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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]

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]

This study compares functional changes to change in measures of disease activity following the introduction of slow-acting anti-rheumatic drugs (SAARD) in patients with active rheumatoid arthritis (RA). Clinical and laboratory variables were simultaneously monitored at 6-monthly intervals, over approximately 18 months. Function was measured by a performance testing, the Keitel function index (KFI), which was divided into sections representing small and large joints [and (HFI); wrist (WFI) and limb function index (LFI)]. One-hundred-and-fifteen patients were studied, of whom 21 were male. The mean age of the subjects was 49 yr (s.D. ± 12) and mean duration of disease 7 yr (S.D. ± 7). The mean KFI at entry was 38 (S.D. ± 18) while at the end of the study it was 31 (s.D. ± 17) (P < 0.0001). The change in KFI following therapy correlated with the change in Ritchie articular index (RAI) (r = 0.4; P < 0.0001), early morning stiffness (EMS) (r = 0.3; P = 0.004), swollen joint count (JC) (r = 0.4; P = 0.0005). C-reactive protein (CRP) (r = 0.2; P < 0.05) and Lansbury systemic index (LSI) (r = 0.35; P = 0.002), but not with change in Westergren erythrocyte sedimentation rate (ESR) or change in time to onset of fatigue. Multiple regression analysis showed that 32% of the variation in KFI at the end of the study could be predicted by a combination of ESR, sulphasalazine therapy, RAI, disease duration and chloroquine treatment at onset (P < 0.05). When HFI at end of study was the dependent variable, 21 % of the variation could be predicted by a combination of ESR, CRP, Lansbury systemic index and JC at onset (P < 0.05). The duration of disease did not significantly influence the potential for change in functional status. This study showed that detailed measurement of function is important in assessing RA activity. Functional impairment in RA is a dynamic process influenced by changes in clinical disease activity with treatment. [ABSTRACT FROM PUBLISHER]

The recent demonstration of cytolytic mediators within synovial CD4+ T-cells of patients with rheumatoid arthritis (RA) has suggested an additional role for these cells in the pathogenesis of the disease. In this study we have investigated the function and regulation of antigen-specific class II-restricted cytotoxic T-cells from the synovial fluid (SFMNC and peripheral blood (PBMNC) of 20 seropositive RA patients, and correlated findings with clinical data. Regulatory factors including prostaglandin E (PGE, interferon-γ (IFN-γ) and interleukin-4 (IL-4) were measured in cell supernatants. A diversity in SFMNC antigen-specific cytotoxicity that correlated with therapy and PGE production was found, and shown to be mediated by synovial prostanoid (products of cyclooxygenase metabolism) inhibition of effector function. Our findings indicate that SFMNC cytotoxicity may be important in the pathogenesis and treatment of RA. Cyclooxygenase inhibition as the sole treatment early in RA may reduce the potentially beneficial inhibitory effect of synovial prostanoids on antigen-specific SFMNC cytotoxicity. [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]

The article reports that intervertebral disc calcification (IVDC) is an uncommon but well-known entity. It appears to be a benign, selflimiting condition which often remains asymptomatic. Researchers describe a child who had calcification of all the intervertebral discs of the thoracic spine. Intervertebral disc calcification is a well-recognized clinical entity, but the etiology remains obscure. The usual causes of connective-tissue calcification in children, such as hypervitaminosis D or dermatomyositis, have not been associated with IVDC. Although IVDC has been attributed to trauma, infection, and abnormal calcium metabolism, none of these factors has been proven. The occurrence of mild fever, leukocytosis, and elevated ESR has been cited in support of an inflammatory origin. It is known that IVDC occurs in neonates and is more common in boys. The frequency increases, reaching a peak between 6 and 10 years of age, then declining as adulthood is approached. The age distribution and the rapid deposition and resorption of the calcification have been ascribed to the abundant blood supply to the discs.