Valtonen J M, Koskimies S, Miettinen A, Valtonen V V
Second Department of Medicine, Helsinki University Central Hospital, Finland.
Ann Rheum Dis. 1993 Jul;52(7):527-30. doi: 10.1136/ard.52.7.527.
The purpose of this study was to analyse retrospectively adult patients with acute joint or muscle symptoms and a high antistreptolysin O (ASO) titre to find out which syndromes of clinical arthritis are associated with serological evidence of streptococcal infection.
Seventy six adult patients with an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high ASO titre (> or = 500 Todd units) were examined in two time periods in the 1980s.
Twenty six patients had arthritis associated with a known rheumatic disease, 25 had non-specific arthralgia/myalgia, 20 had reactive arthritis, and five had septic arthritis. No case of classic rheumatic fever classified by two major criteria was found. Six patients fulfilled one major and at least two minor criteria. The frequency of HLA-B27 was significantly higher in the whole patient group than in the healthy Finnish population (30 v 14%).
It is concluded that classic rheumatic fever is now rare, even in patients with arthritis with a high ASO titre. These results support the suggestion that beta haemolytic streptococci may trigger reactive arthritis as well as rheumatic fever.
本研究旨在回顾性分析患有急性关节或肌肉症状且抗链球菌溶血素O（ASO）滴度高的成年患者，以找出哪些临床关节炎综合征与链球菌感染的血清学证据相关。
在20世纪80年代的两个时间段内，对76名患有急性关节炎综合征或慢性风湿性疾病加重且同时ASO滴度高（≥500托德单位）的成年患者进行了检查。
26名患者患有关节炎且伴有已知的风湿性疾病，25名患者有非特异性关节痛/肌痛，20名患者有反应性关节炎，5名患者有化脓性关节炎。未发现符合两项主要标准的典型风湿热病例。6名患者符合一项主要标准和至少两项次要标准。整个患者组中HLA - B27的频率显著高于健康的芬兰人群（30%对14%）。
得出的结论是，即使在ASO滴度高的关节炎患者中，典型风湿热现在也很少见。这些结果支持了β溶血性链球菌可能引发反应性关节炎以及风湿热的观点。
