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Biomedical subjects

N F Rothfield

Publications and source records attributed to N F Rothfield.

At least 73 records · Page 4Linked to original sources

Familial partial deficiency of the third component of complement (C3) and the hypocomplementemic cutaneous vasculitis syndrome.

Familial hypocomplementemia of the third component of complement (C3) was found in four members of a family. The prospositus had cutaneous vasculitis, hypocomplementemia, arthralgia, proteinuria and thrombocytopenia. The combination of clinical, laboratory and pathologic findings resembled the "hypocomplementemic cutaneous vasculitis syndrome" (HCVS) or the "SLE-like syndrome" but serum C3 concentration was 35 to 57 per cent of normal in the propositus and in three relatives. Results of Clq precipitins, cryoglobulins and serologic tests for systemic lupus erythematosus were negative. Proteinuria (815 mg/day) but no hematuria was present. Analysis of the C3 phenotypes in this family showed that three hypocomplementemic members were apparent homozygous C3 slow but one was heterozygous C3 fast-slow. Metabolic studies with 125-Iodinated C3 in the clinically normal mother showed a 50 per cent reduction in C3 synthesis which was consistent with hypocomplementemia documented by serum protein assay. The occurrence of an immune complex-like disease (with characteristics of the HCVS) in a patient with a familial deficiency of C3 suggests that the preexisting C3 deficiency may predispose such persons to certain diseases.

Adolescent↗

Demonstration of beta 1H globulin together with C3 in the dermal-epidermal junction of patients with systemic lupus erythematosus.

Skin lesions and clinically normal skin from 10 patients with systemic lupus erythematosus (SLE) were examined by immunofluorescence for the presence of C3 and its control protein, beta 1H globulin. beta 1Hwas always found in association with deposited C3; in the instance where C3 deposits were not found beta 1H was also not found. Granular deposits of C3 and beta 1H were found in the dermal-epidermal junction (DEJ) in all of the 5 nonlesional skins studied. In the lesional skin, C3 was found in 4 of 5; in 2 of these 4, beta 1H was also found. As previously demonstrated for in vitro systems, beta 1H also binds in vivo to fragments of C3, presumably C3b, generated during activation of the complement system.

Adolescent↗

Isoniazid induction of antinuclear antibodies. A prospective study.

We prospectively studied 102 patients admitted to the Chest Service with tuberculosis. Four patients (4%) had antinuclear antibodies before therapy and 22 patients (21.6%) developed antinuclear antibodies after treatment. None developed lupus erythematosus cells or signs or symptoms of systemic lupus erythematosus. Age and race were not related to the induction of antinuclear antibodies. The percent of positive sera was similar during and after 3 months of treatment, with higher titers after 3 months of therapy. Although patients were treated with various antituberculosis drugs, isoniazid alone or in combination with other drugs induced antinuclear antibodies.

Antibodies, Antinuclear↗

Systemic lupus erythematosus. Management during pregnancy.

The course of 27 pregnancies in 13 patients with systemic lupus erythematosus (SLE) is presented. The overall incidence of fetal wastage was 33.3%, a figure significantly higher than that observed in the general population. Although serum C3 complement levels rise during normal pregnancy, mean C3 levels remain within the normal range. Since it is a fall in complement levels in patients with SLE which may herald the onset of symptoms and provide a guide to therapy, assay of serum C3 complement levels remains a valid monitoring device in management of these patients during pregnancy. Flares of SLE during pregnancy generally should be treated vigorously with corticosteroids rather than by therapeutic abortion. Continuation of corticosteroid treatment during the first 2 months postpartum is advised to limit the incidence of exacerbation of SLE activity following delivery.

Antibodies, Antinuclear↗

Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to corticosteroid therapy.

The relationship of corticosteroid therapy to the development of aseptic necrosis (AN) in 365 patients with systemic lupus erythematosus (SLE) was investigated. Seventeen patients (4.7%) were identified as having AN. The dosage of corticosteroids ingested during the initial period of therapy in patients with AN was tabulated and compared with that of 25 SLE control patients. There was a substantially greater dose of costicosteroids ingested in the first one, three, and six months of therapy in the patients with AN than in the control SLE group. Severity of disease and duration of therapy were not found to correlate with AN. Total corticosteroid dose was virtually identical in both groups. Thus, high initial corticosteroid dosages in patients with SLE seem to be associated with the development of AN.

Adult↗

Corticosteroid treatment in systemic lupus erythematosus. Survival studies.

Survival rates of two groups of corticosteroid-treated patients with systemic lupus erythematosus (SLE) have been compared using life-table analysis. Group 1 consists of 209 SLE patients studied in New York City between 1957 and 1968; group 2 consists of 156 SLE patients studied in Connecticut between 1968 and 1976. A similar percentage of patients in each group was followed up closely by one of us. The five-year survival rate for group 1 was 70%, compared with 93% for group 2. The improved survival could not be explained by differences in racial composition, incidence of CNS manifestations, or incidence of severe renal disease. The markedly improved survival may be due to several factors, including a generally better understanding of the disease and the recent use of newer antibiotics. The management of the two groups was similar, except that group 2 patient's conditions were managed not only on the basis of clinical evidence of disease activity but also on the basis of the serum complement (C3) level and on the basis of the level of antibody to native DNA. The data suggest that the use of such serologic values may lead to improved survival.

Adolescent↗

Pathways of complement activation in chronic discoid lupus: serologic and immunofluorescence studies.

To assess the relative roles of the classic and alternative pathways of complement activation in chronic discoid lupus erythematosus (CDLE), serum levels of properdin, C3, and C4, and deposition of these proteins in the dermal-epidermal junction (DEJ) of 20 CDLE patients were compared to the findings in patients with clinically active and inactive SLE. Properdin was demonstrated in the DEJ of 10 of 14 (71%) histologically typical skin lesions from patients with CDLE, usually in association with deposits of immunoglobulin, C3, and C4. Properdin levels in CDLE patients were significantly increased (137 +/- 34%) (P less than 0.05) when compared to normal controls (101 +/- 18%) or to patients with clinically active SLE (89 +/- 32%). C3, C4, DNA-binding, and antinuclear antibody tests in CDLE were indistinguishable from those in normals, but significantly different from patients with active SLE (P less than 0.05). The complement profiles of patients with clinically inactive SLE resembled those of CDLE patients more closely than those of active SLE patients.

Adult↗

Prostaglandin E treatment of NZB/NZW mice.

NZB/NZW F1 hybrid mice were treated with pharmacologic doses of prostaglandin E1 (PGE1) (200 microng subcutaneously either once or twice daily) from 6 through 52 weeks of age. PGE1-treated mice were protected against development anemia, clinical nephritis, and death. At 52 weeks 18 of 19 treated mice were alive, wherase only 2 of 19 untretreated control mice were alive. None of the 10 mice treated with PGE1 twice daily exhibited significant (greater than 2+) proteinuria at 1 year of age. PGE1 treatment did not prevent development of antibodies to nuclear antigens. The data also suggest that survival of NZB/NZW mice is prolonged when treatment with PGE1 is begun at 24 weeks, an age at which mice already show evidence of nephritis. Thus all 6 mice treated with PGE1 (200 microng sc twice daily) from 24 weeks were alive at 52 weeks, whereas only 2 of 6 untreated control mice were alive. The mechanisms whereby PGE1 treatment influences the course of disease in NZB/NZW mice are not known.

Animals↗

Aseptic necrosis presenting as wrist pain in SLE.

Aseptic necrosis of the wrist in systemic lupus erythematosus (SLE) is not rare. In 156 patients with SLE, aseptic necrosis occurred in 11 patients, of whom 3 (27%) had wrist involvement. Onset of pain was insidious and the symptoms were thought to be related to synovitis due to SLE. An average of 11 months elapsed before aseptic necrosis was correctly diagnosed. An awareness of this possibility is important in the management of any patient with SLE who complains of wrist pain.

Adolescent↗

Kidney in lupus erythematosus.

The pathologic abnormalities present in patients with SLE have been classified as follows: minimal lupus nephritis, mild (focal) proliferative lupus nephritis, severe (diffuse) proliferative lupus nephritis, and membranous lupus nephritis. Changes in individual patients from one form of nephritis to another are observed infrequently. Pathologic evidence of activity is usually present in patients with hematuria, although it may be found in patients with no evidence of clinical renal disease. Complement components and titer of antibody to native DNA may be helpful in estimating disease activity.

Antigen-Antibody Complex↗

Clinical significance of serum properdin levels and properdin deposition in the dermal-epidermal junction in systemic lupus erythematosus.

61 biopsies of normal skin from the deltoid area and lesional skin from various sites from 48 patients with systemic lupus erythematosus (SLE) were studied for the presence of properdin, C3, C4, and immunoglobulins (IgG, IgM, and IgA) in the dermal-epidermal junction (DEJ) using direct and indirect immunofluorescence. Properdin was present in 50% of normal and 40% of lesional skins. Properdin was present without C4 in only 2 of 38 nonlesional skin biopsies and in only 2 of 20 lesions. There was no significant difference in incidence of deposition of any of the six proteins studied between nonlesional and lesional skin. The frequency of deposition of each of the proteins correlated with clinical disease activity. The presence of proteins in the DEJ did not correlate with the presence of active renal disease at the time of biopsy nor with previously documented active nephritis. In addition, no other single clinical manifestation correlated with the presence of DEJ deposition of any protein studied. IgA was not demonstrated in the DEJ of nonlesional skin of 16 patients in remission and was present in 7 of 23 patients with active disease (P less than 0.05). Deposition of properdin in lesional skin correlated with the presence of extracutaneous disease activity (P less than 0.05). Analysis of serologic studies on serum obtained at the time of biopsy revealed a statistically significant correlation between C4 and C3 (r = 0.67). This correlation was stronger than that between properdin and C4 (r = 0.37). Titer of antinuclear antibody and percent of DNA binding correlated better with C4 levels than with properdin levels. Serum properdin levels were significantly lower in patients with active disease than in those in remission (P less than 0.05). Serum properdin levels were significantly lower in patients with properdin deposits in lesional skin than in those without properdin deposits. The data suggest that both alternative and classical pathways are activated in patients with clinically active SLE.

Adolescent↗

The efficacy of antimalarials in systemic lupus erythematosus.

Of 209 patients who fulfilled the A.R.A. criteria for the diagnosis of systemic lupus erythematosus, 43 were selected for study because each had been treated for at least two years with antimalarials, but had not received antimalarials for at least one subsequent year. In each instance, the antimalarial was discontinued solely because of the development of retinopathy. Each year on antimalarials was matched with a subsequent year off antimalarials for each patient. The year immediately following diagnosis and years of pregnancy were excluded. Paired-t test analysis of matched years revealed that general symptoms (fever, fatigue, weight loss) were less common during years on 500 mg chloroquine daily than during years off the drug (p less than 0.05). Skin manifestations were also less frequent during the years on 500 mg chloroquine daily than during the years off (p less than 0.05). No significant steroid sparing effect was found. However, a greater incidence of flare-ups during the matched years off the drug was statistically significant.

Adolescent↗