Serodiagnosis and immune profile in rheumatoid arthritis

One hundred and seventy-five cases of clinically diagnosed rheumatoid arthritis, 82 non-rheumatoid cases suffering from various other diseases and 40 healthy normal controls were investigated for detection of rheumatoid factor, quantitation of serum immunoglobulin, demonstration of antinuclear antibody (ANA) and LE cell phenomenon. Microlatex agglutination test of serum for rheumatoid factor (RF) showed 64% positivity in rheumatoid group and 1.2% positivity in non-rheumatoid group. All three immunoglobulins (IgG, IgM, IgA) were found to be raised in serum of patients with rheumatoid arthritis, whereas only IgA level was elevated in serum of patients with non-rheumatoid diseases. ANA and LE cell phenomenon were observed in 3.4% and 2.8% cases respectively in cases of clinically diagnosed rheumatoid arthritis who had been suffering from severe active rheumatoid arthritis. In non-rheumatoid group RF was positive in significant titre in only one case of leprosy. Synovial fluid and synovium were found to be heavily infiltrated by plasma cells and lymphocytes. RF appears first in synovial fluid and then in serum. Hence RF titre in blood may not attain significant level for the first several months.

Routine synovial fluid culture: is it necessary? Lessons from an audit

An estimated third of rheumatologists send aspirated synovial fluid samples for culture routinely during the course of management of their patients irrespective of the underlying diagnosis. This is done apparently even when sepsis is not suspected. This audit of 507 synovial fluid culture requests revealed that positive bacterial growth was rare even when sepsis was queried on the request forms but none was positive in any of the routine samples. Our findings throw doubt on the value of routine synovial fluid culture. We recommend that such cultures are undertaken when infection is a possibility and in immuno-compromised patients. An average health district would save pounds 3000 per annum if such a policy was adopted, but across the National Health Service as a whole the total expenditure saved on this unnecessary investigation would be considerable.

Paraplegia due to thoracic disc herniation

Disc herniation at the thoracic the spine level is more common than generally thought. Localisation of pain may be vague and may erroneously point to cardiopulmonary, gastrointestinal, genito-urinary or even psychiatric disease. Magnetic resonance imaging is the investigation of choice, especially if spinal cord compression is suspected.

Carpal tunnel syndrome as a herald of autoimmune rheumatic disorders

In six patients aged 59-71 years carpal tunnel syndrome, seemingly idiopathic, was followed by connective tissue disorders, in most cases autoimmune in nature. Patients with idiopathic carpal tunnel syndrome may therefore require long-term follow-up, if inflammatory rheumatic conditions are not to be missed.

Effect of inaccessible volume on intensity statistics – atoms in fixed special positions

The effect of heavy atoms at fixed special positions on the cumulative distribution function

Carbocyclic analogues of D-ribose-5-phosphate: synthesis and behavior with 5-phosphoribosyl alpha-1-pyrophosphate synthetases

The synthesis of cyclopentyl and cyclopentenyl analogues of the alpha-anomer of D-ribose-5-phosphate from D-ribonolactone and D-ribose is described. These analogues, which have the same absolute configuration as D-ribose-5-phosphate, were incubated with PRPP synthetases in an attempt to prepare the corresponding carbocyclic PRPP analogues. The carbocyclic ribose-5-phosphate analogues were found to be inhibitors, rather than substrates, for 5-phosphoribosyl alpha-1-pyrophosphate synthetases of both bacterial and human origin. The inhibitory behaviour of the analogues is described.

Raynaud's phenomenon in idiopathic carpal tunnel syndrome

Both carpal tunnel syndrome and Raynaud's phenomonon are common conditions in the general population. These two different conditions frequently cause similar symptoms such as tingling, numbness, and "deadness of the fingers". They may also co-exist for instance in scleroderma or rheumatoid arthritis. In order to study the association, if any, between these two conditions, we studied 93 patients with idiopathic carpal tunnel syndrome confirmed in electro-physiological tests with 57 control subjects, for the presence of Raynaud's phenomenon by means of a previously validated questionnaire. Raynaud's phenomenon was detected significantly more frequently (P = 0.002) in patients with idiopathic carpal tunnel syndrome (36%) compared to control subjects (12%). Thus there appears to be an association between these two conditions. The mechanism for this is not clear. Sympathetic dysfunction may play a part. Practitioners should be aware of the similarity of the symptoms and the possibility that the two conditions may co-exist.

Evaluation of "norpeptides" as potential inhibitors of HIV-proteases

Peptide mimics of substrates for HIV-proteases were prepared. These "norpeptides" are identical to a fragment of the HIV-polyprotein except that a crucial scissile bond was deleted, and an alpha,beta-disubstituted amino acid spans the P1 and P1 site. Thus all four stereoisomers of Leu psi[]Ala (i.e. H2NCH(CH2iPr)CH(Me)CO2H, 1) were incorporated into Ac-Ala-Arg-Val-Leu psi[]Ala-Glu-Ala-NH2 (all other residues being L-amino acids), and tested with respect to inhibition of HIV-1 and HIV-2 proteases.

Subcutaneous injection of an analog of neuropeptide FF precipitates morphine abstinence syndrome

Neuropeptide FF (NPFF) has been shown to exert various antiopiate actions, including precipitation of opiate abstinence syndrome by third ventricle injection in morphine dependent rats. In the present study, dansyl-Pro-Gln-Arg-Phe-amide, a lipophilic analog of NPFF, was injected into morphine dependent rats and appropriate sham controls at a dose of 9 mg/kg s.c. Comparison groups were injected with ethanol/water vehicle alone. The NPFF analog precipitated a vigorous opiate abstinence syndrome in morphine dependent rats, but not in sham controls.

Systemic mastocytosis and Sjögren's syndrome

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Primary Sjögren's syndrome in north east England--a longitudinal study

We have documented the initial clinical features of 100 patients with primary Sjögren's syndrome (SS) together with the results of their baseline investigations. The evolution of the disease in these patients has been followed for a median of 34 months (range 3-84 months). The majority of patients were females aged 40-60 years, and common clinical features included eye symptoms (100%), xerostomia (100%), polyarthralgia (94%), Raynaud's phenomenon (81%) and salivary gland swelling (47%). Thyroid disease was relatively common (14%) while other endocrine disease was rare. Four patients died during follow-up, and three cases of lymphoma were detected. Other serious complications included pericarditis (10%), pleuroparenchymal lung disease (9%), renal tubular acidosis (3%) and cerebrovascular accidents (2%). The presence of anti-Ro antibodies identifies patients with more severe systemic disease. Spontaneous improvement occurred in 12 patients, while steroids were required for specific complications in 18. Overall, although lymphoma was found to excess in our group, the high mortality reported with primary SS elsewhere was not seen.