Acta Morphologica 8. Supplementum (1959)

Proceedings of the annual meeting of Hungarian Pathologists and Anatomists. Hévíz, 1958. Pathology of the Rheumatic Deseases

theory of the pathogenesis of rheumatism is based on an imbalance claimed to exist between hyaluronidase and hyaluronic acid. Haemolytic streptococci, these organisms so important in rheumatic conditions, are definitely hyaluroni­dase producers. Other bacterial enzymes may also be at play. Almost all of the bacteria which may be involved in the pathogenesis of rheumatism all contain amino acid decarboxylase, first of all histidine decarboxylase, which in certain conditions converts histidine to histamine. In acute articular inflam­mations the serum has been proved to exert an increased histidine decarboxy­lase activity. In cultures, histidine decarboxylase causes a release of mucopoly­saccharides from connective tissue linkages. If the loss of mucopolysaccharides amounts to about 10 per cent, the connective tissue fibres swell and lose their normal shape and a loss amounting to 20 to 25 per cent converts collagen to a homogeneous mass. Recent information concerning the physical, chemical and histological properties of connective tissue has opened up a new chapter of research on mesenchymal diseases. The fundamental statements made by Klemperer et al. have placed into the focus of interest the changes in the intercellular matter of connective tissue, with the result that a common pathogenetical view has been developed for a variety of conditions which earlier had been thought to be heterogeneous. In view of the similarity of the changes in the ground sub­stance of connective tissue, these conditions have been denoted by the common term of collagenosis. The most characteristic representative of the group is rheumatic polyarthritis. Summing up, none of the theories has offered a full explanation for the aetio-morpho- and pathogenesis of rheumatic diseases. It appears that various factors may start the process, which is determined by constitutional dispositional conditions, individual responsiveness, in at least the same measure as by certain, often overestimated, exogenous factors. In the definition of the concept of rheumatic diseases we find two extremes viz. 1. the pathological-anatomical definition based on the presence of Aschoff bodies or of allergic changes in tissues; and 2. the clinical definition, which is based exclusively on symptoms and signs. The International League against Rheumatism has on its records more than 60 different classifications. Consider­ing that in every case the emphasis is on mesenchymal changes, any organ or tissue of the body may be affected. A true picture of the pathology of rheuma­tism can be obtained exclusively by a synthetic analysis of the clinical and morbid anatomical data. Streptococci are important factors in pathogenesis. Rheumatism is by no means a simple infectious disease and in all likelihood streptococcal infection develops in a previously sensitized organism. The streptococcal factors of particular importance are streptokinase (fibrinolysin), streptodornase (which breaks down nucleotides) and hyaluronidase. Common symptoms and signs

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