Bactericidal Power of Blood in Chronic Arthritis

Abstract

There is considerable evidence that chronic rheumatic joint disease, as well as acute rheumatic arthritis, is neither strictly a metabolic disturbance nor purely allergic in character but the result of hematogenous streptococcic infection of the joints. This evidence is of 4 types: the demonstration of streptococci in involved joints with typical structural alteration in direct relation to the actual distribution of the bacteria; 1 , 2 , 3 the streptococcemia which occurs at intervals during the active phases of the disease; 2 , 4 , 5 the presence of streptococcic antibodies in arthritic patients in concentrations greater than those usually found in normal individuals; 5 , 6 , 7 , 8 and the production experimentally of lesions in the joints of animals by the use of intravenous injections of streptococcus cultures. 2 , 10 On the other hand, other investigators have failed to corroborate some of these observations. 11 - 13

This positive evidence has led to the wide use of agglutination and sedimentation tests as diagnostic procedures in chronic arthritis and to the use of vaccines for treatment of the disease. Our own experience and that of others 7 with the use of agglutination tests and determinations of sedimentation rates have led us to believe that these have little practical value in diagnosis or as indices of the results of treatment. In searching for a more reliable index of immunity to streptococcic infection, we have tested the whole or defibrinated blood of 30 patients and the serum of 38 patients from the Evan-ston Hospital Arthritis Clinic for bactericidal power. As controls, 31 tests on the defibrinated blood and 22 on the serum of normal individuals were done. Bactericidal tests were performed also on the blood and serum of 10 patients suffering from non-streptococcic infections and in patients with acute streptococcic sepsis. In most instances the sedimentation rate and the agglutinating titer were determined on samples of blood drawn at the same time for comparison with the results obtained in the bactericidal tests.