the Cardiac Clinic-this did occur in three instances.…”

Rheumatic Fever as a Familial Disease. Environment, Communicability and Heredity in Their Relation to the Observed Familial Incidence of the Disease 12

“…The identification of the susceptible or resistant individual is not possible by any known serological or cutaneous tests. IrvineJones (6) states that simultaneous attacks may be explained " by some nonspecific but infective agent attacking several people of like 'rheumatic' constitution." Draper (7) has suggested that rheumatic susceptibility may be a sex-linked character.…”