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Double-stranded DNA immune complexes (DNA-ICs) were assayed by millipore filtration and deoxyribonuclease digestion in 40 patients with both active and inactive systemic lupus erythematosus (SLE). The assay is superior to the double-stranded DNA antibody (ds ADA) as an indicator of active disease, and, when combined with the total haemolytic complement (CH50) and ds ADA levels it increases the prediction of the relative risk of active disease. A good correlation between actual levels of DNA-ICs and the degree of activity was also shown. We conclude that measurement of DNA-ICs is of value as an additional monitor in the assessment of activity in SLE. [ABSTRACT FROM AUTHOR]

Plasma DNA has been measured by a new physiochemical approach based on fluorimetric analysis of phenol extracted nucleic acids electrophoresed on polyacrylamide gels. This method is specific for native double-stranded DNA of molecular weight greater than 5 x 10(6). The use of plasma rigorously freed of leucocytes is essential to prevent falsely high values. When such precautions are taken levels seldom exceed 50 ng/ml in normal individuals. Plasma DNA was assayed in 107 samples from 47 patients with both active and inactive systemic lupus erythematosus. In direct contrast to several previous reports no significant increase of plasma DNA was found. [ABSTRACT FROM AUTHOR]

A group of 61 unselected patients with psoriasis attending a dermatology clinic were studied to determine the prevalence of psoriatic arthritis. On defined criteria arthritis was present in 41.6%. Peripheral arthritis was present in 15.5%, and sacroiliitis in 43%. A strong association of distal interphalangeal arthritis with psoriasis and nail dystrophy was confirmed. Tissue typing showed a strong association of B23, 17, in Caucasoid psoriatics, while the haplotype A1/B8 was increased in mixed Caucasoid--Negroid psoriatics. [ABSTRACT FROM AUTHOR]

An epidemiological survey of rheumatoid arthritis (RA) was undertaken in a tribal Xhosa community in the Transkei of Southern Africa. 577 respondents aged 18 and over were examined clinically and of these, 549 were investigated radiologically and 482 serologically. The presence of RA was then assessed by means of a modification of the Rome criteria, as used in previous comparable surveys. The prevalence of 'definite' RA in the adults aged 18 and over in this population was 0-68% and of 'probable' RA, 1-6%. The combined 'definite' and 'probable' prevalence was 2-2%. The relatively low prevalence of RA in this population is consistent with the results of other surveys in unsophisticated African Negro populations in West Africa and South Africa, and contrasts with the higher prevalence encountered in an urbanized South African Negro community and in populations in Europe and the USA. [ABSTRACT FROM PUBLISHER]

Three patients with the unusual combinations of discoid lupus, systemic lupus erythematosus (SLE), and progressive systemic sclerosis (PSS) are reported. The first patient developed PSS eight years after a diagnosis of discoid lupus had been made and this was complicated by myositis six years later. The second patient developed PSS more than 20 years after being diagnosed as having SLE. The third patient developed SLE with predominant features of urticarial vasculitis six years after PSS. Mild myositis also ensued. There were no antibodies to U1RNP demonstrable in any of these patients. The clinical progression of SLE to PSS or vice versa in the absence of features of mixed connective tissue disease is distinctly uncommon. [ABSTRACT FROM AUTHOR]

The correlation of handedness with deformities, radiographic changes, and function of the hand was studied in a large group of patients with rheumatoid arthritis and a dominant right hand. There was no significant difference in the proportion of patients who had swan neck deformity, boutonnière deformity, uncorrectable ulnar deviation, and flexor tenosynovitis in the dominant and non-dominant hands. There were significantly greater radiological changes in the dominant hand, however, and the middle and index fingers were most severely affected. The severe involvement of these fingers may be related to their greater use in daily activities. There was also more severe functional impairment in the dominant hand. [ABSTRACT FROM PUBLISHER]

The spectrum of rheumatoid arthritis (RA) was studied in a group of 52 blacks who attended a rheumatology unit in Cape Town, South Africa. The mean age of the patients was 44.6 years, and the female to male ratio was 3.7:1. Significant radiographic changes were frequently noted, and the mean Larsen scores were 34.9 for the hands, 19.6 for the feet, and 6.6 for the wrists. About two thirds of the patients had received an immunomodulatory drug and 20 (38%) had had one or more surgical procedures for their RA. Anaemia was the commonest extra-articular manifestation, and although the other extra-articular features were uncommon, a variety of features had been detected during the course of the disease. Earlier studies on blacks in Africa suggested that RA was a mild disease; our findings, however, are in agreement with the more recent surveys, which suggest that severe disease is not uncommon. [ABSTRACT FROM PUBLISHER]

A cross sectional analysis of the correlation between clinical, laboratory, and radiological markers of disease activity in 98 patients with classical rheumatoid arthritis (RA) is reported. The median age was 38 years, the median age at onset of disease 29 years, and the median duration of disease seven years. The Keitel function test (KFT) showed good correlation with the Ritchie articular index (RAI) (p less than 0.0001; r = 0.5) and the disability questionnaire (DQ) (p less than 0.0001; r = 0.6). The RAI and DQ correlated weakly with laboratory variables, while the KFT showed significant correlation with the erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and plasma viscosity (PV) (p less than 0.001; r = 0.4; 0.3; 0.4). Only the KFT showed significant correlations with bone mass measurements (p less than 0.01; r = -0.3; -0.4), and the Larsen index at the right wrist (p less than 0.0001; r = 0.4). Consensus analysis suggested that the KFT is a useful single clinical test of disease activity in RA. The hand functional index (HFI), a component of the KFT, showed significant correlation with the total KFT (r = 0.9). Prospective drug trials are needed to establish the value of the HFI in the monitoring of patients with RA. [ABSTRACT FROM PUBLISHER]

Normal rats subjected to end-to-side portacaval shunt showed decreased survival and weight gain, a progressive fall in serum albumin and reciprocal rise in serum gamma globulin when compared with sham-operated controls for 12 weeks. Antibacterial lipopolysaccharide antibody was detected in significant titre at the sixth and twelfth weeks. It is suggested that the elevated levels of gamma globulin and reversal of albumin/globulin ratios noted in these animals may represent an immune response to bacterial lipopolysaccharides released into the systemic circulation as a result of the portacaval shunt. The hyperglobulinaemia of cirrhosis in human subjects may have a similar aetiology. [ABSTRACT FROM PUBLISHER]

The records of 180 patients out of 247 with bacterial endocarditis were examined. 50 patients had rheumatic manifestations. In 10 there was arthritis of 2-12 weeks' duration before diagnosis; 19 had myalgia/arthralgia; 17 had back or neck pain; 14 had demonstrable arthritis; and 2 tenosynovitis of the foot. Of the 14 patients with arthritis, 8 had monarticular arthritis and 6 polyarticular. All but one patient had a raised erythrocyte sedimentation rate, and in one patient rheumatoid factor was positive. The rheumatic features responded when the endocarditis was treated. Some of the symptoms undoubtedly resulted from the infection and fever of the endocarditis, and emboli may have caused the transient aches but there was no evidence that they caused the synovitis in the patients with arthritis. The rheumatic manifestations of bacterial endocarditis can mimic other rheumatic diseases and disguise the underlying disease. [ABSTRACT FROM PUBLISHER]