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Larid G, Pancarte M, Offer G, Clavel C, Martin M, Pradel V, Auger I, Lafforgue P, Roudier J, Serre G, Balandraud N. In Rheumatoid Arthritis Patients, HLA-DRB1*04:01 and Rheumatoid Nodules Are Associated With ACPA to a Particular Fibrin Epitope. Front Immunol 2021; 12:692041. [PMID: 34248985 PMCID: PMC8264359 DOI: 10.3389/fimmu.2021.692041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Rheumatoid arthritis (RA) is associated with HLA-DRB1 genes encoding the shared epitope (SE), a 5-amino acid motive. RA is usually preceded by the emergence of anti-citrullinated protein/peptide antibodies (ACPAs). Citrulline is a neutral amino acid resulting from post-translational modification of arginine involved in peptidic bounds (arginyl residue) by PeptidylArginine Deiminases (PADs). ACPAs recognize epitopes from citrullinated human fibrin(ogen) (hFib) and can be specifically detected by the AhFibA assay. Five citrullinated peptides derived from hFib together represent almost all of the epitopes recognized by patients with ACPA-positive RA, namely: α36-50cit, α171-185cit, α501-515cit, α621-635cit, and β60-74cit. The use of antibody fine specificities as markers of clinical phenotypes has become a major challenge. Our objective was to study whether RA clinical characteristics and HLA-DRB1 genetic background were associated with a specific reactivity against the epitopes borne by the five peptides. Methods 184 ACPA-positive RA patients fulfilling the 2010 ACR/EULAR criteria were studied. Patient characteristics including HLA-DRB1 genotype, were collected from their medical files. Anti-CCP2 antibodies, AhFibA, and antibodies against the five citrullinated hFib (hFib-cit) peptides were analyzed by ELISA. Results Anti-α505-515cit antibodies were associated with HLA-DRB1*04:01 (OR = 5.52 [2.00 - 13.64]; p = 0.0003). High level anti-α505-515cit antibodies were associated with rheumatoid nodules (OR = 2.71 [1.00 - 7.16], p= 0.044). Conclusion Immune complexes containing anti-α501-515cit antibodies and rheumatoid factors might be involved in the development of rheumatoid nodules on the HLA-DRB1*04:01 background. Apheresis of these epitope-specific antibodies might be a new therapeutic opportunity for patients with rheumatoid nodules.
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Affiliation(s)
- Guillaume Larid
- Rhumatologie, Institut du Mouvement et de l'appareil Locomoteur (IML), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Mikael Pancarte
- Université de Toulouse, INSERM, UMRs 1056, UDEAR, Hôpital Purpan, Toulouse, France
| | - Géraldine Offer
- Université de Toulouse, INSERM, UMRs 1056, UDEAR, Hôpital Purpan, Toulouse, France
| | - Cyril Clavel
- Université de Toulouse, INSERM, UMRs 1056, UDEAR, Hôpital Purpan, Toulouse, France
| | - Marielle Martin
- Aix Marseille Université, INSERM UMRs 1097, Arthrites autoimmunes, Marseille, France
| | - Vincent Pradel
- CEIP de Marseille (PACA-Corse, Centre Associé), Laboratoire de Santé Publique, Faculté de Médecine, Marseille, France
| | - Isabelle Auger
- Aix Marseille Université, INSERM UMRs 1097, Arthrites autoimmunes, Marseille, France
| | - Pierre Lafforgue
- Rhumatologie, Institut du Mouvement et de l'appareil Locomoteur (IML), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean Roudier
- Rhumatologie, Institut du Mouvement et de l'appareil Locomoteur (IML), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix Marseille Université, INSERM UMRs 1097, Arthrites autoimmunes, Marseille, France
| | - Guy Serre
- Université de Toulouse, INSERM, UMRs 1056, UDEAR, Hôpital Purpan, Toulouse, France
| | - Nathalie Balandraud
- Rhumatologie, Institut du Mouvement et de l'appareil Locomoteur (IML), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Aix Marseille Université, INSERM UMRs 1097, Arthrites autoimmunes, Marseille, France
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Naeem M, Ballard DH, Jawad H, Raptis C, Bhalla S. Noninfectious Granulomatous Diseases of the Chest. Radiographics 2020; 40:1003-1019. [PMID: 32501738 DOI: 10.1148/rg.2020190180] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Granulomas are pathologically defined as focal aggregations of activated macrophages, Langerhans cells, and lymphocytes. Granulomas form in the lungs when the immune system barricades the substances it perceives as foreign but is unable to remove. Granulomas manifest with numerous imaging appearances in thoracic radiology, and their presence is a nonspecific finding. Granulomatous lung diseases comprise multiple entities with variable clinical manifestations and outcomes. Their imaging findings are rarely specific and can mimic malignancies, often triggering an extensive diagnostic workup. Radiologists must be familiar with the clinical manifestations and imaging findings of these entities to generate appropriate differential diagnoses. This review describes the imaging manifestations of various noninfectious, necrotizing, and nonnecrotizing granulomatous diseases that primarily affect the thorax. ©RSNA, 2020.
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Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Hamza Jawad
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Constantine Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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Emmungil H, Yıldız F, Gözükara MY, Açıkalın A. Rheumatoid pleural effusion with nodular pleuritis. A rare presentation of rheumatoid arthritis. Z Rheumatol 2014; 74:72-4. [PMID: 25096478 DOI: 10.1007/s00393-014-1462-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rheumatoid pleural effusion and lung nodules are unusual complications of rheumatoid disease that typically present subsequently to other more common manifestations of rheumatoid illness. However, these complications may occasionally occur before or concurrently with the development of joint manifestations of disease. We report the case of a 41-year-old female patient with rheumatoid pleural effusion and lung nodule arising simultaneously with the onset of joint symptoms. The patient underwent thoracentesis followed by video-assisted thoracoscopic biopsy to result in a diagnosis of rheumatoid pleuritis and nodular disease. A high index of suspicion and coexistence of the cytologic and histopathologic effusion picture characteristic of rheumatoid pleuritis are of clinical importance in making a diagnosis.
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Affiliation(s)
- H Emmungil
- Department of Internal Medicine, Division of Rheumatology, Mersin State Hospital, Kuva-i milliye str., 35050, Mersin, Turkey,
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Hodkinson B, Meyer P, Musenge E, Ally M, Anderson R, Tikly M. Exaggerated circulating Th-1 cytokine response in early rheumatoid arthritis patients with nodules. Cytokine 2012; 60:561-4. [DOI: 10.1016/j.cyto.2012.06.190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/18/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
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Chan WFN, Atkins CJ, Naysmith D, van der Westhuizen N, Woo J, Nelson JL. Microchimerism in the rheumatoid nodules of patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2012; 64:380-8. [PMID: 21953057 DOI: 10.1002/art.33358] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The rheumatoid nodule is a lesion commonly found on extraarticular areas prone to mechanic trauma. When present with inflammatory symmetric polyarthritis, it is pathognomonic of rheumatoid arthritis (RA), an autoimmune disease in which naturally acquired microchimerism has previously been described and can sometimes contribute to RA risk. Since RA patients harbor microchimerism in the blood, we hypothesized that microchimerism is also present in rheumatoid nodules and could play a role in rheumatoid nodule formation. This study was undertaken to investigate rheumatoid nodules for microchimerism. METHODS Rheumatoid nodules were tested for microchimerism by real-time quantitative polymerase chain reaction (qPCR). The rheumatoid nodules of 29 female patients were tested for a Y chromosome-specific sequence. After HLA genotyping of patients and family members, rheumatoid nodules from 1 man and 14 women were tested by HLA-specific qPCR, targeting a nonshared HLA allele of the potential microchimerism source. Results were expressed as genome equivalents of microchimeric cells per 10(5) patient genome equivalents (GE/10(5)). RESULTS Rheumatoid nodules from 21% of the female patients contained male DNA (range <0.5, 10.3 GE/10(5)). By HLA-specific qPCR, 60% of patients were microchimeric (range 0, 18.5 GE/10(5)). Combined microchimerism prevalence was 47%. A fetal or maternal source was identified in all patients who tested positive by HLA-specific qPCR. Unexpectedly, a few rheumatoid nodules also contained microchimerism without evidence of a fetal or maternal source, suggesting alternative sources. CONCLUSION Our findings indicate that microchimerism is frequently present in the rheumatoid nodules of RA patients. Since microchimerism is genetically disparate, whether microchimerism in rheumatoid nodules serves as an allogeneic stimulus or allogeneic target warrants further investigation.
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Affiliation(s)
- William F N Chan
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
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Humby F, Manzo A, Kirkham B, Pitzalis C. The synovial membrane as a prognostic tool in rheumatoid arthritis. Autoimmun Rev 2006; 6:248-52. [PMID: 17317617 DOI: 10.1016/j.autrev.2006.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The ability to effectively treat patients with rheumatoid arthritis (RA) has become increasingly feasible with the use of powerful treatment regimens early on in the disease. The use of such regimens has, however, created a pressing requirement for better prognostic markers to allow the targeting of these treatments to those most at need, hence minimizing expense and toxicity. As the synovial membrane has been ever more recognised as the primary pathogenetic site in RA its role as a prognostic indicator has been explored. As yet no reliable single prognostic marker has been identified. This article discusses the range of pathological variables already examined and those markers holding most potential.
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Affiliation(s)
- Frances Humby
- Academic Department of Rheumatology, Kings College London School of Medicine, 5th Floor Thomas Guy House, Guy's Hospital, London SE1 9RT, UK
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Wikaningrum R, Highton J, Parker A, Coleman M, Hessian PA, Roberts-Thompson PJ, Ahern MJ, Smith MD. Pathogenic mechanisms in the rheumatoid nodule: comparison of proinflammatory cytokine production and cell adhesion molecule expression in rheumatoid nodules and synovial membranes from the same patient. ARTHRITIS AND RHEUMATISM 1998; 41:1783-97. [PMID: 9778219 DOI: 10.1002/1529-0131(199810)41:10<1783::aid-art10>3.0.co;2-w] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the production of proinflammatory cytokines and expression of cell adhesion molecules in the rheumatoid nodule. METHODS Cytokine content (tumor necrosis factor alpha [TNFalpha], interleukin-1beta [IL-1beta], and IL-1 receptor antagonist [IL-1Ra]), at the messenger RNA (mRNA) and protein levels, and cell adhesion molecule expression were studied in 16 rheumatoid nodules and 6 synovial membranes. RESULTS Macrophages in the rheumatoid nodules contained TNFalpha, IL-1beta, and IL-1Ra mRNA and protein, particularly in perivascular cells of the stroma and in the palisading layer. All cell adhesion molecules studied were expressed in both the rheumatoid nodules and synovial membranes, with increased expression of E-selectin in the rheumatoid nodule compared with the synovial membrane, and with the absence of vascular cell adhesion molecule 1 expression on cells of the palisading layer in the rheumatoid nodule. CONCLUSION The presence of similar proinflammatory cytokines and cell adhesion molecules in the rheumatoid nodule and synovial membrane suggests that similar pathogenic processes result in the chronic inflammation and tissue destruction in these lesions.
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Affiliation(s)
- R Wikaningrum
- University of Otago Medical School, Dunedin, New Zealand
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8
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Elewaut D, De Keyser F, De Wever N, Baeten D, Van Damme N, Verbruggen G, Cuvelier C, Veys EM. A comparative phenotypical analysis of rheumatoid nodules and rheumatoid synovium with special reference to adhesion molecules and activation markers. Ann Rheum Dis 1998; 57:480-6. [PMID: 9797554 PMCID: PMC1752727 DOI: 10.1136/ard.57.8.480] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES (1) To analyse the in situ expression of adhesion molecules in rheumatoid nodules. (2) To compare the endothelial expression of adhesion molecules in synovial tissue and subcutaneous nodules obtained from the same patients. (3) To compare the expression of adhesion molecules and activation markers on T cell lines from nodules and synovium. METHODS (1) Immunohistochemical analysis by APAAP technique of E selectin, CD44, ICAM-1, PECAM-1, and VCAM-1 was performed on 10 rheumatoid nodules from seven patients with rheumatoid arthritis (RA); nodules and synovium were simultaneously analysed from three patients. (2) T cell lines were generated from RA nodules (n = 7) and synovium (n = 7) by interleukin 2 expansion, and subsequently characterised by flow cytometry for surface expression of alpha E beta 7, alpha 4 beta 7, CD44, L selectin, LFA-1a, PECAM-1, and CD30. RESULTS (1) In rheumatoid nodules, the palisading layer strongly stains for ICAM-1 and PECAM-1, but less pronounced for CD44. VCAM-1 staining was usually negative. ICAM-1 is upregulated in the vessels surrounding the central zone of fibrinoid necrosis. The immunohistological picture in different nodules derived from the same patient was similar. (2) The endothelial expression of adhesion molecules is comparable in RA nodules and synovium on an individual level, except for E selectin, which is overexpressed in nodule endothelium. (3) T cell lines from nodules and synovium display similar adhesion molecule profiles. However, the expression of CD30, a T cell activation marker linked with Th2 subsets, is higher in nodules compared with synovium. CONCLUSION These data support a recirculation hypothesis of T cells between articular and extra-articular manifestations in RA, although the activation state of the T cells in each of these localisations may differ.
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Affiliation(s)
- D Elewaut
- Department of Rheumatology, University Hospital Ghent, Belgium
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9
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Edwards JC, Wilkinson LS, Pitsillides AA. Palisading cells of rheumatoid nodules: comparison with synovial intimal cells. Ann Rheum Dis 1993; 52:801-5. [PMID: 7504437 PMCID: PMC1005192 DOI: 10.1136/ard.52.11.801] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The palisading cells of rheumatoid nodules share certain features with synovial intimal cells. The similarities between the two cell populations have been reassessed using new cytochemical markers. METHODS Cell populations in cryostat sections of non-inflamed, rheumatoid and osteoarthritic synovial tissues, and rheumatoid nodules were assessed for the presence of CD68, prolyl hydroxylase, vascular cell adhesion molecule 1 (VCAM-1), and the alpha 4 and beta 1 integrin chains, and the activity of uridine diphosphoglucose dehydrogenase (UDPGD) and nonspecific esterase. RESULTS Synovial intimal cells formed a dual population of macrophages (nonspecific esterase positive, strongly positive for CD68) and fibroblastic cells (prolyl hydroxylase positive). The latter showed prominent VCAM-1 expression and high UDPGD activity as previously reported and also prominent beta 1 integrin chain expression. Palisading cells similarly proved to be a dual population of macrophages and fibroblastic cells. In contrast with synovial intima, however, the fibroblastic cells lacked UDPGD activity and expression of VCAM-1 and showed no preferential expression of the beta 1 integrin chain. The exception to this rule was where nodules contained central clefts, which were lined with cells showing all the features associated with synovial intimal cells. CONCLUSION Palisading cells are a mixture of macrophages and fibroblasts, but the latter show no evidence of synoviocyte differentiation. Cells with features of synoviocytes may occur lining clefts within areas of necrobiosis.
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Affiliation(s)
- J C Edwards
- Division of Rheumatology, University College London Medical School, United Kingdom
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10
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Gardner DL. Pathology and the nine ages of rheumatism. Advances in knowledge of the connective tissue diseases. J Pathol 1993; 169:1-8. [PMID: 8433210 DOI: 10.1002/path.1711690102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- D L Gardner
- Department of Pathology, University of Edinburgh
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11
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Kool J, Gerrits-Boeye MY, Severijnen AJ, Hazenberg MP. Immunohistology of joint inflammation induced in rats by cell wall fragments of Eubacterium aerofaciens. Scand J Immunol 1992; 36:497-506. [PMID: 1519039 DOI: 10.1111/j.1365-3083.1992.tb02965.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
After a single intraperitoneal injection of cell wall fragments of Eubacterium aerofaciens, a main resident from the human intestinal flora, an acute arthritis develops within 2 days which is followed by a chronic arthritis that lasts at least 90 days. In an earlier report the histological appearance of the joint inflammation during this period has been described. In this study we investigated in more detail the cell types that are involved in the development of arthritis by using cell-type-specific monoclonal antibodies in an immunohistological assay. In the acute phase of arthritis, T-helper cells appeared in the synovial tissue together with ED1-positive (ED1+) and ED3-positive (ED3+) macrophages. After a temporary decline at day 12 all macrophage subsets, as well as T-helper cells, reappeared or increased again at day 33. Later, in the chronic phase (days 47-90), an increased number of ED1-positive (ED1+) cells in the synovial tissue and a decreased number of ED2-positive (ED2+) cells in the synovial lining was the most prominent finding when compared with control rats. These results indicate that, apart from T lymphocytes, macrophages also play an important role in the development and continuation of chronic arthritis in this model.
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Affiliation(s)
- J Kool
- Department of Immunology, Erasmus University, Rotterdam, The Netherlands
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Mellbye OJ, Førre O, Mollnes TE, Kvarnes L. Immunopathology of subcutaneous rheumatoid nodules. Ann Rheum Dis 1991; 50:909-12. [PMID: 1768157 PMCID: PMC1004579 DOI: 10.1136/ard.50.12.909] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nodules obtained from five patients with classical seropositive rheumatoid arthritis were studied by an immunofluorescence technique using polyclonal antibodies to IgG, IgA, IgM, C3c, and fibrin, and monoclonal antibodies to the terminal (C5b-9) complement complex (reaction with a neoantigen in C9 revealed during activation), DR antigens, T cells, macrophages, and interdigitating cells. In all instances the central necrotic areas stained strongly for fibrin and more weakly for IgG, IgA, IgM, C3, and terminal complement complex. The surrounding palisading cells reacted with antibodies to DR and macrophages. In the peripheral granulomatous tissue most of the lymphocytes reacted with the antibodies to T cells, whereas various amounts of the larger mononuclear cells were stained by antibodies to DR antigens, macrophages, and interdigitating cells. In all instances the walls of some of the smaller vessels in the granulomatous tissue stained for fibrin, C3, and terminal complement complex. Plasma cells were not seen except for scattered IgM cells in one nodule. These results support the view that the palisading cells are derived from macrophages, and indicate that there is vasculitis with activation of C3 and the terminal complement pathway in the granulomatous tissue.
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Affiliation(s)
- O J Mellbye
- Institute of Immunology and Rheumatology, Rikshospitalet, Oslo, Norway
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Affiliation(s)
- M Ziff
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9030
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