THE SIGNIFICANCE OF JOINT PAINS CAUSED BY STERILE STREPTOCOCCUS TOXIN

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Abstract
It has previously been noted that most persons who have joint pains as a reaction to injs. of sterile scarlet fever toxin have in the past had arthritis or other rheumatic affections, and that frequently such persons have low-grade hemolytic streptococ-cus infections of the nose and throat. The object of the present study was to determine whether the reaction of joint pains to hemolytic streptococcus toxin would identify a group of individuals who were more apt to have rheumatic affections at a subsequent time than those who did not give this reaction. The health performance over a period averaging 1 1/2 yrs. of a group of 181 nurses who had this reaction to immunizing doses of scarlet fever toxin was compared with that of a control group of the same number similarly immunized but not manifesting this reaction. It was found that upper respiratory infections occurred in approx. the same number of both groups, but that in the "joint pain"" group arthritis and carditis occurred 3 times more frequently than in the control group. In routine cultures of the nose and throat, taken because the nurses were on duty at Children''''s Hospital and not because they were ill, hemolytic streptococci were found more than twice as frequently in the "joint pain" group than in the control group. Usually positive cultures were associated with infections which were obvious enough to be recognized when the nurses were examined but not sufficiently incapacitating to keep them off duty. Data support the view that a particular type of sensitiveness to hemolytic streptococcus toxins exists in those individuals who develop one or more features of the rheumatic state as a reaction to acute infection.

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