Antistreptolysin Titers in Rheumatoid Arthritis

The findings of Todd, Coburn and Pauli, and others indicate that the antistreptolysin test furnishes an accurate method for determining the presence of recent infection with hemolytic streptococci of group A. Coburn and Pauli showed that, following hemolytic streptococcal infections, the antistreptolysin titer of the serum rises rapidly, remains elevated for a variable number of months and gradually tends to return to normal values. In nearly all cases in their series there was an appreciable fall in titer within 6 months and within 2 years over half the cases had reached natural levels. Myers and Keefer studied the antistreptolysin titer in 13 cases of active rheumatoid arthritis and found that, although the titers varied considerably, the average was not greater than in normal individuals. They stated that “in most of these patients the disease had existed for many months.” Blair and Hallman determined the antistreptolysin titer in 45 patients with rheumatoid arthritis and found it to be above the normal range (over 100 units per cc.) in one-third of the cases. In their report no reference was made to the duration of the disease at the time of the observations or to the nature of the onset. We have determined the antistreptolysin titer in 219 cases of rheumatoid arthritis, including 22 cases of rheumatoid spondylitis (Marie-Strümpell). Preliminary observations, indicated that in the great majority of well established cases the titer was within normal limits, irrespective of the degree of clinical activity present. However, when the sera of early cases with acute onset were examined quite different results were obtained. In the present report, therefore, the cases are divided into 2 groups, “early” and “late” cases. For convenience, cases of less than one year's duration are considered as “early” and those of longer duration are considered as “late”. In addition, the nature of onset, whether acute, subacute or insidious, has been recorded in each instance.