Immunopathologic study of sural nerves in rheumatoid arthritis.
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Biomedical subjects
Publications and source records attributed to D L Conn.
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A study to determine the presence of immune deposits in the cutaneous vessels of normal-appearing skin was made in 39 patients with rheumatoid arthritis. Immune deposits in skin vessels were found in 20 of the 32 patients with seropositive rheumatoid arthritis. The frequency of such immune deposits was only slightly higher in patients with clinical vasculitis than in those without such vasculitis. There was an association among the presence of immune deposits in skin vessels, presence of antinuclear antibodies, and elevated serum levels of IgM and IgA. The major immunoreactants detected were IgM and C3. The presence of immune deposits in skin vessels does not differentiate seropositive rheumatoid aptients who have clinical vasculitis from those who do not have clinical vasculitis.
Ankylosing spondylitis and rheumatoid arthritis share many common features. However the presence of rheumatoid factor, histologically classic rheumatoid nodules, and the histocompatibility cell wall antigen (HLA-B27) helps distinguish one from the other. Two cases are reported in which these features established the coexisting diagnoses of ankylosing spondylitis and rheumatoid arthritis.
Forty-one patients with rheumatoid arthritis, including 6 with acute vasculitis, 13 with chronic vasculitis, and 22 without vasculitis, were studied for evidence of intravascular coagulation and fibrinolysis (ICF). The mean plasma fibrinogen levels were elevated in all groups. The fibrinogen, platelet count, and fibrin split products were usually elevated in acute vasculitis. Fewer patients on corticosteroids had abnormal coagulation tests. Active plasmin was detected in 12 patients primarily with chronic vasculitis. Plasminogen activator activity was not diminished in vascular endothelium of normal appearing skin of those patients with or without vasculitis. None of the patients demonstrated decompensated intravascular coagulation and fibrinolysis. The results suggest overcompensated ICF occurring in rheumatoid arthritis, but rheumatoid patients with vasculitis cannot be clearly distinguished from those without vasculitis on the basis of the usual tests performed for coagulation and fibrinolysis abnormalities.
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Eight patients with Felty's syndrome who had associated fevers, cutaneous ulcers, or infections were treated with parenteral gold. A satisfactory response was noted in 7 of the 8 patients. Improvement in leukopenia (7/8), decrease in infections (5/8) and fevers (7/8), and healing of ulcers (4/5) were noted. We conclude that gold has a role in the treatment of this complication of rheumatoid arthritis.