Radiographic findings in the hands in patients with systemic lupus erythematosus

Hand radiographs of 59 patients with systemic lupus erythematosus (SLE) were examined. Thirty-four revealed radiographic abnormalities, most commonly periarticular soft-tissue swelling or demineralization. Alignment abnormalities, acral sclerosis, avascular necrosis, soft-tissue calcification and terminal tuft resorption were also seen. All patients with periarticular calcification or terminal tuft resorption had Raynaud's phenomenon. Clinical indicators of disease activity (including low serum complement levels) did not correlate with the presence or severity of radiographic abnormalities. Patients with abnormal radiographs generally were older at the time of diagnosis than those with normal studies.     

Variations in serum alkaline DNase activity: a new means to assess early detection of relapse in patients treated for acute nonlymphoblastic leukemia

Our previously published clinical results on various malignancies indicated that the variations in serum alkaline DNase activity (SADA) could be a sensitive test for therapeutic monitoring of human malignancies. In the present study, the clinical efficacy of SADA detecting relapse in 32 acute nonlymphoblastic leukemia (ANLL) patients in remission was tested. The observation period ranged from 3 to 17 months. A simple and rapid biochemical technique based on spectrophotometric measurements was used to assay SADA. Of the 32 patients, 17 remained in remission and had less than a 15% variation in SADA levels. They had no clinical symptoms of recurrence at any time. In the remaining 15 patients, after a period of stability, a progressive decrease in SADA, with variations of more than 15%, was observed without any treatment. At that time, no abnormalities of clinical parameters were detected in these patients. A recurrence of disease as evidenced by routine examinations was found relatively late after the first decrease in SADA in all 15 patients (range 1.5 to 5.5 months). These results suggest that periodic measurements of SADA during the posttherapeutic course can be used as a means to assess early detection of an eventual recurrence.     

Variability of the erythropoietic response in autoimmune hemolytic anemia: analysis of 109 cases

One hundred-nine cases of autoimmune hemolysis were reviewed to determine the frequency of reticulocytopenia, the state of the erythroid marrow in reticulocytopenic cases, and the course of reticulocyte production indices with time and glucocorticoid treatment. The mean hematocrit at presentation was 24 mL/dL, but 30% of cases had an initial hematocrit less than 20 mL/dL. Median reticulocyte percentage at diagnosis was 9%, and median reticulocyte production index was 2.8 times basal. Twenty percent of cases had an initial reticulocyte count less than 4%, and 37% had an initial reticulocyte production index less than 2.0 times basal. These reticulocytopenic patients were nearly evenly distributed between warm and cold antibody- mediated cases and between primary and secondary cases. Fifty-four percent of reticulocytopenic cases had a bone marrow examination during hospitalization. Three-fourths of these marrows showed erythroid hyperplasia, and erythroid hypoplasia was seen in only one case. Eighty- eight cases had serial reticulocyte measurements, and in only 15% of patients did the reticulocyte production index remain less than 2.0 times basal. Thus, in most cases, the initially low reticulocyte production index may represent a lag in marrow responsiveness to hemolytic stress. In cases with persistent reticulocytopenia, ineffective erythropoiesis is suggested by the frequency of marrow erythroid hyperplasia. In the cases that were initially reticulocytopenic and demonstrated an increase in reticulocyte production index, the magnitude of this increase was significantly greater in glucocorticoid-treated patients than in those not so treated, indicating that a glucocorticoid sensitive component exists in the marrow erythropoietic response to hemolysis. Awareness of the frequency of an initial reticulocytopenia in cases of autoimmune hemolysis may be important in initial diagnosis and treatment.