Patrón genético y serológico en pacientes con diagnóstico de artritis reumatoide / Genetic and serological pattern in patients diagnosed with rheumatoid arthritis

Introducción: La artritis reumatoide es una enfermedad autoinmune de causas desconocidas en la que pueden influir distintas alteraciones genéticas. Se describen casos seropositivos con mayor riesgo de padecer manifestaciones extraarticulares y complicaciones de la enfermedad. Objetivo: Identificar la relación existente entre las alteraciones genéticas y la positividad de autoanticuerpos en pacientes con diagnóstico de artritis reumatoide. Métodos: Investigación básica, no experimental, transversal y descriptiva de un universo de 157 pacientes con diagnóstico de artritis reumatoide según los criterios del Colegio Americano de Reumatología. La muestra quedó conformada por 113 pacientes. Como parte del seguimiento de laboratorio de cada paciente se determinó anticuerpos tipo factor reumatoide y antipéptido citrulinado cíclico. Se realizó el estudio genético para identificar HLA-DR3 y HLA-DR4. Se utilizó la prueba no paramétrica de correlación de Pearson para determinar correlación entre el patrón genético y la seropositividad en estos pacientes. Resultados: Promedio de edad de 58,74 años con predominio de pacientes femeninas (72,57 por ciento). El 38,05 por ciento presentó al menos una comorbilidad asociada. El factor reumatoide fue positivo en el 60,18 por ciento de los pacientes, mientras que el antipéptido citrulinado cíclico positivo se identificó en el 41,59 %. Se halló alteraciones del patrón genético en el 66,37 por ciento de los pacientes; el HLA-DR4 estuvo presente de forma independiente en el 38,67 por ciento de los casos positivos y combinado con el HLA-DR3 en el 20,66 por ciento. Conclusión: Se identificó una correlación positiva considerable entre las alteraciones del patrón genético y la seropositividad. La presencia de alteraciones del patrón genético triplica el riesgo de seropositividad en los pacientes con artritis reumatoide(AU)

Introduction: Rheumatoid arthritis is an autoimmune disease of unknown causes in which the presence of different genetic alterations is invoked. Seropositive cases with a higher risk of appearance of extra-articular manifestations and complications of the disease are described. Objective: To identify the relationship between the presence of genetic alterations and autoantibody positivity in patients diagnosed with rheumatoid arthritis. Methods: Basic, non-experimental, cross-sectional and descriptive research with a universe of 157 patients diagnosed with rheumatoid arthritis according to the criteria of the American College of Rheumatology. The sample was made up of a total of 113 patients. As part of the laboratory follow-up of each patient, the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies was determined, and a genetic study was performed to identify the presence of HLA-DR3 and HLA-DR4. The nonparametric Pearson's correlation test was used to determine the correlation between the identification of HLA types and seropositivity in patients with rheumatoid arthritis. Results: Average age of 58.74 years with a predominance of female patients (72.57%). 38.05 percent presented at least one associated comorbidity. Rheumatoid factor was positive in 60.18 percent of the patients, while positive anti-cyclic citrullinated peptide was identified in 41.59 percent of the cases studied. Genetic pattern alterations were identified in 66.37 percent of the patients; HLA-DR4 was present independently in 38.67 percent of the positive cases and combined with HLA-DR3 in 20.66 percent. Conclusion: A considerable positive correlation was identified between alterations in the genetic pattern and seropositivity. The presence of genetic pattern alterations triples the risk of seropositivity in patients with rheumatoid arthritis(AU)

Artrite reumatoide do tipo EORA com trombocitose significativa: relato de caso / Elderly-onset rheumatoid arthritis with significant thrombocytosis: a case report

Este relato teve como objetivo apresentar um caso de elderly onset rheumatoid arthritis associada à trombocitose reacional significativa. À admissão, o paciente apresentava quadro de poliartrite de pequenas e grandes articulações associado à rigidez matinal. Após exames solicitados, evidenciaram-se trombocitose de 1.697.000 cel./mm³ e anticorpos antipeptídeos citrulinados positivos, sendo diagnosticado com artrite reumatoide do tipo elderly onset rheumatoid arthritis.

This report aimed at presenting a case of elderly-onset rheumatoid arthritis associated with significant reactive thrombocytosis. On admission, the patient presented polyarthritis of small and large joints associated with morning stiffness. After the performance of the requested tests, thrombocytosis of 1,697,000 cells/mm3 and positive anti-CCP were evidenced, and the patient was diagnosed with elderly-onset rheumatoid arthritis.

Alterações da proteína C reativa e fator reumatoide em cães naturalmente infectados por Leishmania spp / Changes in C-reactive protein and rheumatoid factor in dogs naturally infected by Leishmania spp

A leishmaniose visceral canina é uma zoonose considerada doença tropical de prioridade. A leishmaniose afeta vários sistemas do corpo dos cães, incluindo vísceras e pele. A proteína C reativa (PCR) e o fator reumatoide (FR) são exames realizados na medicina para detecção de inflamação e artrites em seres humanos, no entanto, há poucos trabalhos voltados para cães com leishmaniose que demonstrem as alterações ocorridas na PCR e FR. Este trabalho teve como objetivo demonstrar as alterações de PCR e FR e sua correlação com a hiperproteinemia e hiperalbuminemia, além da compararação com o desvio a esquerda presente no exame hematológico. O trabalho foi realizado no Hospital Veterinário do Centro Universitário da Grande Dourados/MS e Centro de Controle de Zoonoses, no qual foram avaliados 34 cães, de diversar raças e idade e submetidos a colheita de sangue venosa para realização de exames em imuno-látex, bioquímica sérica e hemograma, em cães naturalmente infectados por Leishmania spp. Foram utilizados somente cães positivos ao teste rápido DPP® para leishmaniose, juntamente com resultado positivo no exame parasitológico, depois de diagnosticados foram realizados exames hematológicos e bioquímicos. Quando realizado o teste para quantificação de FR em soro sanguíneo, para os 34 animais estudados, foi observado positividade em apenas 1 animal, enquanto que os cães foram positivos para a PCR em 38,23% dos casos estudados. Em casos de animais com leishmaniose é possível estabelecer níveis inflamatórios precocemente, enquanto que o FR demonstrou não ser um bom marcador para animais soropositivos para a doença.(AU)

Canine visceral leishmaniasis is a zoonosis considered a priority tropical disease. The disease affects various body systems of dogs, including viscera and skin. C-reactive protein (CRP) and rheumatoid factor (RF) are tests performed in medicine for the detection of inflammation and arthritis in humans, however, there are few studies aimed at dogs with leishmaniasis that demonstrate changes in CRP and RF. This work aimed to demonstrate the changes of CRP and RF and its correlation with hyperproteinemia and hyperalbuminemia, in addition to the comparison with the left deviation present in the hematological examination. The work was carried out at the Veterinary Hospital of the University Center of Grande Dourados/MS and Zoonoses Control Center, in which 34 dogs of different breeds and ages were submitted to venous blood collection for immuno-latex exams, Biochemistry and blood count in dogs naturally infected with Leishmania spp. Only dogs to the DPP® rapid test for leishmaniasis were used, together with a positive result in parasitological examination, after hematological and biochemical tests were performed. When the test for the quantification of FR in serum was performed, for the 34 animals studied, positivity was observed in only 1 animal, while the dogs were PCR positive in 38.23% of the cases studied. In cases of animals with leishmaniasis it is possible to establish inflammatory levels early, whereas the FR showed not to be a good marker for animals seropositive for the disease.(AU)

Comparative study between immunoturbidimetric and latex agglutination methods for the detection of rheumatoid factor / Estudo comparativo entre as técnicas de aglutinação em látex e de imunoturbidimetria para a detecção de fator reumatoide

INTRODUCTION: The rheumatoid factor (RF) is the most common antibody found in patients with rheumatoid arthritis. It is an inflammatory chronic disease characterized by articular involvement, inflammation of synovial fluid, tissue infiltration by leucocytes and joint destruction, which ultimately determine articular deformities. The rheumatoid factor is found in 70%-80% of the adult population and in 10% of the young population. OBJECTIVE: The aim of this research was to compare immunoturbidimetric and latex agglutination methods for the detection of RF in serum. RESULTS: The immunoturbidimetric method displayed sensitivity (95.2%), specificity (89.4%) and high positive correlation (R² = 0,8077) with the latex agglutination method in positive serum samples. CONCLUSION: The study allowed to demonstrate that both immunoturbidimetric and latex agglutination methods equally discriminate between negative and positive serum samples for RF.

INTRODUÇÃO: O fator reumatoide (FR) é o autoanticorpo mais comum encontrado em pacientes com artrite reumatoide, uma doença crônica inflamatória caracterizada pelo envolvimento articular com inflamação do líquido sinovial, infiltração de tecido por leucócitos e destruição das articulações, que acaba por determinar deformidades articulares. O FR é encontrado em 70%-80% da população adulta e em 10% da população juvenil. OBJETIVO: Comparar os métodos de imunoturbidimetria e aglutinação (prova do látex) para a determinação de FR em soro. RESULTADO: Foi possível observar que o método imunoturbidimétrico apresenta sensibilidade (95,2%), especificidade (89,4%) e correlação positiva elevada (R² = 0,8077) com o método de aglutinação pelo látex em amostras de soro positivas. CONCLUSÃO: O estudo permitiu demonstrar que o método imunoturbidimétrico e o método de aglutinação pelo látex são igualmente capazes de discriminar amostras negativas e positivas para FR.

Approach to Polyarthritis.

A child with polyarthritis is always a diagnostic challenge for the treating physician. By definition, polyarthritis, taken in context as a subgroup of juvenile idiopathic arthritis, is defined as inflammation of more than 4 joints on physical examination. Though the exact incidence and prevalence of polyarthritis in childhood is not known, it is not uncommon in pediatric practice. Polyarthritis can be a clinical manifestation of diverse disease processes and the differential diagnosis is understandably very broad. It can be caused directly by an infectious agent or indirectly by immune mechanisms, may be a component of a systemic disease process or may be idiopathic. The presentation can be acute or chronic. It can represent a benign self limiting illness requiring no specific treatment or may be a severely disabling condition with significant morbidity and, in some cases, even mortality.While in some situations it may be possible to arrive at a provisional clinical diagnosis right at the outset, in others the diagnosis gradually evolves over a period of time. As in most other arthritides, the most important aspects of the diagnosis are a thorough history and a detailed clinical examination. Relevant laboratory investigations can help in facilitating the diagnosis but can often also mislead the treating physician. Hereby we present a clinical approach to a child with polyarthritis.

Association of TBX21 polymorphisms in a Korean population with rheumatoid arthritis

TBX21 (T-bet) is a member of the T-box family of transcriptional factors that contain a conserved DNA binding domain. TBX21 is a critical regulator of the commitment to the Th1 lineage and IFN-gamma production. Th1 and Th2 cells cross-regulate the differentiation of each other, and in this way TBX21 could be an attractive candidate gene for treating autoimmune disease such as rheumatoid arthritis (RA). In present study, we analyzed the genotypic frequencies of six polymorphisms of the TBX21 gene between the 367 RA patients and the 572 healthy controls. We showed that the g.-1514T>C and c.99C>G polymorphisms are suggestively associated with RA susceptibility. It is interesting that the genotypic frequencies of the TBX21 polymorphisms (g.-1514T>C and c.2103A>C) in the male RA patients were significantly different from the male control group (P = 0.0016 and 0.045, respectively). We also found that the g.-1514T>C and c.2103A>C polymorphisms of the TBX21 gene in the male RA patients have significant association with the levels of anti-CCP (P = 0.05) and rheumatoid factor (P = 0.03), respectively. These results suggest that the polymorphisms of the TBX21 gene might be associated with the susceptibility to male RA patients.

Factor reumatoide: asociación con la erosión radiológica y actividad de la artritis reumatoide / Rheumatoid factor: association with the radiological erosion and with the rheumatoid arthritis activity

Objetivo: Definir la relación del factor reumatoide (FR) con la erosión articular radiológica, la actividad de la enfermedad y la discapacidad funcional de la artritis reumatoide (AR). Métodos: Se realizó un estudio transversal con 209 pacientes con AR establecida, de estos, 74 con AR de corta evolución (= 2 años). Se evaluaron los indicadores siguientes: FR por aglutinación del látex (FR-A), FR por inmunoturbidimetría automatizada (FR-T), velocidad de eritrosedimentación (VSG), proteína C reactiva (PCR), índice de actividad de la enfermedad (Disease Activity Score 28, DAS28), índice de discapacidad funcional (Health Assessment Questionnaire score, HAQ) y la presencia de erosiones radiológicas. Resultados: El 77 por ciento de los pacientes positivos de FR-A y el 73 por ciento de los positivos para el FR-T presentaron erosiones radiológicas, opuestamente al 38 por ciento de los negativos para el FR-A (p<0,001) y al 14 por ciento de los negativos para el FR-T (p<0,001). Las cifras medias del FR-A de los pacientes según los 4 grados de afectación articular (máximo: > 6 articulaciones erosionadas; mínimo: 0 erosión, < 6 articulaciones inflamadas) fueron de: 484; 162; 57 y 17 UI/mL (p<0,001); y las del FR-T de: 277; 185; 22 y 33 UI/mL (p<0,01). El valor predictivo positivo (VPP) para la erosión del FR-A >512 UI/mL fue de 92 por ciento y el del FR-T >97 UI/mL fue de 96 por ciento. Los valores medios del DAS28 en los pacientes positivos de FR-A y FR-T fueron de 5,04 y 4,94, respectivamente, mientras que, en los negativos fueron de 4,26 y 3,97 (p<0,001 para ambos); y los del HAQ de 1,31 y 1,29 en los positivos de FR-A y FR-T, respectivamente, mientras que en los negativos de 0,99 y 0,89 (p<0,01 para ambos). Se encontró correlación entre las cifras del FR por ambos métodos y las de VSG, PCR, DAS28 y HAQ (p<0,05 o p<0,01). Conclusiones: Niveles altos del FR se corresponden con un grado mayor de inflamación y destrucción articular en la AR.

Objective: to define the relation of the rheumatoid factor with the radiological articular erosion, the activity of the disease and the functional disability of rheumatoid artritis (RA). Methods: A cross-sectional study was conducted among 209 patients with RA. Of them, 74 with RA of short evolution (= 2 years). The following indicators were evaluated: RhF by latex agglutination (RhF-A), RhF by automated immunoturbidimetry (RhF-T), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score 28 (DAS 28), functional disability index (Health Assessment Questionnaire score, HAQ), and the presence of radiological erosions. Results: 77 percent of the RhF-A positive patients and 73 percent of the RhF-T positive patients presented radiological erosions in contrast with 38 percent of the RhF-A negative patients (p<0.001) and with 14 percent of the RhF-T negative cases (p<0.001). The mean RhF-A figures of the patients according to the 4 grades of articular affectation (maximum: > 6 eroded articulations; minimum: 0 erosion; < 6 swollen articulations) were 484, 162, 57 and 17 UI/mL (p<0.001), whereas those of RhF-T were 277, 185, 22 and 33 UI/mL (p<0,01). The positive predictive value (PPV) for the erosion of RhF-A >512 UI/mL was 92 percent, and that of RhF-T >97 UI/mL was 96 percent. The mean values of DAS28 in the RhF-A and RhF-T positive patients were 5.04 and 4.94, respectively. In the negative, these values were 4.26 and 3.97 (p<0.001 for both). The HAQ values were 1.31 and 1.29 in the RhF-A and RhF-T positive patients, respectively, while in the negative they were 0.99 and 0.89 (p<0.01 for both). Correlation was found between the RhF figures by both methods and those of ESR, CRP, DAS28 and HAQ (p<0.05 or p<0.01). Conclusions: High levels of RhF correspond with a higher degree of inflammation and articular destruction in the rheumatoid arthritis.

Prevalência de manifestações oculares em 198 pacientes com artrite reumatóide: um estudo retrospectivo / Prevalence of ocular manifestation in 198 patients with rheumatoid arthritis: a restrospective study

OBJETIVO: Estimar a prevalência de manifestações oculares na população local de artrite reumatóide (AR). Estimar se a presença de auto-anticorpos como fator reumatóide (FR) e fator antinuclear (FAN) influi no aparecimento destas manifestações e se existe associação entre o aparecimento de manifestações oculares e índice funcional do paciente, idade ao diagnóstico e tempo de doença. MÉTODOS: Foram estudados retrospectivamente 198 prontuários de pacientes com AR, acompanhados durante o período de 2003 a 2006. Avaliou-se a prevalência das manifestações oftalmológicas, perfil de auto-anticorpos, dados demográficos e índice funcional de Steinbrock destes pacientes. RESULTADOS: Síndrome de Sjõgren secundária apareceu em 12,1 por cento dos pacientes sendo mais comum em mulheres (p=0,049) e em pacientes com maior dano articular (p=0,016). Ceratite ulcerativa e esclerite incidiram em torno de 2 por cento dos pacientes. Fator reumatóide (FR) e fator antinuclear (FAN) assim como tempo de doença e idade do paciente ao diagnóstico não influíram no aparecimento das manifestações estudadas. CONCLUSÃO: A síndrome de Sjõgren secundária é a manifestação ocular mais prevalente em pacientes com AR, sendo mais comum em mulheres e em pacientes com mais disfunção articular.

PURPOSE: To study the prevalence of eye manifestations in the local rheumatoid arthritis (RA) population, as well as to know if the presence of rheumatoid factor (RF) and antinuclear antibodies (ANA) affect this profile. To study if there is association between eye manifestations and patient's articular functional index, age at diagnosis and illness duration. METHODS: We reviewed 198 charts of rheumatoid arthritis patients followed-up from 2003 to 2006. They were studied for: prevalence of ophthalmologic manifestations, autoantibody profile, demographic data and Steinbrock's functional index. RESULTS: Secondary Sjõgren's syndrome was seen in 12.1 percent of the patients being more common in women (p=0.049) and in patients with greater articular damage (p=0.016). Ulcerative keratitis and scleritis appeared in 2 percent of patients each. Antinuclear antibodies (ANA) and rheumatoid factor (RF) as well as illness duration and age at diagnosis had no influence in the appearance of eye manifestations. CONCLUSION: Secondary Sjõgren syndrome was the most common ocular manifestation in patients with RA, mainly in women and patients with greater joint damage.

External quality control results for hormones, tumor markers and CRP testing.

Most hormones, tumor markers, C-reactive protein, and rheumatoid factor (RF) are measured immunologically. Immunological methods based on the antigen-antibody reaction have certain specific problems, including their principle of determination, character of antibodies used, reaction conditions, and others. Free thyroxine (FT4) and thyroid stimulating hormone (TSH), as well as alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), prostate antigen, carcinoantigen 19-9 (CA 19-9), and CA 125 are very commonly measured in the routine medical laboratory. Authentic materials can be obtained for hormones and CRP, and efforts to improve quality control and standardization have been made for years. Results of surveillance for FT4, TSH, and AFP were not poor, but inter-laboratory differences for CEA, CA 19-9, and RF were not insignificant.

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.

Immunological parameters in leprosy patients with and without arthritis.

Twelve patients of leprosy with arthritis and 161 patients without arthritis were studied for immunological parameters like immunoglobulins (IgG, IgM, IgA), C-reactive proteins and rheumatoid factor. There was increase in the levels of IgG, IgA value in leprosy patients with and without arthritis compared to healthy control. IgM level was decreased in both the groups compared to control, but significant decrease was observed (p < .01) in patients with arthritis. C-reactive protein was significantly positive in leprosy with arthritis group (p < .01) and positive in 12 cases of leprosy without arthritis group compared to negative control group. Rheumatoid factor was present in leprosy with arthritis (16.6%) compared to both the control group and leprosy without arthritis group. This study concluded the presence of arthritis in leprosy patients as a definite entity which showed changes in immunological parameters.

Immunologic parameters in infective endocarditis: a prospective study.

To evaluate the role of immunoglobulins, complement, circulating immune complexes (CIC), heart antibodies (HAb) and rheumatoid factor (RF) in infective endocarditis, we studied 28 consecutive patients before and after therapy. Statistically significant elevation was seen in IgG (p less than 0.001) and IgA (P less than 0.001) level prior to initiation of therapy as compared to a control group. Following drug treatment a fall was noted in IgA (P less than 0.01) and IgM (p less than 0.01) level as compared to basal values. Low C3 levels were seen in those with renal involvement (p less than 0.05). CIC levels estimated by 4% PEG precipitation assay were found to be elevated in 64% of patients. Patients with shorter duration of illness (less than three months) had higher levels of CIC containing IgG (P less than 0.005), IgA (P less than 0.05) and IgM (P less than 0.05), as compared to those with a longer duration. Initial CIC levels did not predict the clinical course and were found to be of no value in prognosis, although an improvement in congestive heart failure was associated with a rise in C3 (P less than 0.05) and IgM (P less than 0.05) containing CIC and an overall clinical improvement with a rise in IgA (p less than 0.05) containing CIC. There was no statistically significant difference in CIC level, for the entire group studied, before and after therapy. Patients who had rheumatoid factor in their initial serum sample demonstrated a fall in IgG, IgA and IgM containing CIC and a rise in C3 with therapy. The converse was true for those who lacked RF.(ABSTRACT TRUNCATED AT 250 WORDS)

Artrite reumatóide juvenil: revisäo e atualizaçäo / Juvenile rheumatoid arthritis: review and update

Neste artigo säo enfocados os principais aspectos clínicos, laboratoriais e etiopatogênicos, atualizados, da artrite reumatóuide juvenil (ARJ). Paralelamente, os autores comparam alguns achados dos seus pacientes com os descritos na literatura. Com essa finalidade, foi realizado um estudo clínico-laboratorial retrospectivo de 130 pacientes portadores de ARJ acompanhados no Setor de Reumatologia Pediátrica da Disciplina de Alergia, Reumatologia e Imunologia Clínica do Departamento de Pediatria da Escola Paulista de Medicina, no período de 1982 a 1989. Esses pacientes (73 mulheres e 57 homens) foram analisados de acordo com o tipo e idade de início, manifestaçöes clínicas (articulares e extra-articulares)., laboratoriais e prognóstico. Nossos dados foram semelhantes aos já relatados, excetuando-se o acometimento ocular (iridociclite crônica) e a presença do fator reumatóide (FR) IgM e fator antinúcleo (FAN), que foram menores do que os descritos por outros autores. Quanto ao prognóstico, foi no tipo de início pauciarticular que tivemos o maior número de remissöes (40%) e no poliarticular o menor (27%). Os dois óbitos de nossa casuística ocorreram em crianças com o tipo sistêmico. A pesar de ainda näo conhecermos a etiologia da ARJ, bem como os mecanismos responsáveis pelo seu desencadeamento e conseqüentemente näo termos um tratamento definitivo, a experiência conseguida ao longo dos anos tem possibilitado aos profissionais que cuidam desses pacientes näo só fazer o diagnóstico ...

Non-organ specific & organ specific antibodies in rheumatoid arthritis.

Fifty patients of rheumatoid arthritis clinically diagnosed (by ARA criteria) were studied for both non-organ specific [rheumatoid factor (RF), anti-nuclear antibodies (ANA), extractable nuclear antibody (ENA), granulocyte specific anti-nuclear antibody (GS-ANA), anti-smooth muscle antibody (SMA) and anti-mitochondrial antibody (AMA)] and organ specific, [anti-adrenal (AAA), anti-islet cell (ICA), antithyroid antibody (ATA) and anti-parietal cell (PCA)] auto antibodies. RF was positive in 80 per cent of patients. ANA was positive in 44 per cent of patients, ENA in 62 per cent, SMA in 20 per cent, AMA in 18 per cent and GS-ANA in 68 per cent. Of the organ specific antibodies, PCA was demonstrable in 28 per cent of the patients and none of the other antibodies were present. Circumstantial evidence indicates that ANA and GS-ANA are not synonymous but independent, cross-reacting entities and the presence of both increase the sensitivity (94%) of diagnosis of RA.

Inmunoglobulinas séricas en la artritis reumatoidea / Serum immunoglobulins in rheumatoid arthritis

En el Servicio Nacional de Reumatología se estudió el suero de 90 pacientes con artritis reumatoidea definida, con el objeto de determinar los niveles de las inmunoglobulinas IgA, IgG e IgM para correlacionarla con la velocidad de eritrosedimentación globular (VSG) y se encontró un predominio de los niveles de IgA en los enfermos que presentaron cifras de VSG por encima de 60 mm en la primera hora, en relación con la fase activa de la enfermedad

Soropositividade do fator reumatóide nos pacientes portadores de artrite reumatóide no Hospital Universitário Regional do Norte do Paraná / Soropositivity for rheumatoid factor in pacients with rheumatoid arthritis in the Hospital Universitário Regional do Norte do Paraná

Os autores estudaram a soropositividade dos fatores reumatóides (Látex, Waaler-Rose) em 77 pacientes portadores de AR. A positividade pelo método do Látex foi de 58,4% e pelo Waaler-Rose foi de 28,5% no momento do diagnóstico. Na evoluçäo dos pacientes houve soroconversäo de 6 dos 32 inicialmente negativos para o Látex e 7 dos 54 para Waaler-Rose (passando a positividade para 66,2% e 37,6% respectivamente). Os critérios clínicos foram os mais importantes para o diagnóstico, raramente necessitando-se de métodos invasivos. Na rotina de triagem diagnóstica deve-se dar preferência ao Látex, pois neste estudo mostrou-se bem mais sensível e de menor custo. Reservamos o Waaler-Rose para os casos de dúvida diagnóstica ou interesse científico

Biopsia sinovial percutânea na avaliaçäo diagnóstica do paciente reumatológico / Percutaneous synovial biopsy for the diagnostic evaluation of the patient with rheumatic diseases

Quarenta e sete biopsias nsinoviais percutâneas efetuadas em 22 pacientes com doença reumatóide, sendo quatro com a forma juvenil, 13 com poliartrite e 12 com monoartrite näo definidas, foram avaliadas. Os achados anátomo-patológicos confirmaram as evidências clínicas em 76% dos pacientes com doença reumatóide ou doença reumatoide juvenil; sugeriram diagnóstico de doença reumatóide em 80% dos pacientes com poliartrite e em dois casos de monoartrite indefinidas; evidenciaram a presença de bacilos álcool-ácidos resistentes em dois e granuloma em um dos casos de monoartrite. Em vista de tais resultados, achamos que a biopsia sinovial percutânea possa auxiliar na proprdêutica diagnóstica dos pacientes com poli/monoartrites näo definidas

Factor reumatoideo en artritis reumatoidea juvenil

Se estudiaron 60 niños afectados de artritis reumatoidea juvenil con la finalidad de observar la frecuencia de positividad del factor reumatoideo en ellos. El factor reumatoideo fue determinado cuantitativamente utilizando las pruebas de Látex y de Waler Rose. Se encontró sólo un 6.3% de postividad, tanto para la prueba de Látex como la de Waler-Rose; esta prueba fue particularmente positiva en el grupo de niños adolescentes. Se concluye que en los niños, la positividad es baja debiéndose guiar de la clínica para el establecimiento del diagnóstico. Dado que ambas pruebas dieron resultados similares se aconseja preferir al Látex cuantitativo por ser esta prueba más económica y sencilla