Active Rheumatic Heart Disease Research Articles

Enhancement of IL-1, IL-2 production and IL-2 receptor generation in patients with acute rheumatic fever and active rheumatic heart disease; a prospective study.

In a prospective study, patients with quiescent rheumatic heart disease (CRHD), streptococcal pharyngitis (SP) and healthy normal subjects produced comparable amounts of IL-1 and IL-2, but acute rheumatic fever (ARF) patients produced significantly elevated amounts of IL-1 and IL-2 at all intervals up to 48 weeks. In active rheumatic heart disease (ARHD), IL-1 activity returned to within normal range at 48 weeks, but IL-2 activity remained persistently elevated compared with CRHD, SP and healthy age- and sex-matched volunteers. CD4+ T lymphocytes were significantly increased in the peripheral blood of ARF and ARHD patients. The amount of IL-2 produced by ARF and ARHD patients correlated with the percentage of helper T lymphocytes (CD4+ cells) but not with the percentage of suppressor/cytotoxic T lymphocytes (CD8+ cells). Moreover, pre- and post-phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear cell (PBMC) cultures from ARF and ARHD patients contained higher proportions of IL-2R+ (CD25+) cells than those from patients with SP, CRHD and normal individuals, which persisted up to 48 weeks. The percentage of CD25+ cells in both types of PBMC cultures directly correlated with the percentage of CD4+ cells and not with CD8+ cells in active rheumatic patients only. These findings indicate that the immune response in ARF and ARHD patients is skewed to produce activated helper T cells that release IL-2 which drives the accumulation of more T helper cells. The result is an undamped helper T cell response in the peripheral blood of these patients.

Increase in Activated T Cells and Reduction in Suppressor/Cytotoxic T Cells in Acute Rheumatic Fever and Active Rheumatic Heart Disease: A Longitudinal Study

In a prospective study, patients with acute rheumatic fever (ARF) and active rheumatic heart disease (ARHD) showed a significant increase in CD4+ T cells, CD22+ B cells, and CD4:CD8 cell ratio but a significant decrease in the percentages of CD8+ and CD3+ T lymphocytes compared with patients with quiescent RHD (CRHD) or streptococcal pharyngitis (SP) and normal controls. The proportion of interleukin-2 receptor (IL-2R)+ (CD25+) cells was higher in peripheral blood mononuclear cell cultures (both before and after phytohemagglutinin stimulation) of ARF and ARHD patients than in those of CRHD or SP patients or controls; this finding persisted up to 48 weeks. In ARF patients, the percentage of CD8+ cells returned to within normal range at 48 weeks. Furthermore, the percentage of IL-2R+ cells correlated positively with the percentage of CD4+ but not of CD8+ lymphocytes, suggesting that helper/inducer T cells are in an immunologically activated state and may account for aberrations in the distribution of lymphocyte populations in peripheral blood of ARF and ARHD patients.

Rheumatic Fever and Active Rheumatic Heart Disease

Rheumatic Fever and Active Rheumatic Heart Disease

Active rheumatic carditis in patients over 40 years of age

1. 1. Thirty-four case records of histologically active rheumatic heart disease in patients over 40 years of age were studied. 2. 2. The histologic manifestations of rheumatic activity in these patients were compared with the clinical histories. Contrary to our expectations, this study did not result in a good clinicopathologic correlation (Table II). Only in our arbitrary Group I was clinicohistologic correlation satisfactory. 3. 3. Three groups of patients have been described as to their clinical manifestations. In general, their counterpart can be found in the younger age groups. 4. 4. It is suggested that the occurrence of active rheumatic carditis in older patients should be considered more frequently so that the clinical diagnosis will be made more often. Unexplained fever and unusual responses to digitalis may be clues to this end.

The significance of rheumatic activity in chronic rheumatic heart disease: Part II. A method of classification

1. 1. A method of separating patients with active rheumatic heart disease into classes of increasing degrees of activity is described. It is based on the percentage of abnormal leucocyte counts in each case. Patients placed in the inactive group comprise those whose counts were within the normal range. In nine cases the disease was classified as inactive, in sixteen as active in the first degree, in fifteen as active in the second degree, and in nineteen as active in the third degree. 2. 2. Beginning with the inactive group and proceeding through the groups of first, second, and third degree activity, there was progressive increase in the range and in the average leucocyte counts. 3. 3. The average age of the patients in the inactive and first degree groups was higher than that in the second and third. 4. 4. Using the criteria tested in this study, it was found that rheumatic activity was more intense in patients in the third degree group and least in those in the inactive group. 5. 5. The activity of the rheumatic process was least during the summer of each year. 6. 6. Fluctuation in the degree of activity, according to the classification, was very gradual, usually one degree at a time. Since most acute manifestations of rheumatic activity occurred in the higher degree groups, a pre-existing active phase of a lower degree was usually present. Evidence is adduced to show that there are symptomless periods in patients with third degree activity.

THE BLOOD SUGAR AND CARDIAC INVOLVEMENT IN RHEUMATIC FEVER

The rarity of rheumatic heart disease in diabetic patients is significant. Several authors have made references to the infrequency of the development of the former condition in these patients. In a study of fifty-eight cases of active rheumatic heart disease, I have been impressed by the high blood sugar tolerance and low blood sugar curve found to be present in many of these patients. Joslin¹observed only six cases of acute rheumatic fever in approximately 6,000 cases of diabetes during the course of twenty-nine years. He said: "Rheumatic heart disease is of extraordinary rarity. In 1917 I could recall no case of diabetes under fifty years of age in which the patient complained of shortness of breath or presented the signs of an incompetent heart due to valvular disease of a definite and unquestionable rheumatic origin. In a series of fifty-six autopsies performed on young adult diabetics, only one

Roentgen therapy of active rheumatic heart disease. A summary of eleven years' experience: Levy, Robert L., and Golden, Ross: Am. J. M. Sc. 194: 597, 1937

Roentgen therapy of active rheumatic heart disease. A summary of eleven years' experience: Levy, Robert L., and Golden, Ross: Am. J. M. Sc. 194: 597, 1937

Rheumatic heart disease in Southern Florida: Incidence and clinical notes

1. 1. Only 16 cases of rheumatic fever or chorea occurred among 16,200 medical cases in Miami during a period of eight years. 2. 2. Among 413 patients with organic heart disease seen by the author during the past two years in hospital, clinic, or private practice, 103, or practically 25 per cent were of rheumatic etiology. However, in only 6 instances did the rheumatic disease orginate in southern Florida. 3. 3. Rheumatic heart disease is found with only one-third the frequency among elementary school children born in Miami that it is found in children born in the North who have taken up residence in Miami. 4. 4. There is evidence that patients with active rheumatic heart disease improve at a more rapid rate if moved to southern Florida from northern climates during the cold months.