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Summary
Analysis of the material consisting of joint exudate and sera from 62 patients with active rheumatoid arthritis has shown a difference between the number of positive streptococcal agglutination reactions in the joint exudate and sera. The hemagglutination test gave no difference in the number of positive reactions in sera and joint exudate treated with hyaluronidase.
The streptococcal agglutination tests — L- and O-agglutination reactions — were thus positive in 64.5 % (L-aggl.) 69.4 % (O-aggl.) in hyaluronidase-treated joint exudate against only 51.6 % (L-aggl.) and 40.3 % (O-aggl.) of the sera.
The author suggests that the difference can be due to the appearance of inhibitors in sera directed against streptococcal agglutination reactions during development of R.A. 10 cases of R.A. were followed for 2 years with repeated control of the serological reactions during the development of the R.A. This material suggests that the streptococcal agglutination reactions can temporarily disappear to recur later and be positive.
The discrepancy between hemagglutination test and streptococcal agglutination reactions might be partly explained by the occurrence of inhibitors against streptococcal agglutination reactions in association with temporary improvement of the patients with a decrease in the activity in the individual cases.
The investigations hitherto performed have thus shown a discrepancy between the character of the agglutinating factors in joint exudate and in sera from patients with rheumatoid arthritis. This difference argues against the assumption that the streptococcal agglutination reactions should be a manifestation of the same agglutinating factor as the hemagglutination test, for example. The streptococcal agglutination reactions should therefore be conceived as not being identical with other serological reactions and therefore as having a different diagnostic and prognostic value.