Anti-thyroid microsomal antibody in synovial fluid as a revealing feature of seronegative autoimmune thyroiditis

Two cases of recurrent monoarthritis are described in which antithyroid microsomal (antiMi) autoantibody (Ab) was found in synovial fluid (SF) before any clinical or serological evidence of thyroid disease. Subsequently, the follow-up of the two patients showed the appearance of thyroiditis within 2-5 years. The presence of anti-Mi Ab in SF might anticipate the appearance of autoimmune thyroiditis even in the absence of serum detectable antithyroid Ab, as was later observed in these two cases.

Esophageal involvement in mixed connective tissue disease

A study of esophageal symptoms and function was performed in 21 patients with mixed connective tissue disease (MCTD). Esophageal involvement was found in 18 cases (85%), in 14 (66%) with typical symptoms, in 15 (71%) with manometric abnormalities and in 11 (57%) with both. The manometric pattern was characterized by reduction of amplitude and coordination of peristaltic waves throughout the esophageal body and reduction of lower esophageal sphincter (LES) competency. In comparison, 38 patients with systemic sclerosis showed a similar but more severe pattern, particularly at the level of the distal esophagus and LES. Thus, although similar, the esophageal involvement in MCTD was not exactly the same as that of systemic sclerosis. Furthermore, in MCTD a correlation between manometric abnormalities and cutaneous involvement was lacking, and this suggests that esophageal disorders are not always linked with clinically evident scleroderma-like features of this disease. Since the diagnosis of MCTD is made in the presence of the clinical picture of more than one connective tissue disease, the detection of esophageal involvement by a sensitive technique such as esophageal manometry in a patient with suspected MCTD may be a useful diagnostic aid.

Clinical value of a peculiar nuclear fluorescence staining in systemic sclerosis

Using unfixed rat liver sections as substrate for the detection of antinuclear antibodies, distinct nuclear staining was observed in the sera of patients with systemic sclerosis. Its reaction differed from previously described fluorescence patterns and was characterized by numerous fine speckles throughout the nucleus associated with one or more coarse lines. These lines were more evident in diluted sera, when fine speckled fluorescence faded. This picture "fine speckles with lines" (FLS) was defined. The FLS pattern was present in 35% of 91 patients with systemic sclerosis, while it was absent in 517 patients with rheumatic and non-rheumatic disorders and in 100 matched healthy subjects. Moreover, the FSL pattern was significantly associated with the diffuse subset of systemic sclerosis (50% of cases) and was related to the presence of anti-Scl-70 antibody. These results indicate that this fluorescent pattern of antinuclear antibodies may be considered a simple and very useful aid in the diagnosis and prognosis of systemic sclerosis.

Anti-double-stranded DNA antibodies in the healthy elderly: prevalence and characteristics

Using Crithidia luciliae fluorescent assay a significant prevalence (7.6%; P less than 0.006) of anti-double-stranded DNA antibodies was found in a healthy old population. A negative enzyme-linked immunosorbent assay for anti-total histone antibodies excluded a false-positive reaction. Anti-double-stranded DNA antibodies in the aged differed from those found in patients with systemic lupus erythematosus and were characterized by a low titer (95.6% of cases), belonging to the IgA class alone (95.6%), no complement-fixing ability (100%), and negativity to Farr assay (100%). It is concluded that, in elderly subjects without signs and symptoms of disease, including systemic lupus erythematosus, such a peculiar anti-double-stranded DNA antibody may be detected.

Renal artery thrombosis and hypertension in a 13 year old girl with antiphospholipid syndrome

The case of a 13 year old girl with renal artery thrombosis and hypertension is described. A cerebrovascular accident and a probable occlusion of the superior mesenteric artery also occurred. Very high levels of 'lupus anticoagulant', anticardiolipin antibodies as well as false positive Venereal Disease Research Laboratory tests were repeatedly shown. Moreover, the patient fulfilled at least four classification criteria for systemic lupus erythematosus, but only a slight positivity for antinucleolar antibodies was present. The striking relation between antiphospholipid antibody levels and clinical events and the treatment of this complex syndrome are discussed.

Renal function during calcitriol therapy in chronic renal failure

Some authors have reported that vitamin D treatment worsens renal function. We studied 10 patients with stable renal function, who were given calcitriol (0.5 micrograms/day) for a 4-month period. Creatinine and inulin clearance were performed at the beginning and at the end of the treatment. Although serum creatinine increased and creatinine clearance decreased, inulin clearance did not show significant variations. Furthermore, serum creatinine fell to the baseline value within 60 days after discontinuation of vitamin D therapy. The increased serum creatinine may be explained by an augmented release from muscular tissue, probably due to the improvement of uremic myopathy induced by calcitriol.

Autoantibodies of systemic rheumatic diseases in the healthy elderly

Antinuclear antibodies, anticardiolipin antibodies and IgM rheumatoid factor were determined in 300 healthy aged subjects, comparing their prevalence to that in 100 healthy subjects aged between 19 and 44 years and 352 patients under 65 years of age, affected by various systemic rheumatic diseases. Increased production of IgM rheumatoid factor and antinuclear and anticardiolipin antibodies was found as characteristic of aged humans, and suggested that a correction for age should be considered in evaluating the clinical significance of autoantibody profiles in elderly patients.

Osteonecrosis of the femoral head after renal transplantation. Pathogenetic considerations

In 5 out of 16 renal transplantation patients, osteonecrosis of the femoral head developed in the presence (p less than 0.01) of significant uremic neuropathy; its possible pathogenetic role is discussed.

[Radiological lesions of the hands in rheumatoid arthritis with rheumatoid factors and antinuclear antibodies]

Hand radiograms of 119 consecutive patients affected with rheumatoid arthritis (RA) were examined. The patients were distributed in different groups: 46 with (RF+) and 73 without (RF-) rheumatoid factor; 23 with (ANA+) and 96 without (ANA-) antinuclear antibodies. We found that RF+ group significantly differs from the RF- in order to the presence of symmetrical erosions of proximal interphalangeal joints (PIP) and the presence of monolateral erosions of metacarpophalangeal joints (MCP), particularly of the 2nd. We also observed that the frequency of MCP erosions, particularly of the 2nd was higher in ANA+ than in ANA-, and that monolateral PIP erosions were higher in ANA- than in ANA+ group. Moreover, the patients having both RF and ANA more frequently show erosions of symmetrical PIP and monolateral MCP as well as monolateral of the carp. It is therefore suggested that in RA patients having RF or ANA the articular lesions of the hand are different from those of the patients who don't show such serological markers.

Biofiltration vs. bicarbonate dialysis: influence on plasma volume changes and extravascular fluid mobilization

The present study compares the effects of bicarbonate hemodialysis (Bic. HD) and biofiltration (BF), a new hemodiafiltration technique, on plasma volume (PV) changes and extravascular fluid mobilization (Vfm). Ten uremic patients underwent one experimental session of Bic. HD and, one week later, one of BF, both on the second dialysis of the week. Net ultrafiltration rate was limited to 700 ml/min. At the start of each session, whole blood volume (WBV), PV and red cell volume (RCV) were determined using 5 mu Ci of radioiodinated serum albumin (RISA). PV and Vfm were calculated at hourly intervals using a serial hematocrit method. On Bic. HD, PV increased at 60 min. then decreased at 120 and 180 min., with efficient Vfm only during the first hour. On BF, PV increased throughout treatment, with greater Vfm. It would appear that PV is better preserved in BF, on account of more efficient Vfm.

Anticentromere antibody in localized scleroderma

Using metaphase chromosome spreads as substrate for indirect immunofluorescence technic, we observed anticentromere antibody in three of twenty-five patients affected with various clinical forms of localized scleroderma. Anticentromere antibody is generally considered a serologic marker of the CREST syndrome, a more benign subset of systemic sclerosis. However, none of the three anticentromere antibody-positive patients with localized scleroderma had Raynaud's phenomenon, acrosclerosis, or any signs or symptoms of systemic disease; on physical and laboratory examination, they showed only typical cutaneous features of localized scleroderma: two showed linear scleroderma, and one showed localized morphea. A 2-year 8-month follow-up of two patients did not disclose any clinical evidence of systemic sclerosis. The occurrence of anticentromere antibody in patients with localized scleroderma seems to offer supportive evidence that a relationship exists between localized scleroderma and systemic sclerosis.

Prevalence of anticentromere antibody in blood relatives of anticentromere positive patients

Anticentromere antibody (ACA) was investigated in 116 blood relatives of 22 ACA positive patients affected with scleroderma and, for comparison, in 82 healthy subjects matched for age and sex who belonged to 25 families. No relative showed any evident scleroderma symptom although in 8 an unusual cold sensitivity of the extremities was present. ACA at a low titer (40), was found in 4 relatives (3.44%), while it was absent in control sera. The 4 ACA positive relatives were first as well as second degree relatives of probands. Two had familial disease: one idiopathic chronic hypoparathyroidism and the other mental retardation. The third had myasthenia gravis and the fourth unusual cold sensitivity and allergic dermatitis. At present we cannot explain the significance of ACA occurrence in relatives of ACA positive patients. Followup clinical and serological studies could show a possible association of low titer of ACA with subclinical scleroderma features in patients who later develop overt disease.

Nuclear membrane-staining antinuclear antibody in patients with primary biliary cirrhosis

An antinuclear antibody specific for nuclear membrane (ANMA) was observed by the immunofluorescence method in sera from patients with primary biliary cirrhosis (PBC). ANMA was present in 18 of 63 PBC sera (28.5) and in 1 of 431 control sera (0.2%). Its reaction appeared as a thin fluorescent ring confined to the nuclear envelope and was more evident when the sera were highly diluted and the fluorescence, due to frequently associated antimitochondrial antibody, faded. The ANMA fluorescent pattern was confirmed by indirect immunoperoxidase staining. ANMA was seen on both tissue cryostat sections and HEp-2 cells. It was a poorly or non-complement-fixing IgG, specific for an antigen resistant to DNase I, RNase, and trypsin. The significance of its presence in PBC in unknown at present. Identification of its antigen with one of the centromeric antigens is suggested.

Association of anti-centromere and anti-Scl 70 antibodies in scleroderma. Report of two cases

In testing for antinuclear antibodies the sera of 121 patients affected with scleroderma, we found in 2 of them the concurrent presence of anti-centromere and anti-Scl 70 antibodies. Since the association of these antibodies has never been reported, to the best of our knowledge, we report the clinical and serological features of the 2 patients. Both subjects were women with an incomplete CREST syndrome (RST), a relatively limited involvement of the skin, a mild pulmonary fibrosis without apparent signs of other visceral involvement. On the other hand, the clinical course of the disease was different in the 2 cases. One patient had a longer disease duration and up to date the clinical features appear to be unchanged; the other had a shorter disease duration, when suddenly she died of cardiac arrest.

Therapy of acute pancreatitis in systemic lupus erythematosus with plasmapheresis and corticosteroids

A 24-year-old woman with systemic lupus erythematosus had, after reduction of corticosteroid therapy, a severe relapse of the disease with hepatitis, nephritis and pleurisy. After admission to the hospital, she was given 60-80 mg/day of prednisone and acute pancreatitis developed on the third day. Plasmapheresis, followed by injection of 1 g of methylprednisolone, was started. This combined therapy induced a prompt and complete recovery in a few days.

[Rheumatoid factors: value of their determination in patients with rheumatoid arthritis]

IgM, IgA, IgG rheumatoid factors were investigated by a indirect immunofluorescence method in three groups of patients affected with rheumatoid arthritis of various picture: 30 patients with mild articular disease, 20 with severe joint involvement and 19 with articular and systemic symptoms. Rheumatoid factors occurred more frequently in patients with articular and extraarticular severe rheumatoid arthritis; moreover these patients showed higher titres and higher incidence of different immunoglobulin class rheumatoid factors in comparison with rheumatoid patients having mild joint disease.

[Assay of rheumatoid factors by the indirect immunofluorescence method]

Sera from 69 patients affected with rheumatoid arthritis were examined for IgM, IgG and IgA rheumatoid factors (RF) by a indirect immunofluorescence method. The results were compared with those obtained from the classical rheumatoid factor latex test. By this technique we have demonstrated antigammaglobulin activity in a high proportion (23%) of sera from latex test seronegative rheumatoid patients. Moreover, by fractionated antisera it was possible to detect also IgG and IgA factors. Indirect immunofluorescence results to be a simple and available technique for detection of RF, also in many "seronegative" patients.

[Anti-tissue autoantibodies in malignant pulmonary neoplasms]

Tissue antibodies (Ab) were investigated in 85 patients affected with pulmonary malignancy of different histologic type and, as control, in 40 non-smoker healthy subjects and in 40 smoker subjects with chronic bronchitis. A significantly higher number of patients (64, 7%) had tissue Ab in comparison with both control groups (17% in non smoker group and 25% in smoker and chronic bronchitis group, respectively). Antinuclear antibodies were found in 29.4% of patients, antismooth muscle in 31.7%, anti-mitochondrial Ab in 4.7%, antityroid microsomes Ab in 4.7%, anti-gastric parietal cells Ab in 4.7%, anti-reticulin Ab in 11.7%. The patients at third stage of disease showed all antibodies as well as anti-nuclear more frequently that patients at first and second stage. Antibodies to cytoplasmic antigens were found in patients with anaplastic and squamous cancer, but not in patients with adenocarcinoma. Our observations suggest that immunologic abnormalities similar to those present in autoimmune disease, may be associated to pulmonary malignancy.

[Tissue autoantibodies during therapy with levamisole for rheumatoid arthritis]

In 20 patients affected with rheumatoid arthritis, tissue autoantibodies were studied during a year of treatment with levamisole. Before therapy, antinuclear antibodies were present in 11 cases, anti-thyroid microsomes in 1 and anti-smooth muscle in 6. During therapy, autoantibodies remained almost unchanged in all patients, thus indicating that levamisole does not influence this aspect of humoral immunity in rheumatoid arthritis. Furthermore, no correlation was found between autoantibody pattern before treatment and effects of levamisole on clinical course of disease.

[The microsomal antibody (LKM) in liver pathology: its association with other autoantibodies]

Twenty patients found LKM antibody positive during the routine screening for autoantibodies, were studied for the association with other autoantibodies. Sixteen sera (80%) were found positive either for ANA (50%) or SMA (50%) or both (20%). Eleven patients (55%) were over 40 years old, 3 patients were HBsAg+ve, 4 have toxic and alcohol-related liver disease. These results provide evidence that the LKM antibody is not confined to young people chronic active hepatitis, but is present also in CALD of adult with various etiology. Its association with other autoantibodies (especially ANA) suggest that also LKM could be a marker of autoimmunity. The presence of ANA may be an expression of more severe stages of the disease.