The Pathogenesis of Rheumatic Fever

Abstract

It is evident that there are two distinct types of response on the part of the body to the infectious agent of rheumatic fever; viz., proliferative and exudative. The perivascular proliferative type of lesion, resembling an infectious granuloma, explains the subacute and chronic character of the clinical symptoms in many patients with this disease. Marked exudation of serum into the periarticular tissues and of serum and cells into the joint cavities are concomitants of the acute arthritis occurring with high fever and general intoxication; these acute exudations disappear following the administration of certain drugs. But their disappearance does not mean necessarily that all lesions of the proliferative type have resolved. In fact, we know that these last mentioned lesions, when present in the subcutaneous tissues, often continue for months; and from analogy we may conclude that they have a similar persistent character in other tissues of the body invaded by the causative agent of rheumatic fever.

The Induction of Rheumatic-Like Cardiac Lesions in Rabbits by Repeated Focal Infections With Group a Streptococci

“…Rows of fine verrucae, characteristic of active rheumatic valvular endocarditis of several weeks' duration, have not, however, been found on these rabbit heart valves. It should be noted that in man, moreover, verrucae are probably secondary to interstitial valvulitis of several weeks' duration, for careful microscopic study of valves of the hearts of patients dying early in an attack of rheumatic fever (5) reveals chiefly interstitial inflammation and in some instances palisades of endocardial and subendocardial cells similar to those found in these rabbits. For example ( Fig.…”

The Leucocyte Curve as an Index of the Infection in Rheumatic Fever 1

“…After the temperature had returned to normal the leucocytosis again subsided, but the leucocytes remained slightly above normal at the time of discharge. This case illustrates both the continuous and relapsing nature of the disease and the persistence of leucocytosis, as well as the slight, or negligible influence of anti-rheumatic drugs on the leucocytosis during the first 4 months. An interesting point is the transient fall of the leucocyte curve to normal in the 5th month, and its subsequent rise which preceded the last cycle of fever and tachycardia.…”

“…F. SWIFT, C. P. MILLER, JR., AND R. H. BOOTS nodules. As already mentioned in another place (Swift,4) we may consider that against the infectious agent of rheumatic fever there are two types of tissue response: exudative and proliferative. The exudative, of which leucocytosis may be considered an example, is much more subject to the influence of the anti-rheumatic drugs than are the proliferative types, such as subcutaneous nodules.…”

The Effect of Anti-Rheumatic Drugs on the Arthritis and Immune Body Production in Serum Disease

“…The percentages with moderately severe arthritis were about the same in each series, i.e., 14.6 per cent of the treated patients and 15.2 per cent of the untreated. Further, it will be noted that only the one patient mentioned above, who was insufficiently treated, or 3 per cent of the treated patients, had a severe arthritis, compared with over 30 per cent among those untreated. Thus, as is well shown in this table, the lessening in the frequency and severity of the arthnrtis in the treated patients is quite evident.…”

“…Neocinchophen, because of its anti-exudative influence in acute rheumatic fever (3) and the ease with which it is tolerated by patients, was employed in the first twenty-five cases; it was replaced by aspirin in the last nine. Depending upon the age and weight of the patient and his tolerance for the agent, neocinchophen was used in amounts of 8 to 10 grams daily, aspirin in doses of 5 to 6 grams.…”