Rheumatic fever historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lance Christiansen, D.O., Anthony Gallo, B.S. [2]
Overview
Rheumatic fever was first described by Galen, a Greek physician in the Roman Empire, in the second century A.D. The term was first used post-Renaissance by Guillaume de Baillou, a French physician, in the early 1600s.
Historical Perspective
Rheumatic fever was first described by Galen, a Greek physician in the Roman Empire, in the second century A.D. The term was first used post-Renaissance by Guillaume de Baillou, a French physician, in the early 1600s. It was first thought that individuals developed an allergic response to Streptococcus pyogenes, but later it was determined that rheumatic fever was an autoimmunological response. Thomas Sydenham described a case of severe rheumatic fever in the late 1600's and a similar description is provided in Encyclopedia Britannica's first edition published in 1771. At times the word, rheumatism, was used as a general term for both acute rheumatism and chronic rheumatism.
In north America, western Europe, Japan, much of Australia and New Zealand rheumatic fever became very uncommon. It decreased in frequency in modern western societies in a progressive fashion from the early 1900's, but it decreased remarkably after WW II so by 1970 it was thought to be a very rare disease in the USA, for instance, but it never disappeared. In certain populations such as the aboriginies of Austrialia and New Zealand it remained common and it also remained common in the aborigines of North America although it is not mentioned frequently in medical literature.
More important, perhaps, are the more chronic, inflammatory, autoimmunologial disease states, which have not been well appreciated in modern times, but which were understood, at least to some degree, during prior eras. Rheumatic fever, an acute, inflammatory, autoimmune disease state was, from the mid-1600's at least, when Sydemham discribed rheumatic fever reasonably accurately, until the early 1900's was termed, often, acute rheumatism or acute articular rheumatism. (Rheumatic Fever and Streptococcal Infections, cited above).
The chronic non-suppurative target-organ manifestions of rheumatic fever, rheumatic heart-valve disease, is not caused by acute rheumatic fever, but it is due to a reasonably elevated, chronic, inflammatory, rheumatic, autoimmune state, which is caused by repeated, or at times chronic, infections by virulent strains of Streptococcus pyogenes. Rheumatic heart-valve disease is common in American society, but there is no outcry from treating cardiologists, and cardiac surgeons, concerning the ongoing development of the high-grade, chronic, rheumatic state within individuals in the American population.
As rheumatic fever slowly, but progressively became less common after about 1850, as the advances of the industrial revolution were instituted into economically developed societies, especially after 1900, high-grade cases of rheumatic fever became less common in modernized parts of the world. Fewer physicians took care of patients with severe rheumatic fever so it slowly became difficult to diagnose, even in the late 1930's, by modern, western-educated physicians. One might think that physicians in modern countries have the least experience and therefore the least knowledge about rheumatic fever, however, they often have advanced knowledge about other aspects of medical science.
During WWII, conditions of over-crowding developed in military training sites, and at sites of war-making activities, so rheumatic fever, as a disease entity, became more common in that environment. Leaders in the U.S. Navy Medical Corps hired T. Duckett Jones, MD, an investigator in the area of rheumatic fever, to study rheumatic fever's epidemiology and clinical development. Dr. Jones, eventually, devised certain sign and symptom criteria to provide an aid for diagnosing rheumatic fever. Those diagnostic criteria were published in the following text, (Jones,T.D., Journal of the American Medical Association|JAMA], 1944; 126:481–484) and have become known as the "Jones Criteria". They are still currently used, in a modified form, to diagnose rheumatic fever. They have been periodically revised by the American Heart Association in collaboration with other groups.[1] Two major criteria, or one major and two minor criteria, when there is also evidence of a previous strep infection, support the diagnosis of rheumatic fever.[2][3]
Unfortunately, since the 1930's, most physicians in modern western countries have dealt with fewer and fewer cases of rheumatic fever so at this time only the very most high-grade cases can be recognized and the symptoms and signs of those cases are what compose the "Jones Criteria". Even with the Jones Criteria having existed for decades, most cases of rheumatic fever suffer from mis-diagnosis, because most physicians simply do not think that rheumatic fever exists in modern, western countries including the USA. Out of mind out of sight is the rule.
References
- ↑ Ferrieri P. Proceedings of the Jones criteria workshop. Circulation 2002; 106: 2521–23
- ↑ Steven J Parrillo, DO, FACOEP, FACEP. "eMedicine — Rheumatic Fever".
- ↑ "Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association". JAMA. 268 (15): 2069–73. 1992. PMID 1404745.