Discussion: Microbes and Microbial Products in the Pathogenesis of Rheumatoid Inflammation
In the discussion of Dr. Dumonde’s paper the question was raised as to the possible role of extrinsic microbial antigens and autoantigens in the pathogenesis of human rheumatoid arthritis (RA). In his answer, Dr. Dumonde pointed out that there is circumstantial evidence that the rheumatoid syndromes may be precipitable by microbial infection, but some 50 years of microbiologic, cell biologic, and immunologic research have failed to associate the presence of any microorganism or its antigens in the joint with RA. He suggested that mechanisms of pathogenesis may exist by which the host reacts at a distance from the invasion at the portal of entry of a microorganism. Highly sophisticated techniques of bacteriology and immunology have been applied to the joint in RA and to detect specific host responses to microorganisms, but all this work has led to essentially negative results. Yet, there remains the clinical impression, particularly in juvenile rheumatism, that infections precipitate rheumatic disease. Thus, it was proposed that RA is a reactive arthritis to a wide spectrum of microbial products.