THERE has been a tendency to regard rheumatoid arthritis as a disease of the musculoskeletal system. Any associated cardiac lesions were usually considered the results of an unrelated process, such as arteriosclerosis, hypertensive vascular disease or rheumatic fever. However, in the past several years attention has been drawn to the occurrence of pancardiac abnormalities, incapable of being ascribed to such coexistent disorders, in patients with rheumatoid arthritis. Several recent studies have extended and considerably broadened the classical concepts of this disease. In 1932 Wetherby1 found evidence of rheumatic heart disease in 2 per cent of a group of 350 patients with "chronic arthritis." He admitted his inability to diagnose satisfactorily those conditions which began with acute migratory polyarthritis—at first considered rheumatic fever—and which progressed to involvement of the joints typical of rheumatoid arthritis. There were 32 such patients, mostly in the younger age groups, in 18.7 per cent of
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