ANTICARDIOLIPIN ANTIBODIES IN RHEUMATOID ARTHRITIS

Anticardiolipin antibody (ACA) was present in the sera of 49%of 90 consecutive patients with rheumatoid arthritis (RA). TheACA was absent in 30 control patients with osteoarthritis. C-reactiveprotein levels equal to or exceeding 7 mg/dl were found in 10patients all of whom were ACA positive. ACA was present in a larger proportion of rheumatoid factor(RF) positive than of RF negative patients. Male sex and extra-articularmanifestations of RA were both more common in ACA positive thanACA negative patients. In the ACA positive group the lupus anticoagulant and VDRL testswere negative. However, a small number of patients had evidenceof vascular events. KEY WORDS: Anticardiolipin antibody, C-reactive protein, Rheumatoid arthritis, Osteoarthritis     

ANTIBODIES TO SYNTHETIC PEPTIDE P62 CORRESPONDING TO THE MAJOR EPITOPE OF RHEUMATOID ARTHRITIS NUCLEAR ANTIGEN IN A WEST AFRICAN POPULATION WITH RHEUMATOID ARTHRITIS

Using a synthetic peptide (P62) we have investigated antibodiesto rheumatoid arthritis nuclear antigen (RANA) in 58 West Africanpatients with RA, 51 with malaria, 111 with tuberculosis (TB)and 166 healthy controls by ELISA using a synthetic peptide(P62). As in Western populations the RA.sera showed significantlyincreased levels of anti-P62 antibodies though in our studythe mean litres were only elevated twofold above the controls.The levels in malaria and TB were normal. Our data extend previouswork by showing that raised anti-P62 antibodies is a consistentfinding in RA world-wide including indigenous West African patients. KEY WORDS: Epstein-Barr virus, Rheumatoid arthritis nuclear antigen, Rheumatoid arthritis, Africans     

ANTIBODIES TO TYPE II COLLAGEN IN EARLY RHEUMATOID ARTHRITIS

Antibodies to native and denatured type II collagen were investigatedin a group of 79 patients with rheumatoid arthritis (RA) ofdisease duration less than 12 months (median 8 months; range3–12 months). Using a solid-phase ELISA to measure theseantibodies, the incidence of patients with levels above theupper limit of normal (mean of normal plus 3 SD) was low ascompared to previous findings in patients with established disease.The majority of positive sera contained small amounts of IgMantibodies to denatured type II collagen whilst a few had IgGantibodies to native and denatured type II collagen. These findings suggest that the production of high levels ofserum anti-type II collagen antibodies in patients with RA isa secondary phenomenon, which may exacerbate the disease ratherthan be a primary cause of disease. KEY WORDS: Collagen, Type II, Early rheumatoid arthritis, Antibodies     

THE PREVALENCE OF SERUM IgG ANTIBODIES TO TYPE II COLLAGEN IN AMERICAN PATIENTS WITH RHEUMATOID ARTHRITIS

Serum IgG antibody levels to native and denatured bovine typeII collagen were elevated in 31.5 and 21.5% sera respectivelyfrom 200 American patients with RA. The prevalence of serumantibodies to native type II collagen is significantly higherthan previously found in large studies of the prevalence ofthis autoantibody in Britain and Japan when using the same methodology. KEY WORDS: Collagen, Type II, Antibodies     

ANTIBODIES TO THE 65kDa MYCOBACTERIAL STRESS PROTEIN IN WEST AFRICANS WITH RHEUMATOID ARTHRITIS, TUBERCULOSIS AND MALARIA

We have studied IgG antibodies to recombinant mycobacterial65 kDa heat-shock protein in West African rheumatoid arthritis(RA) patients and local control groups, including those withtuberculosis or malaria. Mean levels were higher among the patientswith RA than among healthy controls, but did not achieve statisticalsignificance. Our findings may relate to the level of mycobacterialexposure in West Africa. KEY WORDS: Heat shock protein, Rheumatoid arthritis, Infectious diseases     

ANTI-PROTEUS ANTIBODIES IN RHEUMATOID ARTHRITIS SAME-SEXED SIBSHIPS

One hundred and forty-two RA patients and 121 of their healthysame-sexed siblings were tested for antibodies (Abs) to Proteusmirabilis and Escherichia coli by indirect immunofluorescence.Eighty-five individuals had active RA (CRP>10 mg/l) and 57inactive RA. The anti-Proteus Ab titre in the active RA groupwas significantly higher than in the inactive RA and non-RAgroup (P<0.0001 in both cases). Anti-Proteus Abs were significantlyelevated in 30 individuals with active RA compared with theirhealthy HLA-identical same-sexed siblings (P>0.001). In 42HLA-DR4 positive and 15 HLA-DR4 negative active RA patients,the Ab titre was non-significantly higher in the former group.Anti-E. coli Abs were not significantly elevated in any of thegroups. Longitudinal data on 36 RA patients demonstrated a significantpositive correlation between changes in CRP and changes in anti-Proteusantibody titres (r=0.52, P<0.001). These observations requirean explanation. KEY WORDS: Active disease, Inactive disease, HLA-identical, HLA-DR4, Escherichia coli, C-reactive protein, Rheumatoid factor     

ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES IN RHEUMATOID ARTHRITIS PATIENTS

We determined the occurrence of antineutrophil cytoplasmic antibodies(ANCAs) and their specificities in 77 rheumatoid arthritis (RA)patients and compared them with 25 patients with psoriatic arthritis(Pso), 19 with drug-induced lupus erythematosus (DI-LE) and11 with systemic lupus erythematosus (SLE). Thirty-two per centof RA patients had positive indirect immunofluorescence (IIF)stains (P or atypical ANCA). Twenty-nine per cent of patientswith rheumatoid vasculitis (RAV), 48% with long-standing RA(LSRA) and 20% with early RA (Ely RA) had positive ANCAs comparedwith 4% of Pso patients, 47% of DI-LE patients and 45% of SLEpatients. Western blotting (with polymorphonuclear cell extractsor alpha-granules) and alpha-granule enzyme-linked immunosorbentassay (ELISA) yielded variable results and proved unhelpfulfor characterizing the specificities of ANCAs. ELISAs basedon commercial purified lactoferrin (LF), myeloperoxidase (MPO),human elastase (HLE) and cathepsin G (CG) showed that anti-HLEantibody was the most prevalent (14%) antibody in RA, followedby anti-MPO antibody and anti-LF antibody (10% each). Statisticalanalysis of antibody prevalence by clinical presentation showedthat LSRA patients were more likely to have anti-HLE antibodyand that DI-LE patients were more likely to have anti-CG antibodycompared with the other patient groups. In lupus patients serialELISA titration of ANCAs (LF and MPO) was found to be reliablefor predicting the outcome. The overall incidence of ANCAs inRA patients was 33% by IIF. KEY WORDS: Rheumatoid arthritis, Antineutrophil cytoplasmic antibodies, Rheumatoid vasculitis, Systemic lupus erythematosus, Drug-induced lupus, Psoriatic arthritis     

早期类风湿关节炎病人中类风湿因子的临床意义

报告９６例早期类风湿关节炎病人血清中ＩｇＭ类风湿因子和ＩｇＡ免疫球蛋白测定的３年随访结果。根据Ｘ线摄片评价骨侵蚀的情况。结果发现，ＩｇＭ类风湿因子和ＩｇＡ免疫球蛋白越高，越容易引起发病头３年内的骨侵蚀。这说明它们是早期诊治类风湿关节炎的２项有价值的实验室指标。这个结果还为早期使用ＩＩ线药物提供了科学依据。     

FIBROSING ALVEOLITIS DUE TO SULPHASALAZINE IN A PATIENT WITH RHEUMATOID ARTHRITIS

Rheumatoid arthritis is being increasingly treated with sulphasalazine.We report the first case of a patient being treated for rheumatoidarthritis who developed severe dyspnoea with chest radiographshadowing, reversible on discontinuation of sulphasalazine andsubsequent steroid therapy. An histological diagnosis of fibrosingalveolitis was made. Thirteen cases of similar reactions tosulphasalazine, all in patients treated for inflammatory boweldisease, can be found in the literature. We identify two typesof pulmonary reaction, an eosinophilic pneumonitis and a fibrosingalveolitis. Adequate his-tological investigation is needed todifferentiate between the two and management may be different.The diagnosis of pulmonary reactions are important because theycan be easily confused with complications of the underlyingdisease but the prognosis is much better KEY WORDS: Eosinophilic pneumonitis, Bronchoalveolar lavage, Transbronchial biopsy, Drug reaction     

抗类风湿关节炎36kD和33kD抗体对类风湿关节炎诊断意义的研究

我们自艾氏小鼠腹水癌细胞（Ｅｈｒｌｉｃｈａｓｃｉｔｅｃｅｌｌｓ）提取抗原，进行免疫印迹法检测，发现８８例类风湿关节炎（ＲＡ）患者中有２８例抗３６ｋＤ（分子量为３６０００）抗体阳性，占３１．８％．而在１００例其他结缔组织病患者及４０例正常对照组中均无１例出现阳性。然而，用上述方法提取的抗原，以免疫印迹法检测时，抗ＲＡ３３ｋＤ抗体或抗ＲＮＰ抗体均可与３３ｋＤ区带反应，说明抗３３ｋＤ抗体对诊断ＲＡ的特异性不高。结果表明抗３６ｋＤ抗体是ＲＡ的特异性抗体。如果同时出现抗３６ｋＤ及抗３３ｋＤ抗体，则更加有利于诊断。     

RHEUMATOID FACTOR ASSOCIATED WITH A SECRETORY COMPONENT IN RHEUMATOID ARTHRITIS

The authors' objective was to study the serum secretory immunoglobulinA (S-IgA) concentration and the presence of rheumatoid factor(RF) complexed with a secretory component (SC) in rheumatoidarthritis (RA). Sixty-three RA patients were studied. Therewere 49 healthy subjects in the control group. The S-IgA concentrationand the presence of IgA isotype RF were determined by ELISAin the serum. The presence of SC complexed to RF (SC–RF)was studied by a sandwich-type enzyme-linked immunosorbent assaywith an antibody against the SC used to capture S-immunoglobulin,and associated anti-globulin activity was revealed with a peroxidase-conjugatedhuman IgG Fc fragment. We observed a significant increase inS-IgA in RA (mean 76.8 µg/ml ± 152.9 S.D.), ascompared to controls (mean 13.6 µg/ml± 11.9 S.D.)(P <0.01). Forty-one per cent of RA patients presented aS-IgA concentration above the upper threshold, but we did notobserve any association with disease activity. S-IgA concentrationwas correlated with the presence of IgA-RF. Twenty-seven RApatients had a positive SC–RF versus one in the controlgroup (P<0.01). The presence of SC–RF was associatedwith an increased S-IgA concentration (P <0.0001), and thepresence of RF-IgA (P <0.002). However, no association withdisease activity was noted. Our study showed that serum S-IgAwas increased in RA, and that part of the RF were complexedwith SC. These results suggest contribution of mucosal lymphocytesin the pathogenesis of RA. KEY WORDS: Secretory immunoglobulin, Rheumatoid factor, Rheumatoid arthritis, Mucosa-associated lymphoid tissue     

DENTAL STUDY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Twenty-one patients with rheumatoid arthritis took part in acomparison of three toothbrushes, each used for one month ina randomized trial. The three toothbrushes were a conventionaltoothbrush with modified handle to allow ease of gripping, anelectric toothbrush, and thirdly a fingerstall attached to anormal toothbrush. There was no change in the patients' rheumatoid status duringthe trial. The patients were scored for plaque and gingivalchanges but no difference was found between the three toothbrushes. We recommend a standard toothbrush with a modified grip forthe rheumatoid hand; the extra expense of an electric toothbrushcannot be justified. ^*Paper read at the Annual Meeting of the British Associationfor Rheumatology and Rehabilitation, London, 17 April, 1980.     

PYODERMA GANGRENOSUM IN A PATIENT WITH RHEUMATOID ARTHRITIS RESPONDING TO TREATMENT WITH CYCLOSPORIN A

We describe a patient with pyoderma gangrenosum and seronegativeRA who responded to treatment with low-dose cyclosporin A. KEY WORDS: Pyoderma gangrenosum, Rheumatoid arthritis, Cyclosporin A     

ERRORS IN THE PREDICTION OF CREATININE CLEARANCE IN PATIENTS WITH RHEUMATOID ARTHRITIS

The accuracy of two equations used to predict creatinine clearancewas assessed in 27 patients with rheumatoid arthritis (RA) and34 controls. Both equations were accurate in controls, but overestimatedthe clearance in RA patients. The degree of overestimation wasnot related to patient characteristics. Uncritical use of theseequations in RA patients may lead to serious error. KEY WORDS: Renal function, Muscle mass     

BOTH INHERITED HLA-HAPILOTYPES ARE IMPORTANT IN THE PREDISPOSITION TO RHEUMATOID ARTHRITIS

The distribution of the HLA-DR allele frequencies of 105 RApatients has been compared with the expected distribution underrecessive and dominant modes of inheritance using control datafrom 2041 controls and the antigen genotype frequency amongpatients methodology. The observed distribution was compatiblewith a recessive mode of HLA-linked inheritance in RA, witha dominant mode rejected, whether HLA-DR4 was considered alone,or HLA-DR4 and HLADRI were combined as if they were behavingas a single predisposing gene. Mean sibship concordance rates(MSCRs) were calculated for categories of proband HLA-DR genotypes.The highest MSCR was seen for HLA-DR4 homozygous probands, andthe lowest for HLA-DR2 or 7/non-4 genotypes. These combinedobservations suggest that interactions between both inheritedHLA-haplotypes are important in the predisposition to RA. KEY WORDS: Rheumatoid arthritis, HLA-haplotypes, HLA-DR, Mode of inheritance     

DYSPHAGIA DUE TO VERTICAL SUBLUXATION OF THE AXIS IN RHEUMATOID ARTHRITIS

Two patients with rheumatoid arthritis developed swallowingdifficulties. These were mild in one case but severe in theother. Associated pyramidal tract signs and striking upwardtransloca-tion of the dens made it seem probable that dysphagiawas attributable to medullary compression despite the absenceof other bulbar features. A history of dysphagia may thereforehave serious implications for patients with rheumatoid disease.     

TRANSITION QUESTIONS TO ASSESS OUTCOMES IN RHEUMATOID ARTHRITIS

The importance of patient-based assessments of outcomes of carein RA is increasingly recognized. There are a number of methodsof gaining such data. One method is to request patients to assesschange in health status by means of transition questions. Thisis considered advantageous to other methods because it directlyaddresses perceptions of change over time and is short and simple.One hundred patients with RA completed a range of clnical, laboratoryand health status assessments on two occasions 3 months apart.On the second occasion they also completed a transition question.Results show the question to be valid and to correlate witha number of different changes obtained from assessments. Psychologicalmood did not appear to iniluence transition judgements. A smallminority of patients experienced changes for specific dimensionsof health status in the opposite direction of the transitionitem. Transition judgements may have an important role in evaluationstudies and audit. KEY WORDS: Outcome, Health status, Functional status, Rheumatoid arthritis     

PULMONARY DISEASE DUE TO GOLD IN RHEUMATOID ARTHRITIS

A case of pneumonitis developing during the course of gold therapyin a patient suffering from rheumatoid arthritis is reported.The lung complication was of sudden onset and only improvedafter withdrawal of gold and initiation of steroid therapy.We suggest gold therapy may be associated with pulmonary complicationsof rheumatoid arthritis.     

ELBOW JOINT FORCES IN PATIENTS WITH RHEUMATOID ARTHRITIS

Whilst developing an elbow endoprosthesis, the joint forceswere estimated for patients with rheumatoid arthritis. Elbowflexion strength of rheumatoid patients was found to be 45 %of normal. Muscle strengths and limb geometry data were foundby a dissection technique, which allowed joint forces to becalculated during flexion, extension and abduction efforts.Forces up to 2.4 kN were predicted to act on the distal humerus,with similar forces acting in both radius and ulna. The skeletalstructure is well adapted to carry the predicted forces, andonlay-type prostheses are recommended for elbow replacement. _*Paper read at the Annual Meeting of the British Associationfor Rheumatology and Rehabilitation, London, April 1979.