Biomedical subjects
Publications and source records attributed to R C Bucknall.
A sixteen year old girl with systemic lupus erythematosus developed acute transverse myelopathy. She was treated with high dose steroids, cyclophosphamide, and plasma exchange and regained partial neurological function. Previous descriptions of transverse myelopathy complicating systemic lupus erythematosus are reviewed, with particular reference to the efficacy of high dose steroid treatment.
A 26 year old woman had recurrent unilateral pleural effusions secondary to active systemic lupus erythematosus. The effusions were resistant to conventional treatment with steroids but did not recur after tetracycline pleurodesis.
An ELISA has been developed for serum antibodies to streptococcal cell wall peptidoglycan-polysaccharide polymers (PG-GSP). A significantly increased prevalence of serum anti-PG-GSP antibody was found in juvenile chronic arthritis and both seropositive and seronegative rheumatoid arthritis (RA), compared with ankylosing spondylitis, systemic lupus erythematosus, myeloma and healthy controls. Anti-PG-GSP antibody was always of the IgG class and there was no correlation of anti-PG-GSP levels with C reactive protein, rheumatoid factor (RF) or anti-streptolysin O titres. There was no direct cross-reaction of RF with PG-GSP, nor did the presence of IgM-RF significantly interfere with the assay. Examination of paired serum and synovial fluid samples offered no evidence for local production of anti-PG-GSP antibody in synovial tissue. These data are compatible with an increased systemic immunization by bacterial fragments in RA.
Twenty-five patients with rheumatoid arthritis (RA) and neutropenia, of whom 19 had a palpable spleen, were compared with 24 patients with uncomplicated RA, and 16 patients with RA and associated splenomegaly without neutropenia. Clinically patients with neutropenia had evidence of a more systemic disease as assessed by prevalence of rheumatoid nodules, weight loss, and recurrent infections. However, there was less evidence of active synovitis than in the other 2 groups. Marrow neutrophil reserve was studied by means of a hydrocortisone stimulation test and was found to be lower in all 3 groups than in normal persons but with most marked depletion in the neutropenic group. Removal of the spleen in some patients with neutropenia resulted in a significant increase in marrow neutrophil reserve. Circulating immune complexes as detected by anticomplementary activity and platelet aggregation tests were detected in 68% of the RA neutropenia group, 31% of the RA splenomegaly group, and 8% of the uncomplicated RA group. Our results show that, assessed both clinically and by the above tests, patients with neutropenia have a greater prevalence of abnormalities which may be directly related to their neutropenia. Patients with splenomegaly alone closely resemble patients with uncomplicated RA.
A radioimmunoassay has been developed for measuring IgG antiglobulins using baboon IgG as antigen. Raised levels were virtually confined to the sera of patients with rheumatoid arthritis (RA) and not found in other seronegative arthritides. High levels were found in both seropositive and seronegative (as judged by latex slide and sheep cell differential agglutination for IgM antiglobulins) patients with RA and were associated with systemic disease but not synovitis. Very high levels (more than twice the upper limit of normal) showed a strong association with vasculitis.
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Comparison of clinically assessed activity of disease with 112 paired readings of the erythrocyte sedimentation rate (ESR) and the plasma viscosity (PV) in 23 patients with polymyalgia rheumatica (PMR) showed the following. (1) A correlation between ESR and PV in both sexes, reaching the significance obtained in a comparison group of patients with rheumatoid arthritis (RA) (109 paired readings), with no significant difference between the PMR and RA groups on analysis of variance of the regression slopes. (2) A degree of scatter of readings around the regression lines so that they could not be used for prediction of ESR from the PV or vice versa. (3) varkappa(2) analysis of normal and abnormal values of ESR and PV which showed a highly significant correlation. However 10 readings were abnormally high for ESR in the presence of a normal PV. 5 of these 10 observations were associated with clinical features of disease activity. 20 readings were abnormally high for PV in spite of a normal ESR with only one instance of clinical activity. These data indicate that it is not possible to provide exact guidelines for a ;safe' level of ESR or PV applicable to the individual patient, and measurement of both these indices of disease activity is recommended.
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Eight patients with systemic lupus erythematosus (S.L.E.) have been treated with plasmapheresis. In four patients in whom immunochemical studies indicated high levels of circulating immune complexes, the removal of 5-8 litres of plasma weekly produced a striking clinical and immunochemical improvement. The four other patients, with only minor complement disturbances and no direct evidence of circulating immune complexes, could not be shown to benefit from plasmapheresis and one patient in this group died of cerebral lupus despite intensive treatment with cytotoxic drugs. It is concluded that plasmapheresis may be of value as an adjuvant to the treatment of acute S.L.E.
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Four patients with rheumatoid arthritis (R.A.) developed myasthenia gravis after taking penicillamine. In one patient withdrawal of the drug was followed by spontaneous remission of the myasthenia, and in two the dose of anticholinesterase was subsequently reduced. In the fourth patient continuing penicillamine treatment was associated with increasingly severe myasthenic features, but on withdrawal of the drug these resolved. As myasthenia gravis rarely complicates R.A. its onset in these patients shortly after the start of penicillamine treatment suggested that penicillamine may have precipitated this condition.
10 patients with Crohn's disease in various states of activity have been injected with 3.3 times 10-9 plaque-forming units of the bacteriophage phi chi 174, as a test for their capacity to produce antibodies. 9 patients had a completely normal primary and secondary antibody response. One patient had higher levels of preimmunization antibodies than have been encountered in normal subjects and developed a secondary (IgG) response to the first dose of antigen. We conclude that there is no evidence of a general disturbance of antibody-producing capacity in subjects with Crohn's disease.
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The heterogeneity of the specificities of anti-acetylcholine receptor (anti-AChR) antibodies of myasthenia gravis (MG) patients has been demonstrated by comparing reactions against a panel of xenogeneic AChR. For each patient there was a more or less unique cross-reactivity profile. Such heterogeneity emphasizes the need to use human AChR for the routine detection of anti-AChR. In vitro cross-reactivity was important in predicting the effect of anti-AChR after passive transfer to rats. Specificity may influence the outcome in human neonates receiving maternal anti-AChR via the placenta. In contrast to the extreme heterogeneity seen in spontaneous MG, the antibodies associated with D-penicillamine-induced MG were more homogeneous.
OBJECTIVE: A prospective study to compare the MR and CT images of patients with suspected sacroiliitis and to establish the optimal MR sequences to demonstrate the changes of sacroiliitis was conducted. MATERIALS AND METHODS: Thirty-nine patients and nine controls were imaged in the axial plane, with SE T1-, T2-weighted fast spin echo (T2), T1 with fat suppression (T1WFS), and fast short tau inversion recovery (fast STIR) sequences on a 1.5 T system. The sacroiliac joints of all patients were imaged with CT. The images were evaluated by two independent radiologists. Following the blinded reading, direct comparison of T1 and T1WFS, T2, and fast STIR of the CT positive group was made to determine the optimal MR sequences. RESULTS: The sensitivity and specificity of MR images for the detection of cortical erosions and subchondral sclerosis when compared to CT images were 100 and 94.3%, respectively; interobserver variation was low (k = 0.80). T1WFS and fast STIR images were superior to T1 and T2 images, respectively, in demonstrating the changes of sacroiliitis. CONCLUSION: MRI (T1WFS and fast STIR) can replace CT in cases with a strong clinical suspicion of sacroiliitis and equivocal or normal plain radiographs.
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