[show abstract][hide abstract] ABSTRACT: Biopsies of apparently normal skin were obtained from 30 unselected patients with systemic lupus erythematosus. The immunoglobulin class distribution of the immune deposits at the dermal-epidermal junction was determined in order to assess associated disease patterns and to investigate the possibility that the immunoglobulin classes in the skin were an indication of the classes of serum anti-native DNA antibodies. Biopsy specimens containing IgG deposits were obtained from 10 patients with more active disease and a greater incidence of glomerulonephritis than those patients with only IgM deposits or negative biopsies. However, in this unselected group of patients the immunoglobulin class of the immune deposits did not necessarily indicate the class of serum anti-native DNA antibodies. Therefore biopsy of clinically uninvolved skin will not always identify SLE patients with an immunological restriction to IgM antibody production.
Annals of the Rheumatic Diseases 09/1979; 38(4):351-5. · 9.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: An antibody with erythrocyte and lymphocyte activity, present in the sera of patients with systemic lupus erythematosus (SLE), demonstrated additional reactivity with neurons. The neuronal reactivity was greater with cortical neurons than with cerebellar and caudate nucleus neurons, was predominantly IgG, and was immunologically specific. Selected sera from 22 patients with active SLE were tested for the presence of antineuronal antibody. Eleven of 12 sera obtained from patients with neuropsychiatric disease demonstrated definite neuron reactivity, in contrast to only 2 of 10 sera obtained from patients without evidence of neuropsychiatric involvement (P less than 0.005). Five of 21 sera from patients with rheumatoid arthritis, but no sera from 5 other disease control groups, contained antineuronal antibody. Serial studies of 2 SLE patients with transient psychotic episodes demonstrated a close association between antibody titer and the appearance of psychosis in one. These observations suggest that the detection of antineuronal antibodies in patients with SLE may be of value in the diagnosis and management of neuropsychiatric complications.
[show abstract][hide abstract] ABSTRACT: The spectrum of organ involvement in 50 patients with systemic lupus erythematosus has been assessed in a prospective study. All patients were admitted to hospital electively for 2 days and a complete clinical and laboratory assessment protocol completed. Subsequent hospital admissions depended on clinical status. The overall mean observation period was 29 months. Widespread multisystem involvement was found in every patient. Subclinical abnormalities of respiratory and cerebral function were common even in patients in clinical remission. A more conservative approach than has been generally recommended was used for the management of systemic lupus erythematosus and is supported by the estimated 5-year survival of 98%.
Annals of the Rheumatic Diseases 05/1978; 37(2):121-8. · 9.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: Sera from ten patients with systemic lupus erythematosus (SLE) were tested for lymphocytotoxic antibodies (LCA) before and after absorption with cord and adult erythrocytes at 4 degrees C. Seven of the sera showed a significant reduction in cytotoxicity after absorption with the cord erythrocytes, but minimal or no reduction following absorption with the adult red blood cells. Of the remaining three sera, the cytotoxicity was equally reduced by cord and adult red cells in one and was unaffected by absorption in two. Eluates were prepared from the two sera using cord and adult red blood cells. The cytotoxicity of the cord cell eluates was significantly greater than those of the adult red cell eluates. These data indicate that the LCA in most SLE sera have specificity for the i antigen, which is present on lymphocytes and cord erythrocytes.
[show abstract][hide abstract] ABSTRACT: The incidence of lymphocytotoxic antibodies in patients with systemic lupus erythematosus (S.L.E.) was significantly lower during pregnancies ending in normal live births than in pregnancies ending in spontaneous abortions (P less than 0.005). It was possible to absorb the lymphocytotoxic antibodies from S.L.E. sera with purified trophoblast antigens. The presence of a trophoblast-reactive lymphocytotoxic antibody which fails to disappear during pregnancies which end in abortion suggests an immunological mechanism for spontaneous abortion in S.L.E.
The Lancet 01/1978; 2(8050):1205-7. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: A prospective clinical study of cold-reactive lymphocytotoxic antibodies in systemic lupus erythematosus has been completed. A highly significant association between serum lymphocytotoxicity and the development of cerebral manifestations was observed. While lymphocytotoxic antibodies from patients with cerebral lupus were absorbed by homogenates of human brain, those from patients who at no time had evidence of cerebral disease failed to cross-react with brain. It is suggested that subpopulations of lymphocytotoxic antibodies differ in their brain reactivity, and that one population may be causally related to the development of some of the features of cerebral lupus.
[show abstract][hide abstract] ABSTRACT: A prospective analysis of 50 successive patients with systemic lupus erythematosus, seen over a 4-year period, has been completed. 336 sera were examined for the presence of antibody to ribonucleoprotein using a counterimmunoelectrophoresis assay. Antibody was present in the sera of 16% of patients and was detectable in about the same titre throughout the course of the disease. The presence of the antibody did not appear to identify a subgroup of lupus patients with individual clinical characteristics.
Annals of the Rheumatic Diseases 01/1978; 36(6):557-9. · 9.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: Antibodies to the ribonucleoprotein (RNP) component of extractable nuclear antigen were measured in patients with systemic lupus erythematosus (SLE) and other connective tissue subgroups by counterimmunoelectrophoresis. Antibodies to RNP were found in the sera of 32% of patients with a primary diagnosis of SLE, 29% of patients with features of SLE and erosive joint disease, none of 9 scleroderma patients, and in 75% of 8 patients with features of SLE and scleroderma. In the SLE patients overall there was an increased frequency of sclerodactyly and severe Raynaud's phenomenon in the patients with antibodies to RNP but no association of antibodies to RNP was found with the presence of erosive joint disease, Sjögren's syndrome, or the absence of renal disease in these patients.
Annals of the Rheumatic Diseases 11/1977; 36(5):442-7. · 9.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anti-DNA antibodies have been detected previously in patients with chronic discoid lupus erythematosus (DLE) despite the absence of overt systemic manifestations. 27 patients with DLE were followed up 3 years after the detection of anti-DNA antibodies in 7. None had developed other features of systemic lupus erythematosus. We conclude that the occasional finding of anti-DNA antibodies in patients with DLE does not predict those likely to develop systemic disease.
Annals of the Rheumatic Diseases 11/1977; 36(5):476-7. · 9.11 Impact Factor
[show abstract][hide abstract] ABSTRACT: One hundred and seventy-two patients with various connective tissue diseases were investigated for the presence of serum antibodies to extractable nuclear antigen (ENA) and its major components, ribonucleo-protein (RNP) and Sm antigen. The counter-immunoelectrophoresis assay allowed independent detection and measurement of antibodies to the different components. All 13 patients with mixed connective tissue disease (MCTD) had anti-RNP antibody in high titres, 16% of patients with systemic lupus erythematosus (SLE) had low titres, and none of the patients with scleroderma had anti-RNP antibody. MCTD seems to be more benign than either SLE or scleroderma. The counterimmunoelectrophoresis assay is a simple and sensitive technique for confirming the diagnosis.
[show abstract][hide abstract] ABSTRACT: A patient with clinical and serological manifestations of systemic lupus erythematosus (SLE) without renal or neurological manifestations was managed conservatively for 4 1/2 years. At this time she developed ascites and abnormal liver function tests, and was found to have severe chronic active hepatitis (CAH) with cirrhosis and portal hypertension. No clinical or biochemical evidence of liver disease was documented over the first 3 1/2 years of her illness, though no tests were performed in the 12 months before diagnosis. This case emphasizes the value of monitoring liver function tests over extended periods in such patients, since appropriate immunosuppressive therapy may benefit CAH, and as in this case, systemic manifestations of CAH may simulate SLE and precede clinical liver disease.
The Journal of Rheumatology 6(1):38-42. · 3.26 Impact Factor