VARIOUS RHEUMATIC SYNDROMES IN ADULT PATIENTS ASSOCIATED WITH HIGH ANTISTREPTOLYSIN-O TITERS AND THEIR DIFFERENTIAL-DIAGNOSIS WITH RHEUMATIC-FEVER

Objectives-The purpose of this study was to analyse retrospectively ad ult patients with acute joint or muscle symptoms and a high antistrept olysin O (ASO) titre to find out which syndromes of clinical arthritis are associated with serological evidence of streptococcal infection. Methods-Seventy six adult patients with an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high ASO titre (greater-than-or-equal-to 500 Todd units) were exami ned in two time periods in the 1980s. Results-Twenty six patients had arthritis associated with a known rheumatic disease, 25 had non-specif ic 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 t he whole patient group than in the healthy Finnish population (30 v 14 %). Conclusions-It is concluded that classic rheumatic fever is now ra re, even in patients with arthritis with a high ASO titre. These resul ts support the suggestion that beta haemolytic streptococci may trigge r reactive arthritis as well as rheumatic fever.