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After introductory observations on the role of the kidney in protein metabolism, the methodology and results of disc electrophoresis on polyacrylamide, using detergents, are discussed. Separation of urinary proteins according to molecular weight permits the differentiation of kidney diseases into those of the glomerulus and of the tubules. Proteinurias of prerenal and postrenal origin are also differentiated. Owing to the considerable time involved, this methodology cannot at present be introduced for routine purposes.

Lyophilised hemodialysates of uremic patients were fractionated on Sephadex G-15 for investigation of potential uremic toxins. One of the oligopeptides found in the fraction of postulated toxins was purified to homogeneity by gel, reversed-phase and adsorption chromatography and by high-performance liquid chromatography. Dansyl Edman degradation revealed the sequence Ala-Phe-Phe-Gly-Glu, which was synthesized by the solid-phase method. The comparison of synthetic and natural hexapeptide by chromatographic methods, mass spectrometry, 1H- and 13C-nuclear magnetic resonance proved the correct sequence. The peptide showed only weak activity in immunological test systems and in the lymphocyte proliferation test.

In ten patients with systemic lupus erythematosus lymphocyte suppressor cell function was repeatedly monitored over a period of nine months. The method used is based on the finding that in vitro addition of ConA to PWM-stimulated lymphocytes activates suppressor T cells which in turn inhibit immunoglobulin synthesis. Nine of ten SLE patients exhibited significant impairment of IgG suppression but no correlation was found between the outcome of the IgG suppressor cell assay and disease activity or the treatment protocol applied.

In peripheral blood of SLE-patients fluctuating patterns of Fc-gamma-receptor bearing T-lymphocytes have been observed, when long term monitoring has been performed. No influence of disease activity and corticoid treatment on number of Fc-gamma-receptor bearing lymphocytes was seen.

Disc electrophoresis and N-acetyl-beta-D-glucosaminidase (NAG) of urine are sensitive indicators of renal damage. In 28 from 50 patients with definite rheumatoid arthritis, a tubular proteinuria and a high urinary NAG-excretion and in 10 other patients one of these pathological parameters were detected. A positive correlation with disease activity was noted. Both methods are able to demonstrate a rheumatoid involvement of renal function.

Five by five patients with rheumatoid arthritis were treated with gold salts, D-penicillamine and cyclophosphamide. The T-lymphocyte subpopulations were measured. In patients, treated with gold salts or D-penicillamine, we did not find alterations of the number of TG- and TM-lymphocytes. The daily treatment with 100 mg cyclophosphamide will result in a significant reduction of TG-lymphocytes.

A method is described for the determination of the enzyme N-acetyl-beta-D-glucosaminidase in gel-filtered urine. The individual reaction parameters were tested, and the reliability of the method was determined. The stability of the enzyme in urine was investigated at different temperatures over a 6 week period. The excretion of N-acetyl-beta-D-glucosaminidase, like the analysis of urinary proteins by disc electrophoresis, is a sensitive parameter for renal damage. The two methods were compared, using 50 random urine samples from patients with chronic polyarthritis; both methods were found to have equal diagnostic value.

A 62-year-old female patient with splenomegaly, severe granulocytopenia, recurrent infections and negative rheumatoid factor test initially had no clinical evidence of rheumatoid arthritis. Leucopenia responded to splenectomy and did not recur during 7 years follow-up. Symmetrical metacarpophalangeal joint-swelling developed 9 months after 7 years of radiographic destruction. This case emphasizes that arthritis may occasionally be a late and minor manifestation of Felty's syndrome.

The clinical significance of the histomorphological evaluation of synovial tissue from 389 patients with joint diseases was studied. From these data we conclude: (1) the histomorphological diagnosis in joint diseases is rarely of decisive value (6.2%); (2) in 23.1% of cases the histomorphological diagnosis is judged to be of clinical assistance; (3) the histomorphological grading of the inflammatory reaction in the joint under study corresponds in approximately two out of three cases to the clinical judgement.

50 patients with definite rheumatoid arthritis treated with D-penicillamine were studied every 4 weeks by disk electrophoresis of the urine to make an early record of the glomerular proteinuria of the immune complex nephritis, which has been described as a side effect of this treatment. In 30 of these patients we found, however, a tubular proteinuria which correlated well with the disease activity and which disappeared after successful basic treatment. This finding indicates interstitual renal involvement due to the basic disease.

In 52 patients with severe rheumatoid arthritis the therapeutic efficacy of 600 mg/die of D-penicillamine was evaluated for two years in a prospective trial. Patients were included in the study only if the duration of their disease exceeded 6 months (upper limit 12 months), and there was involvement of 6 or more joints and an elevated erythrocyte sedimentation rate (1 hour values greater than or equal to 25 mm). In 26 patients (50%) a decline in the activity index could be observed, but 18 of these subjects had a deterioration of findings as assessed by X-ray. The increase of the activity index indicated no therapeutic benefit in 26 patients (50%), which could be confirmed in 23 subjects by X-rays.

A new simple identification of rheumatoid factor on nitrocellulose was developed that allows quantitative detection. Verification of the results was done by comparison with the established Waaler-Rose-Test and Latextest: Correlation coefficient of linear regression for Latextest rLR = 0.717 and for Waaler-Rose-Test rLR = 0.665; Spearman rank correlation coefficient for Latextest rs = 0.798 and for Waaler-Rose-Test rs = 0.700. The interday and intraday variations showed good results. The histograms for different patient groups showed significant distributions. The nitrocellulose-test satisfies ARA-criterium No. 6.

In this review, three patients with severe inflammatory acne accompanied by a distinct rheumatologic syndrome are discussed together with 44 similar cases reported in the literature. This syndrome, here referred to as "acne-associated arthritis (AAA)" usually involves male teenagers and twins. The most characteristic clinical findings relate to the axial skeleton as well as the sterno-costo-clavicular region. Although no association with HLA-B27 has been found, AAA shares a number of clinical, radiological and histomorphological features with seronegative spondylarthropathies. Furthermore, nosological connections seem to exist with a number of ill-defined "hyperostotic osteoarthropathies." Similar characteristics are known from other "pustulotic or neutrophilic dermatosis." The hypothesis of an infectious etiology of AAA has not been substantiated. Responses to systemic antibiotics are generally disappointing, whereas steroids have been shown to exhibit some therapeutic efficacy.

D-penicillamine treatment of 50 patients with rheumatoid arthritis with negative ANF tests, was followed by means of protein disk electrophoresis of the urine. In the beginning the urine proteins were analysed every 4 weeks, later at intervals of 3 to 6 months. A glomerular proteinuria, caused by an immune-complex nephritis, can be recognized very early by this method. A glomerular proteinuria was the reason for discontinuing the treatment in 10 of the 50 patients (8 seropositive, 2 seronegative), drug fever occurred in one case with seropositive arthritis. Protein disk-elektrophoresis of the urine is an appropriate method to recognise renal damage earlier than with any other known routine method.

In 34 patients with severe rheumatoid arthritis the therapeutic efficacy of 600 mg/die of D-penicillamine was evaluated for five years. Patients were included in the study only if the duration of their disease exceeded 6 months (upper limit 12 months), and there was involvement of 6 or more joints and an elevated erythrocyte sedimentation rate (1 Hour values greater than or equal to 25 mm). In 9 patients (26%) a decline in the activity index could be observed, but 7 of these subjects had a deterioration of findings as assessed by x-ray. The increase of the activity index indicated no therapeutic benefit in 25 patients (74%), which could be confirmed in all subjects by x-ray.