The history of bacteriologic concepts of rheumatic fever and rheumatoid arthritis.

OBJECTIVES

Review of the development of etiologic and pathogenetic concepts of rheumatic fever (RF) and rheumatoid arthritis (RA) from the beginning of clinical bacteriology to the discovery of antibiotics.

METHOD: Analysis of English and German language publications pertaining to bacteriology and "rheumatism" between the 1870s and 1940s.

RESULTS

Early in the 20th century there was a widely held belief that a microbial cause would eventually be found for most diseases. This encouraged pursuit of the intermittent findings of positive blood and synovial fluid cultures in cases of RF and RA. Development of a streptococcal agglutination test supported the erroneous belief that RA is a streptococcal infection, while the simultaneous development of other immunologic tests for streptococci suggested that a hemolytic streptococcus was etiologic in RF. Table 1 provides a chronology of major events supporting and retarding resolutions.

CONCLUSIONS

Much of the conflicting data and inferences regarding the etiology of RF and RA can be attributed to the absence or inadequacy of controls in observations of clinical cohorts and laboratory experiments.