Gibofsky A, Zabriskie J B
Hospital for Special Surgery-Cornell University Medical College, New York, New York, USA.
Curr Opin Rheumatol. 1995 Jul;7(4):299-305. doi: 10.1097/00002281-199507000-00006.
Rheumatic fever is a catastrophic illness in many parts of the world, particularly in developing nations, where the incidence has been estimated to be between 10 and 15 million new cases each year. In the United States, rheumatic fever had become a rarity, having virtually disappeared by the mid 1960s. Of increasing concern, however, was the abrupt rise in the incidence of rheumatic fever in the United States in the mid 1980s, with reported "outbreaks" in middle-class communities in five cities and two military camps. Recently, a number of cases of poststreptococcal reactive arthritis have been reported. On close examination, however, these are most likely alternate clinical presentations of rheumatic fever. It is widely accepted that rheumatic fever occurs following an overactive immune response by a genetically susceptible host to oropharyngeal infection with group A beta-hemolytic streptococci. Nevertheless, details of pathogenesis at a level allowing more effective intervention remain obscure. The question of pathogenesis holds a deep interest, because rheumatic fever is one of the few autoimmune diseases with a known infectious etiology.
在世界许多地区，尤其是发展中国家，风湿热是一种灾难性疾病，据估计，这些地区每年有1000万至1500万新发病例。在美国，风湿热已变得罕见，到20世纪60年代中期几乎已消失。然而，越来越令人担忧的是，20世纪80年代中期美国风湿热发病率突然上升，有报道称在五个城市的中产阶级社区和两个军事营地出现了“疫情”。最近，有一些关于链球菌感染后反应性关节炎病例的报道。然而，经过仔细检查，这些很可能是风湿热的不同临床表现。人们普遍认为，风湿热是由遗传易感性宿主对A组β溶血性链球菌口咽感染产生过度活跃的免疫反应后发生的。然而，在能实现更有效干预的层面上，发病机制的细节仍不清楚。发病机制问题备受关注，因为风湿热是少数几种已知有感染病因的自身免疫性疾病之一。
