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CORRESPONDENCE
February 15, 1962.-The cause of rheumatoid arthritis remains unknown. Svartz at
the 6th International Congress of Internal
Medicine held in Basel reported that bacteria from the nasopharynx of patients with
rheumatoid arthritis provoked in animals a
hemagglutinating factor of the same type
as that provoked by rheumatoid factor.
While rheumatoid factor is not the cause
of rheumatoid arthritis, Svartz said, it may
be a metabolite caused by the causative organism of the disease. This appears to be a
microorganism whose properties resemble
those of group B streptococci.
At a symposium on arthritis held last
year in Baltimore, Good and Witebesky
backed the concept that rheumatoid arthritis is triggered by an infectious agent. At
the same time, Ziff expressed doubt about
the role of infection, viewing rheumatoid
arthritis as an autoimmune disease.
Furthermore, the relationship of rheumatic fever to rheumatoid arthritis has been
the subject of conflicting reports. Even as
late as 1960, Coehrs et al. (ARTHRITISAND
RHEUMATBM 3:298, 1960) reported the
finding on postmortem cardiac examinations
of thirty-six patients who had rheumatoid
arthritis. These revealed a high incidence
of lesions, suggesting previous attacks of
rheumatic fever. A variety of inflammatory
changes was observed, supporting previous
reports of similar studies.
Others feel strongly that patients with
rheumatic heart disease and rheumatoid arthritis may have both unrelated diseases.
Continuous chemoprophylaxis for prevention of recurrent attacks of rheumatic fever
is universally accepted, and the long-term
prevention of rheumatic fever recurrences
by eradicating streptococcal infections has
been a standard procedure and an effective method for many years.
I tried to id,entify for myself the relationship between rheumatic fever and rheumatoid arthritis. For this purpose I posed
the question to many rheumatologists and
cardiologists as to whether they ever saw
typical rheumatoid arthritis in a patient
who previously had well documented rheumatic fever and who received regularly
prophylactic penicillin injections. Many negative answers were received. There was one
questionable positive answer. Dr. Taranta
of Irvington House, New York, a worker
with large experience in this field, stated
that among many patients conforming to
the above criteria, one single patient developed rheumatoid arthritis, but a second
thought of his was that this patient might
have had rheumatoid arthritis originally
and not rheumatic fever.
I would like to repeat this question
through your Journal and I hope that many
readers will give helpful information and
comments to elucidate this problem further.
ARPADG. GERARD,M.D.
502 Rahway Avenue
Woodbmdge, N . J .
SIR:
I should like to thank Dr. Robert Stecher
for his article on the World List of Periodical Literature (ARTHRITIS AND RHEUMATISM, August 1961, p. 378). I have found
this very informative.
I agree with Dr. Stecher’s assessment of
the value and popularity of Documenta
Rheumatologica Geigy. I have called his
attention to the fact that he did not mention my contribution to this series: “Prevention & Treatment of Polyarthritis by Active Immobilization ( 1959).” So far this
has been published in England only.
At the Melbourne Institute of Rheumatology we have produced a 30 minute sound
film to demonstrate the technique of active
immobilisation. Recently Dr. William Kuzell
(San Francisco), Dr. Murray Weiner (New
York) and Dr. Charley Smith (Denver)
have ordered prints of this film, which have
been duly sent. So there are three copies
of the film in the U.S.A., should any of
your readers be interested in the technique.
MICHAELKELLY, M.D.
Institute of Rheumatology
410 Albert Street
East Melbourne, Australia
280
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