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KMID : 0381219720040010033
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Journal of RIMSK
1972 Volume.4 No. 1 p.33 ~ p.50
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THE VARIOUS RHEUMATIC DISEASES IN INTERNAL MEDICINE AND ITS PATHOGENESIS
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Abstract
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1. Rheumatism:
The Greek word "rheumatismos", which designated mucous (catarrh) as an evil humor which was thought to flow from the brain to the joints and other portions of the body producing pain. Since recent studies have shown that an alteration of an important constituent of the joint mucin (the muco-polysaccharide; hyaluronic acid) actually occurs in at least some of the "rheumatic diseases", the term, at long last, may be somewhat appropriate. The rheumatic diseases are those conditions in which pain & stiffness of some portion of musculo skeletal system are prominent. These are diseases of connective tissue.
2. Streptococcal infection:
Streptococcal sore throat:
The commonest infection due to 8-hemolytic streptococci is streptococci sore throat. In the infant & small child it occurs as a sub acute nasopharyngitis with a thin serous discharge & little fever but with a. marked tendency of the infection to extend to the middle ear the mastoid & the meninges. The cervical lymph nodes are usually enlarged. The illness may persist for weeks or months, In children between the. Ages of 3^-12 the disease in more acute & is characterized by intense nasopharyngitis, tonsillitis.& intense redness & edema of the mucous membranes & a high fever usually.
Rheumatic fever in a sequel of group A. hemolytic streptococcal infections & in characterized by febrile & toxic states of varying intensities & duration by the occurrence of multiple disseminated focal inflammatory lesions in the heart, blood vessels & joints & sometimes by serofibrinous inflammations of´ the great body cavities & joints. The disease is further characterized by a tendency for the fever, toxicity & arthritis to disappear after the proper administration of certain antipyretic drugs.
3. Hypersensitivity-theory:
Rheumatic heart disease is an inflammatory carditis but few diseases will involve chiefly the endocarditic un-specific verrucous endoccarditis. usually was diagnosed at autopsy table but it in not a terminal disease. Evidence of frequent accompaniment of infectious diseases, perhaps antigen-antibody reaction.
It is a type of allergic phenomenon. Small verrucue can be seen on the valves, particularly on mitral valve, or aortic valve. Described the Cohn´s statistics data of rheumatic fever & carditis. Also described the data of pathological studies of the un-specific verrucous endocarditis by Lell, Moore.
Pathological findings are essentially to change markedly in connective tissue which is rich in hyalu-
ronates, the joints, blood vessels, interstitial tissues. This is matrix for changes. There are two types of changes;
(1) Degeneration of matrix c appearance of fibrinoid material. It is the acute nature, later stage
hyaluronidase is appearing.
(2) Proliferative changes can be seen:
(a) Appearance of large cell-Aschoff cell. Appears in allergic responses. may be a pathological plasma cell.
(b) Appearance of myoblasts.
4. Auto-immune theory:
In 1955, Cavelti proposed that the rheumatic fever is caused by auto antibodies in response to damaged tissue of the host & that such antibodies result in further tissue damage & antigen formation. He produced antibodies to the heart & connective tissue as well as kidney of rats & rabbits, by repeated
injections of emulsions of the homologous tissues in conjunction killed streptococci.
Group A streptococci are unable to cause rheumatic fever directly, it is possible that repeated streptococcal infections by their effect on the host create new substances which are then capable of producing rheumatic fever. Cardiac lesions closely resembling those of rheumatic fever were induced in rabbits following repeated skin infections C group A streptococci. These studies on the concept of the hemolytic streptococcus-host combination have at present only an indirect speculative bearing on the pathogenesis of rheumatic fever. Rheumatic heart disease as seen in the human has not been produced in animals on the basis of this or other ´concepts. This autoimmune theory would be farther developing in rheumatic diseases. Heteroimmunization, isoimmunization problems are important subjects on autoimmune -research field. Side-chain theory of Ehrlich has been dominating concept for near a century long. In 1959, the appearing of the Burnet´s clonal selection theory which is an interesting concept of the transplantation immunity field. The immunological homeostasis, immune paralysis, homograft rejection phenomenon, specific immunological tolerance & etc. are important & interesting problems of the biological defense power which are relating with the hereditary protein structures as the´ structure gene. Such a biological defense power mechanism would be to contribute in the pathogenesis of rheumatic diseases in .near future.
5. Collagen diseases:
Klemperer, pollack & Baehr described the new important concept in the histopathological studies. Further studies have shown that a number of diseases which were apparently unrelated from a clinical point of view are characterized by a fundamentally similar type of fibrinoid degeneration of collagen which was regarded as the common denominator for this group of diseases.
Identified as belonging to this group of diseases are; serum sickness, periarteritis nodes, disseminated lupus erythematosus, rheumatic fever, rheumatoid arthritis, & its variants, scleroderma, dermatomyositis & probably calcinosis.
6. Describe the rheumatic clinical aspects on the various points, etiology, pre & post-streptocochoi
cal infection, symptoms & signs, diagnosis, differential diagnosis, Jones revised rheumatic criteria, laboratory tests and etc.
7. Korean Rheumatism association:
We organized in 1971, March. Korean Rheumatism association and we participated b South East Asia & Pacific Area League Against Rheumatism (SEAPAL) ´
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