The Antistreptolysin Titer in Rheumatic Fever, Arthritis and Other Diseases

Abstract

Since 1933 a number of serologic tests have been made in the study of patients with rheumatic fever, arthritis, and several other diseases, who have come under the authors' care. These tests include gonococcus complement fixation, hemolytic streptococcus agglutinin and precipitin tests, and antifibrinolysin and antistreptolysin titrations. A preliminary report of the results of these was made in 1936 (1). The purpose of the present report is to give a more detailed analysis of the results of antistreptolysin determinations performed from 1933 to the end of 1938.We have determined the titer of the serum of normal subjects and patients with the following diseases: 1. Scarlet fever 2. Rheumatic fever and chorea 3. Rheumatoid and other types of arthritis 4. A few cases of such miscellaneous conditions as erythema nodosum, pericarditis, lupus erythematosus disseminatus, and periarteritis nodosa. The cases studied were from the Third (New York University) Medical Division of Bellevue Hospital and from the Arthritis Clinics of New York University College of Medicine. The sera were analyzed without knowledge of the clinical diagnoses. The serological determinations were done according to the method of Hodge and Swift (2). Because of the time required for antibody formation to take place, no patient with antistreptolysin titer within the normal range was included in our analysis unless serial determinations were made over a period of at least 4 weeks.1 In all, 1,539 determinations have been made on the sera of 817 patients with the diseases listed above. We have also collected and rearranged results 1 Except in the scarlet fever patients, some of whom were followed only 3 weeks. obtained by others for the purpose of convenient reference.

A Comparative Study of Antihy Aluronidase, Antistreptolysin “O,” Antistreptokinase, and Streptococcal Agglutination Titers in Patients With Rheumatic Fever, Acute Hemolytic Streptococcal Infections, Rheumatoid Arthritis and Non-Rheumatoid Forms of Arthritis 1

“…A similar observation in relation to antistreptolysin titers was made by Bunim and McEwen in 1940 (9 3. The mean antihyaluronidase titer for patients with active rheumatic fever was significantly higher than in any other group of patients studied.…”

“…Antibodies against streptolysin "O" are formed in response to infection with the hemolytic streptococcus and for this reason measurement of antistreptolysin "O" has proved a useful test for indicating recent infection with the hemolytic streptococcus. Among the earlier important investigations of the antistreptolysin "O" titer in patients with hemolytic streptococcal infection, rheumatic fever and glomerulonephritis were those of (3), Myers and Keefer (1934) (4), Blair Fellow, 1947Fellow, -1949 and Pauli (1935) (7), Longcope (1936) (8), Bunim and McEwen (1940) (9), Windblad (1941) (10), and Mote and Jones (1941) (11). More recent studies have confirmed these earlier observations that the antistreptolysin "O" titer increases significantly following hemolytic streptococcal infections of the upper respiratory tract and during rheumatic fever.…”

The Serum Antistreptolysin Titer in Chronic Glomerulonephritis

“…Although, as was previously indicated, there was a higher incidence of the greater rises in antistreptolysin titer among the younger patients than among the older groups, the height of the rise depended on the presence or absence of edema, as well as on the age distribution. This is illustrated in Table V (8) found "no strict correlation between the age of the patient, the severity of the chorea, and the height of the antistreptolysin titer." Mote and Jones (6) found that the incidence of rises in antistreptolysin titer was greater in younger "healthy" control subjects than in the older age groups, presumably because of "a higher incidence of very mild or subclinical respiratory infections in children."…”

The Relation of the Serum Antistreptolysin Titer to the Exacerbation in Chronic Glomerulonephritis

“…The explanation for this apparent correlation between the magnitude of the antistreptolysin titer response and the occurrence of exacerbations in chronic glomerulonephritis is not clear from the data at hand. However, several possibilities may be considered, all of which have been mentioned by several authors (7,8,9,10,11,12,13) in discussions of the relation of the serum antistreptolysin titer to various diseases due to or associated with the group A hemolytic streptococcus. For example, certain strains of hemolytic streptococci may be more prone to evoke both exacerbations and larger rises in titer than other strains, although there is no direct evidence to support this possibility.…”