HLA-B27 and clinical aspects of ankylosing spondylitis: results of prospective studies.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to H Deicher.
Explore the source record for details and available documents.
Fifty-one patients with rheumatoid arthritis were examined at 6-month intervals during a 2-3-year investigation period. Correlations of an inflammatory activity index calculated from nine criteria with several laboratory parameters were computed. ESR correlated most closely, followed by the IgM concentration of circulating immune complexes, hemoglobin, C3A, and fibrinogen.
Explore the source record for details and available documents.
Peripheral blood mononuclear cells (PBM) from four patients with IgG myeloma and four patients with benign monoclonal gammopathy (BMG) were stimulated with pokeweed mitogen (PWM), and the in vitro immunoglobulin production over 7 days was measured with an enzyme-linked immunosorbent assay. All myeloma patients were sufficiently treated with cytostatic drugs. Their PBM did not produce monoclonal Ig in vitro, as opposed to PBM from two patients with BMG. Unseparated PBM from myeloma patients produced smaller amounts of polyclonal Ig than unseparated cells from normal donors. However, macrophage-depleted PBM from myeloma patients produced amounts of Ig comparable to those of normal donors when autologous or allogeneic adherent cells were returned in defined numbers. T cells from three of the four myeloma patients could provide help for the Ig production by B cells from healthy donors. These results indicate that functionally normal polyclonal B cells circulate in the blood of myeloma patients. The circulating T-cell population also has no obvious defect. In contrast, blood macrophages seemed to be altered with respect to their regulating function for polyclonal Ig production. The results obtained by using cell populations from patients with BMG did not differ from those of healthy people.
The calculation of tumor cell mass according to Salmon and Wampler was applied in a retrospective study comprising 79 unselected patients with multiple myeloma. The method proved to be a useful parameter for judging prognosis and course of the disease. IgG myelomas showed a better and prolonged regression of tumor cell mass than IgA myelomas. The average reduction of tumor cell mass under chemotherapy amounted to approximately 0.5 log. 38.5% of all patients went into a plateau phase after an initial decrease of their tumor cell mass, 30.8% showed varying values, whereas in 7.7% the reduction of the tumor cell mass occurred in a protracted fashion. The investigation of those patients in whom the first chemotherapy regimen was exchanged for another one showed, however, that the tumor cell mass calculation could not replace other controls, particularly X-ray controls pertaining to the progression of bone destruction. In benign monoclonal hyperglobulinemia, the calculation of the "tumor cell mass" can be applied as a sensitive parameter for judging the transition into multiple myeloma.
Resting blood flow, spontaneous variations of resting blood flow and postischemic peak flow of the fingers, measured by venous occlusion plethysmography, were reduced in patients with rheumatoid arthritis (n = 39) as compared to normals (n = 18). Resting blood flow and postischemic peak flow were reduced only in patients without skin vessel wall immune complex (IC) deposits, whereas spontaneous variations of resting blood flow were found to be reduced in patients with IC deposits. However, after inducing sympathicolysis, postischemic peak flow was reduced in both groups. These findings were consistent with the presence of organic lesions of the finger arteries in both groups associated with additional functional vasospasm in patients without complex deposits, that in the other group may have been counteracted by the presence of IC deposits.
Explore the source record for details and available documents.
Significantly decreased platelet serotonin contents were measured in rheumatoid arthritis, systemic lupus erythematosus (SLE), progressive systemic sclerosis, and mixed connective tissue disease. An inverse relationship between platelet serotonin levels and clinical disease activity was observed in both rheumatoid arthritis and systemic lupus erythematosus. SLE patients with multiple organ involvement showed the lowest platelet serotonin values. No correlation was observed between platelet serotonin contents and nonsteroidal antiinflammatory drug treatment, presence of circulating platelet reactive IgG, or the amount of circulating immune complexes. The results are interpreted as indicating platelet release occurring in vivo during inflammatory episodes of the rheumatic disorders investigated.
By using three different assay methods, circulating immune complexes have been detected in 85% of sera from patients with malignant melanoma, and in 77% of sera from patients with breast cancer. These methods were a C1q-binding assay, a double-antibody conglutinin-binding ELISA, and a polyethylene glycol 6000 precipitation technique followed by quantitative determination of immunoglobulins in the redissolved precipitate. Detection rates of circulating immune complexes using any one of these methods separately ranged from 33% to 56%, indicating the presence of different types of circulating immune complexes in cancer patients' sera. The combined use of the three methods mentioned resulted in an increased diagnostic sensitivity and a doubling of the predictive value. However, tests for circulating immune complexes cannot be considered as useful parameters for early diagnosis of cancer, since the comparatively low incidence of malignancies in the population at large, together with the presence of circulating immune complexes in other, nonmalignant, diseases of considerable prevalence, appears to preclude effective application of any nonspecific method for early diagnosis of cancer in general.
Circulating immune complexes were determined in the sera of patients with ankylosing spondylitis using a polyethylene glycol precipitation laser nephelometer technique. Positive results were obtained in 52% of sera from patients with active disease, but only in 20% from those in inactive stages. The immunoglobulin/complement protein ratio differed from that seen in rheumatoid arthritis and in systemic lupus erythematosus, due to the relatively larger amounts of C3 and C4 present in the immune complexes. These findings indicate that circulating immune complexes in ankylosing spondylitis may not be of pathogenetic significance because of their degree of solubilization.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sera from patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were assessed for in vitro platelet activation as measured by serotonin release; 24% (30) of 124 tested RA sera and 51% (35) of 69 SLE sera induced a significant 3H serotonin release. Investigation of 17 synovial fluid samples from RA patients revealed significant release in 82%. Concomitant testing for lymphocytotoxic antibodies and immune complexes did not show any correlation to platelet activation. Upon gel filtration the release-inducing activity of positive sera was localized in the region of 160 000 Daltons. Further characterization by ion exchange chromatography, immune electrophoresis, chromatographic and SDS PAGE molecular weight determinations, as well as analytical ultracentrifugation all confirmed the IgG nature of the release-inducing protein. Negative blocking experiments performed by preincubation of platelets with Fc-IgG fragments prior to challenge with a release-inducing serum excluded the participation of Fc receptors in the reaction. It was concluded that the release was caused by a platelet reactive IgG antibody. This antibody may also cause release of platelet mediators in vivo and may thus contribute to the pathogenesis of the generalized vasculopathy in both diseases.
Among 86 patients selected as possibly having ankylosing spondylitis because of clinical symptoms and radiologically normal sacroiliac joints. HLA-B27 was positive in 41%. Four years later a representative sample of 38 individuals were re-examined and radiographed. HLA-B27 positive patients developed sacroiliitis as defined by radiological criteria twice as often (P less than 0.05). They also showed increased uptake of technetium 99 m upon quantitative scintigraphy with a region of interest method and more often probable or definite ankylosing spondylitis as defined by the New York criteria. Further differences between the HLA-B27 positive and negative follow-up groups concerned the frequency of clinical symptoms and peripheral arthritis. It is suggested that HLA-B27 typing may be helpful both in diagnosis and in judging the prognosis of possible or abortive ankylosing spondylitis.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.