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     

GENERALIZED GRANULOMA ANNULARE: RELATIONSHIP TO DIABETES MELLITUS AS REVEALED IN 8 CASES

Clinical or chemical (latent) diabetes was discovered in 7 of 8 patients with generalized granuloma annulare; all were women. The average age of onset of their disease was 50 years. Treatment with chlorpropamide and low carbohydrate diet seemed to alleviate the skin manifestations in 6 of 7 patients so treated.     

Skin complications in immunosuppressed patients: follow-up of kidney recipients

Thirth-five patients who received thirty-seven kidney transplants (two patients received live; the rest cadaver kidneys) were followed up for skin complications. There were thirty-nine instances of overt skin infection. In twenty-one instances we encountered fungal, in ten pyogenic and in eight viral infection. The course of these infections was more severe and more protracted than is usual in other patients. In nine instances, the skin infection contributed directly to the death of the patient. One patient developed Kaposi's sarcoma and another pyoderma gangrenosum. This study suggests that immunosuppressive treatment, which all our patients were continuously receiving, enhances their susceptibility to infection and to malignancy and may have been an aetiological factor in pyoderma gangrenosum.