Demonstration of L. E. cells at local inflammatory sites in patients with systemic lupus erythematosus

Synovial fluid cells in systemic lupus erythematosus: light and electron microscopic studies

Joint fluid findings in systemic lupus erythematosus (SLE) have been described in only a few series and systematic electron microscopic study of the synovial fluid (SF) cells has not been reported. We describe the evaluation of 17 SF in patients with SLE with routine analysis and electron microscopy. Joint effusions had a wider range of leukocyte counts than often appreciated, with counts varying from 875 to 39,250 cells per mm3. LE inclusions were seen in eight fluids and have been shown to contain chromatin-like filaments by electron microscopy. There was little associated electron dense immunoglobulin-like material. Tubuloreticular structures (TRS) found in seven SF were mostly in mononuclear cells including some LE cells. The known association of TRS with alpha interferon and viral infections may have important implications for pathogenesis.

The deoxyribonucleic acid (DNA) skin test in systemic lupus erythematosus. I. Clinical evaluation

A clinical evaluation of the intradermal DNA-test was carried out on a series of patients with untreated or with treated definite systemic lupus erythematosus (SLE), or with suspected SLE with or without circulating antinuclear factors. A saline solution of a commercially available DNA-preparation was used. The course of the DNA reaction was followed for 24-48 h after the injection. All nine cases of untreated definite SLE had a positive DNA test 6 h after the injection, and eight cases a positive result at 24 h. All seven patients with definite SLE who were on low-dosage systemic steroid treatment had a clinically positive. DNA test at 6 h. In all except one of these cases the test was still positive at 24 h. All five patients with definite SLE on antimalarial treatment had a positive test at 6 h which had become negative at 24 h after the injection. Eleven of the twelve patients with suspected SLE and circulating antinuclear factors had a positive DNA test at 6 h, which in nine cases persisted for 24 h. On the other hand, of the eleven ANF negative patients with various connective tissue diseases five had a positive test at 6 h. In only one of these cases it persisted for 24 h. Two of the eighteen control patients with various dermatoses exhibited a positive test at 6 h, and in one of these the positive reaction persisted for 24 h. It is concluded that the intradermal skin test using native DNA is a useful diagnostic tool for the detection of SLE when the reaction is followed up for 24 h. Antimalarial treatment seems to decrease skin reactivity to native DNA.