The clinical progression of apparent juvenile rheumatoid arthritis to systemic lupus erythematosus

Ten patients with juvenile rheumatoid arthritis (JRA) developed clinical manifestations of systemic lupus erythematosus (SLE) in 2 1/2 to 21 yr. At onset there was little to distinguish these patients from other children with JRA. Chronic arthritis developed in all and was not different from that seen in JRA. Onset of SLE followed a flare of arthritis in 8 patients, development of serositis in 5, and fever and rash in 5. LE cells and elevated DNA-binding were found in all patients, and glomerulonephritis was demonstrated in the 6 patients on whom renal biopsies were done. This group of patients may represent an important diagnostic subset of children with JRA or SLE.

Pulmonary hypertension in a child with mixed connective tissue disease

Mixed connective tissue disease (MCTD) is characterized by high titers of antibody to ribonucleoprotein (RNP) in patients with features of several rheumatic diseases. We describe a child whose MCTD included arthritis, Raynaud's phenomenon, mucocutaneous ulcerations, sclerodermatous skin changes, restrictive lung disease, reduced carbon monoxide pulmonary diffusing capacity, abnormal esophogeal motility, and severe pulmonary hypertension. High antibody titers to ds-DNA and RNP were present. Clinical improvement followed therapy with prednisone and cyclophosphamide. Improvement in the degree of pulmonary hypertension was documented by repeat cardiac catheterization 8 months after the initiation of combination therapy.

Lip and nonpreferred forearm EMG activity as a function of orienting task

Subjects performed orthographic or semantic orienting tasks while preparing an overt response (pressing one of two buttons). Electromyographic (EMG) activity of lip and nonpreferred forearm muscles and heart rate were monitored. Only lip EMG activity distinguished the extent of covert processing, evidencing greater activity during the semantic than sensory task. In contrast, increased nonpreferred forearm EMG and cardiac activity accompanied the behavioral response. It was concluded that general semantic and autonomic activity serve biological needs, but in addition, there are specific patterns of physiological response that are intrinsic to convert information processing.

The association of autoimmune diseases and anti-IgA antibodies in patients with selective IgA deficiency

The prevalence of antibodies to immunoglobulin A (IgA) was studied in eighty-three subjects with selective IgA deficiency (SIgAD), thirty-three normal individuals, thirty-two children with juvenile rheumatoid arthritis (JRA) and normal or elevated IgA, seventeen children with systemic lupus erythematosus (SLE) and normal or elevated IgA, and thirteen patients with hypogammaglobulinaemia. Anti-IgA antibodies were detected by haemagglutination of human erythrocytes coated with one of two IgA myelomas by the chromic chloride technique. Antibodies to IgA were not found in significant titre in individuals with normal or elevated IgA or in those with hypogammaglobulinaemia. In IgA deficient patients, elevated titres were found in 25--30% of those who were healthy or who had non-rheumatic diseases, 50% of those with rheumatoid arthritis, 77% of those with JRA and 100% of those with SLE. Patients with rheumatic diseases and SIgAD may therefore be particularly at risk of developing anti-IgA-mediated reactions to blood products.

Neuromuscular circuits in affect-laden information processing

Substantial evidence has accrued indicating the involvement of neuromuscular circuits in covert information processing. The physiological systems imparting emotional tone to covert processing, however, are less well understood. Reviewed here are findings from a variety of methodologies which suggest that somatic patterns, particularly in the face, reflect moment by moment emotional reactions. These findings imply neuromuscular involvement in affect-laden information processing; less conclusive, though suggestive, are data indicating that the proprioceptive feedback from these phasic and specific patterns of response are integrated cortically and influence covert processing and overt responding.

Reiter's disease in children

Three Canadian Indian boys, aged 2, 14, and 15 years, with features of Reiter's disease (RD) had arthritis occur that was characterized by noticeable tenderness and large effusions. The two youngest also had conjunctivitis and urethritis and thus conformed to the classical triad of RD. The eldest had dysuria and a history suggesting keratoderma blennorrhagica. All had HLA-B27 antigen. Inclusions indicative of chlamydial infection were seen in assays from the two youngest boys. Previously documented cases of childhood RD have been reviewed. More flexible diagnostic criteria may be useful in identifying this class of seronegative arthritis in children.

Serum IgE levels in patients with selective IgA deficiency

In this study serum IgE levels were measured by a double-antibody radioimmunoassay in 31 patients with serum IgA concentration less than 0.01 mg/ml who were followed in the arthritis and allergy clinics. On a group basis there was no significant difference in mean serum IgE levels between the IgA deficient patients and normal subjects of the same age. However, in the absence of atopic disease, IgA deficient patients had significantly lower serum IgE levels. When atopy was associated with IgA deficiency IgE levels were the same as in the normal subjects but significantly lower than those of atopic non-IgA deficient patients. IgE levels in those with recurrent respiratory tract infection were not different. Adults with anti-IgA antibodies had significantly lower IgE values. IgE levels in patients with RA, JRA or SLE were not significantly different. Selective IgA deficient patients may have a relative deficiency of serum IgE depending on the comparison group.

Diagnostic significance of antibody to native deoxyribonucleic acid in children with juvenile rheumatoid arthritis and other connective tissue diseases

Sera of children with juvenile rheumatoid arthritis and other connective tissue diseases were tested for antibodies to native DNA by a radiolabeled-binding assay. Normal values were obtained in 130 children with JRA, including 28 with uveitis and 14 with selective IgA deficiency. Normal values were also found in sera from children with dermatomyositis, scleroderma, polyarteritis, ankylosing spondylitis, and a variety of other nonconnective tissue diseases. The only sera with elevated DNA-binding assays were from children with systemic lupus erythematosus. On the basis of these data, increased levels of antibodies to native DNA distinguished patients with active SLE from children with JRA.

Intravenous gamma globulin in the management of patients with hypogammaglobulinemia

The safety and efficacy of plasmin-treated gamma globulin (PG-GG), an intravenous preparation with low anticomplementary activity, was assessed as an antibody replacement therapy in 14 patients with hypogammaglobulinemia. Seven were studied in 2 treatment periods of 6 and 15 mo on PT-GG with an intervening control period of intramuscular gamma globulin (IM-ISG). Frequency of infusions ranged from 2 to 4 wk to maintain a serum IgG concentration of less than 2.5 mg/ml. Three patients with severe chronic pulmonary disease were removed from the study because of lack of clinical improvement and were placed on single-donor plasma. The remaining 11 patients had a decrease in the number of hospitalizations or severe infections. Five patients had one or more systemic reactions (21/240 infusions). Symptoms abated rapidly with temporary interruption of the infusion. From these results, we conclude that PT-GG represents a relatively safe, efficacious mode of replacement therapy which has had uniformly high acceptance in patients with hypogammaglobulinemia.

A syndrome of childhood polyarteritis

In this report the clinical, laboratory, and histopathologic findings of nine children with polyarteritis are reviewed. All have had evidence of systemic involvement. Eight presented with fever, calf pain, erythematous painful nodules, and elevation of the acute-phase reactants. All were treated with prednisone at a dosage of 2 mg/kg/day. All of the children are alive but have had relapses at least once during the course of tapering the dosage of corticosteroids. Serious complications of disease have included myocardial infarction, hypertension, and impaired renal function.

Clinical patterns of chronic iridocyclitis in children with juvenile rheumatoid arthritis

In the present study we have reconfirmed an earlier observation of the association of iridocyclitis with limited joint involvement in children with JRA. Children who develop iridocyclitis are predominantly girls whose sera are positive for antinuclear antibodies. Iridocyclitis was found to be asymptomatic at onset. Only periodic slit lamp examinations will detect the majority of cases. Iridocyclitis began a median of 2 years after onset of arthritis. Although most episodes occurred within 7 years after onset of arthritis, the risk of this development may never be absent in these children, even after they enter adulthood. In the present study, 16% of the afflicted children experienced either unilateral or bilateral blindness.

Scleroderma in children

Fifteen children with scleroderma have been presented. All had characteristic cutaneous abnormalities at onset and during the course of disease. All were girls. All had visceral involvement, primarily of the gastrointestinal tract, heart, and lungs. The presence of visceral disease might have been missed without specific and extensive diagnostic procedures, including gastrointestinal barium studies, esophageal motility, pulmonary function and carbon monoxide diffusing capacity, and plethysmography. Raynaud's phenomenon was frequent and accompanied by evidence of occlusive vascular disease. Contractures around joints were readily evident and arthralgias were common, but evidence of objective arthritis was absent. Sixty percent of the patients in this series had ANA. Overlap syndromes with myositis and SLE were present in 7 patients. Three of 15 children died 6-10 years after onset of disease.

Dermatomyositis in the pediatric patient

Forty-one children with dermatomyositis who were treated with corticosteroids and who have been followed over a period of 15 years have been presented. Progressive proximal muscle weakness was seen in all and 60% had muscle pain. The skin rash considered classic for dermatomyositis was seen in 33 children at the time of diagnosis. Elevation of serum muscle enzymes, electromyographic abnormalities, and muscle biopsy evidence of acute myositis were of confirmatory diagnostic value. The course of the disease in this study group has reconfirmed the efficacy of adrenal corticosteroid treatment in conjunction with an individualized physical therapy program and consistent followup. Prognosis for life and minimal functional disability has been good. There have been 3 deaths recorded in this series, only one of which was certain in its relationship to dermatomyositis.

Serologic studies in juvenile rheumatoid arthritis: a review

Careful study of inflammatory and immunologic parameters in JRA and other connective tissue diseases of childhood has contributed to our current understanding of these diseases. Examination of serum for acute phase reactants, and antibodies to immunoglobulin antigens and nuclear antigens, combined with radiologic evaluation of symptomatic joints and, when indicated, examination of joint fluid or synovial membrane, may confirm the diagnosis of JRA. Changes in inflammatory indicators can be used as an index of adequacy of treatment. An ANA positivity in the child with pauciarticular arthritis should always prompt frequent slit-lamp examinations for asymptomatic iridocyclitis. The role played by auto-antibodies in the pathogenesis of JRA is unknown, as is the possible effect of proteins like CRP on the regulation of the inflammatory process in these children.

Relationship of antibody affinity to onset of immune complex disease in New Zealand mice

Affinity (KR) of antibody to human serum transferrin in New Zealand mice was measured by a globulin precipitation technique. KR was low in mice immunized early in life, increased with age of immunization up to 16-26 weeks, and then fell to low levels. KR in young and old NZB mice was increased by immunization with antigen in Freund's complete adjuvant. The correlation between low affinity antibody production and susceptibility to immune complex disease is discussed.

The effect of immunological adjuvants on the relative affinity of anti-protein antibodies

Inbred mice of a strain (B1OD2 new) known to produce either no detectable antibody or antibody of low affinity to two protein antigens administered in saline, were immunized with human serum transferrin (HST) in one of nine adjuvants. Such immunization increases the level and relative affinity of anti-HST antibody. The adjuvants used varied in the degree to which they augmented these parameters of the antibody response--that is, FCA and FIA were capable of inducing high levels of high affinity antibody, whereas other adjuvants elicited lower levels of high affinity antibody. The possibility is discussed that substances with adjuvant activity may effect antibody production at two stages: (1) at the stage of antigen selection of cells for proliferation and (2) at the stage or proliferation of antibody producing cell precursors.

Secondary hypertrophic osteoarthropathy. An unusual cause of arthritis in childhood

Although an uncommon occurrence in childhood, hypertrophic osteoarthropathy secondary to tumors- most commonly to osteogenic sarcoma with pulmonary metastasis-may cause severe join pain and swelling. The syndrome should be considered in the differential diagnosis of acute arthritis in childhood

Evidence for the genetic control of antibody affinity from breeding studies with inbred mouse strains producing high and low affinity antibody

The amount (Abt) and relative affinity (KR) of antibody produced in response to protein antigens injected in saline has been measured in the parents, F1 hybrids and backcross offspring of inbred mice which produce high and low KR antibody to these antigens. The results obtained support the view that antibody affinity is under polygenic control. Furthermore, strain related variation in Abt is independent of KR and the breeding experiments indicate that these two parameters are under independent genetic control.