The effect of serum from patients with systemic lupus erythematosus on the immune response of normal lymphocytes.

In contrast to influences that act to reduce the function of suppressor T cells, we describe a factor found in the sera of 13/28 patients with systemic lupus erythematosus (SLE) that augments the response of normal donor peripheral blood lymphocytes to stimulation by pokeweed mitogen (PWM) in vitro. This factor was present in 1/2 of our patients with active SLE, but not in normal blood donors; it required the presence of pooled AB serum in the culture medium; was specific for stimulation by PWM and not by phytohemagglutinin, concanavalin A or purified protein derivative; it appeared to act predominantly on B lymphocytes and was neither immunoglobulin nor interferon. This augmentation was seen to a lesser degree with rheumatoid sera, but not with psoriatic arthritis sera or sera of SLE patients on dialysis.

Persistence of pneumococcal antibodies after immunization in patients with systemic lupus erythematosus.

Antibody levels to 12 different pneumococcal capsular polysaccharides as well as the combined mean antibody level were measured in 19 patients with systemic lupus erythematosus (SLE) at 1, 2 and 3 years after immunization with a polyvalent pneumococcal vaccine and compared to 5 normal control subjects immunized at the same time. The mean levels in the 19 SLE patients were lower in all 3 years but the difference reached significance only in Year 1. At 3 years, 8 of the 19 SLE patients had levels below that considered to be protective and one such patient developed a pneumococcal pneumonia.

Specific antibody response after in vivo antigenic stimulation in systemic lupus erythematosus.

Several in vitro studies have demonstrated a polyclonal B cell response to antigenic stimulation in patients with systemic lupus erythematosus (SLE). To determine if this polyclonal response occurs in vivo, 18 patients with SLE were antigenically stimulated with the pneumococcal vaccine Pneumovax . Mean antibody response to immunization was the same in SLE and normal control subjects. Although elevated antibody levels to several viruses were present in SLE subjects preimmunization, these levels did not change postimmunization. Total immunoglobulin levels, immune complex levels, and antiblood group B antibody levels did not change in SLE patients after immunization. Antiblood group A titers rose in both SLE patients and normals due to a media contaminant in the Pneumovax . Thus, SLE patients appear to have a specific antibody response to antigenic stimulation with pneumococcal polysaccharide. Polyclonal activation as seen in vitro in SLE may be more restricted in vivo.

The clinical course of end-stage renal disease in systemic lupus erythematosus.

Despite treatment advances, renal failure still develops in patients with systemic lupus erythematosus (SLE). With the common use of long-term maintenance hemodialysis, this complication is no longer fatal. In order to evaluate factors that contribute to the outcome of patients with SLE receiving long-term hemodialysis, we retrospectively analyzed the clinical course of 14 patients with SLE receiving hemodialysis for more than three months, and compared them with 62 patients receiving long-term hemodialysis who did not have SLE. While receiving long-term hemodialysis, SLE activity was minimal, with most manifestations involving the CNS or synovitis. Five-year survival was significantly lower in the SLE than in the non-SLE group (58.6% v 88.5%), but no deaths were directly attributable to SLE activity. Morbidity in the SLE group was primarily due to infection and vascular access problems.

Relation between antithrombin III and clinical and serological parameters in systemic lupus erythematosus.

The increased frequency of thromboembolic events in patients with systemic lupus erythematosus (SLE) has been attributed to reduced or dysfunctional antithrombin III (At-III). We analysed At-III values, measured by three different assay techniques, in SLE patients, patients with rheumatoid arthritis, and normal and hospitalised controls. In addition, attempts were made to correlate At-III activities of SLE patients with specific clinical and serological parameters such as disease activity, renal involvement, previous thrombosis, degree of proteinuria, and serum complement concentrations. Our results failed to show a significantly reduced At-III in SLE with any method. At-III titres did not correlate with disease activity, concentrations of serum complement or albumin (both only minimally reduced in most patients), or a previous history of thrombosis. At-III deficiency does not appear to be an inherent feature of SLE, and reduced activities should only be anticipated when there are specific aetiological factors present, such as massive proteinuria, extensive hepatic disease, or active thrombosis.

The effect of continuous normalization of serum hemolytic complement on the course of lupus nephritis: a five year prospective study.

We have completed a five year prospective study of the effect of continuous normalization of serum hemolytic complement (CH50) in 25 patients with lupus nephritis. At the end of five years 22 patients were being actively followed; 13 in a CH50 controlled group and nine in a CH50 uncontrolled group. Serial renal biopsy specimens were obtained from 19 patients. The results demonstrate a trend toward stabilization of renal histology, creatinine clearance and serum creatinine at a lower final mean dose of prednisone in the complement controlled group.

Articular complications of meningococcal meningitis. An immune complex disorder.

A case of noninfectious arthritis was associated with meningococcal meningitis. Elevated levels of immune complexes were demonstrated in both serum and synovial fluid by the C1q binding assay and Raji cell assay. We believe this complication of meningococcal infection is another disorder in which immune complexes may play a pathogenic role.

Impaired response to pneumococcal vaccine in systemic lupus erythematosus.

An immunization program with pneumococcal vaccine was carried out in 38 patients with systemic lupus erythematosus (SLE). Mean antibody levels at 1 month and 1 year were significantly lower than in normal controls. This decreased response did not correlate with drug therapy at the time of immunization. Other parameters such as anergy state, renal function, and serum immunoglobulin levels also did not correlate with antibody response. There were no adverse effects noted in the vaccinated group in comparison to matched non-vaccinated SLE patients.

Brachial plexus neuropathy as the initial presentation of systemic lupus erythematosus.

A patient presented with bilateral brachial plexus neuropathy which 2 weeks later evolved into a polyneuropathy involving all four extremities. On further investigation, the patient was found to have systemic lupus erythematosus. Treatment with steroids was accompanied by complete resolution of the neurologic findings.