High prevalence of rheumatoid factor in community-based series of patients with rheumatoid arthritis meeting the new (1987) ARA criteria: RF-negative non-erosive rheumatoid arthritis is very rare.

The aim of the study was to assess the prevalence of rheumatoid factor (RF) in a community-based rheumatoid arthritis (RA) series. The subjects of the series represented prevalent RA cases in the Kuusamo community in Northern Finland with 13,000 adult inhabitants. The patients were selected from the official Finnish data registers and from among the subjects who had consulted the local general practitioners due to rheumatic complaints in the recent years, using the American Rheumatism Association (ARA) 1987 classification criteria for inclusion. For this study, ninety-five out of the 103 RA patients so found were RF-tested by immunoturbidimetry. At the time of the study. 71 (75%) of the 95 cases were RF positive, 83 (87%) being 'ever' positive (in one case the early RF status was unclear). Our result contrasts with the much lower prevalence figures (25-60%) obtained from the earlier cross-sectional population-based RA studies, which have used the ARA 1958 definite RA as the inclusion criterion of the subjects. All the eleven patients with RF-negative RA had erosive joint disease. The RF-negative RA patients had a significantly lower frequency of HLA-DR4 (18%) than the RF-positive ones (58%), p < 0.05. We found a high frequency of RF among prevalent community-based RA cases meeting the ARA criteria. According to our results, RF-negative non-erosive RA is very rare among cases selected with the above methods.

Tenascin is increased in epithelial lining fluid in fibrotic lung disorders.

Tenascin is an extracellular matrix glycoprotein increased immunohistochemically in tumorous and fibrotic lung tissues as demonstrated by immunohistochemistry. We hypothesized that in bronchoalveolar lavage (BAL) fluid also the tenascin concentration would be elevated in patients with various fibrotic lung disorders. The aim of our study was to investigate whether BAL fluid tenascin would be increased compared with serum tenascin in patients with usual interstitial pneumonia (UIP), sarcoidosis, and extrinsic allergic bronchioloalveolitis. For this purpose BAL fluid was collected from five patients with UIP, 12 patients with sarcoidosis, five patients with extrinsic allergic bronchioloalveolitis, and six patients in a control group. BAL fluid and serum tenascin concentrations were detected by the enzyme immunoassay method. The BAL fluid results were expressed as tenascin concentrations in the epithelial lining fluid (ELF), as estimated by the urea method. The ELF tenascin concentration was increased in the patients with fibrotic lung disorders relative to the control group (mean 0.12 microg/ml) and was highest in the UIP group (mean 5.72 microg/ml) and sarcoidosis group (mean 4.76 microg/ml). It is concluded that the tenascin concentration in the ELF is increased in patients with UIP, sarcoidosis, and extrinsic allergic bronchioloalveolitis, suggesting active synthesis of tenascin in the lower respiratory tract in such disorders.

Prognostic significance of synovial fluid analysis in estimating the efficacy of intra-articular corticosteroid injection in patients with spondylarthropathy.

The predictive value of synovial fluid (SF) analysis and some other variables for the efficacy of intra-articular corticosteroid therapy of knee joints in 20 patients with spondylarthropathy and hydropsy in a knee joint was estimated in a prospective study. The knee joints were initially aspirated and 30 mg triamcinolone hexacetonide injected intra-articularly. The tenderness scores and the circumferences of the knee joints were measured at the start and after the two months follow up period. Between the patients with and without improvement in tenderness scores of the knee joints SF protein (p = 0.021), SF lactate (p = 0.033), SF IgG (p = 0.018) and SF IgM (p = 0.047) differed significantly, all being lower in patients with improved tenderness scores. There were no significant differences in the variables between patients with at least 2 centimetres decrease of knee joint difference and those with less during follow up.

Predictive value of synovial fluid analysis in estimating the efficacy of intra-articular corticosteroid injections in patients with rheumatoid arthritis.

The predictive relevance of synovial fluid analysis and some other variables for the efficacy of intra-articular corticosteroid injections in 30 patients with rheumatoid arthritis and hydropsy in a knee joint was evaluated in a prospective study. At the onset of the study, the knee joints were aspirated and 30 mg triamcinolone hexacetonide injected intra-articularly. The circumferences and the tenderness scores of the knee joints were measured at onset, after two months, and at the end of the six months' follow up. Of the variables studied, synovial fluid C4, percentage of synovial fluid polymorphonuclear leucocytes, blood haemoglobin, and serum C3 correlated significantly with the decrease in knee joint circumference after two months, whereas only the percentage of synovial fluid polymorphonuclear leucocytes correlated significantly after six months. Between the patients with and without improvement in the tenderness scores of the knee joints, only serum IgM differed at the examination after two months; this was higher in patients whose scores showed no improvement.

Supplementation with selenium, vitamin E and their combination in gynaecological cancer during cytotoxic chemotherapy.

The biochemical responses to 8-week supplementary treatment with selenium and/or vitamin E were evaluated in 41 patients with gynaecological cancer during cytotoxic chemotherapy, in Finland, a selenium-deficient country. After the control course of 1-day treatment with cytostat agents, 11 patients received a combination of selenium and vitamin E (sodium selenate, 200 micrograms/day + vitamin E, 300 mg/day), 11 received selenium (sodium selenate, 200 micrograms/day) and seven received vitamin E (300 mg/day) as supplementary therapy, while 12 patients had no supplementary drugs. Sodium selenate alone and combined with vitamin E significantly increased the serum selenium levels, but the activity of serum glutathione peroxidase (GSH-Px) increased significantly only in the selenium- and vitamin E-treated patients with low initial GSH-Px activity. The cytotoxic chemotherapy did not change the activity of GSH-Px, while the concentrations of lipid peroxides decreased. Sodium selenate alone or with vitamin E did not modify this decrease. Sodium selenate alone significantly decreased the capacity of the platelets to produce thromboxane A2; it increased high-density lipoprotein cholesterol levels and prevented the cytotoxic-chemotherapy-associated increase of creatine kinase. Selenium supplementation might thus be beneficial during cytotoxic chemotherapy in ovarian cancer patients with low selenium levels.

Clomiphene citrate administration to normogonadotropic subfertile men: blood hormone changes and activation of acid phosphatase in seminal fluid.

Clomiphene citrate was administered as a 50 mg oral daily dose to 44 normogonadotrophic (serum FSH 2-10 mIU/ml) subfertile men for 3 months. The treatment resulted in significant increases in FSH and LH concentrations, whereas prolactin remained unchanged. Serum testosterone and oestradiol both increased highly significantly. The increased testosterone levels suggest that the elevated LH levels had not led to "down regulation" of Leydig cell LH/hCG receptors, neither had the greatly increased estradiol led to depletion of these receptors. This is suggested to be a result of the blocking of testicular oestradiol receptors by the estrogen antagonist, clomiphene. Sperm count increased highly unchanged. The spermatic fluid concentrations of zinc and magnesium ions were also increased, whereas fructose remained unchanged. The katalytic activity of acid phosphatase in spermatic fluid increased highly significantly, whereas the concentration of the main prostate-specific acid phosphatase, as measured by a specific radioimmunological method, remained unchanged. Therefore, the increased Zn and Mg ion concentrations may be responsible for activation of acid phosphatase (s) in semen, or the treatment led to increased secretion of other prostatic acid phosphatase(s) than the main enzyme. However, it is clear that the secretion of the main prostatic acid phosphatase into semen is under different control than that of Zn++ and Mg++.

Rapid radioimmunoassay for prostate-specific acid phosphatase in human serum.

We describe a rapid radioimmunoassay for human prostatic acid phosphatase (EC 3.1.3.2) in serum, with use of monospecific antisera raised in rabbits against the primary highly purified acid phosphatase (pl 4.9) from human prostates, and with a second antibody-polyethylene glycol porecipitation. This radioimmunoassay is sensitive and can be performed within 5 h. Concentrations of the immunoreactive acid phosphatase in sera of healthy men (n = 394) ranged from 0.3 to 3.6 microgram/L (mean 1.94, SD 0.66 microgram/L). Concentrations of the enzyme in sera of men with benign prostatic hyperplasia (n = 56) or with carcinoma of nonprostatic origin (n = 24) were identical with those of the reference group. Serum concentrations of immunoreactive prostatic acid phosphatase of patients with occult, non-metastatic, and metastatic prostatic carcinoma varied from 1.7 to 9.3 (n = 9), 4.2 to 59.4 (n = 12), and 20 to 198 (n = 10) microgram/L, respectively. The amount of immunoassayable prostatic acid phosphatase was unchanged for at least five days in serum stored at 4 degrees C.

Serum prostate-specific acid phosphatase: development and validation of a specific radioimmunoassay.

We describe radioimmunoassay for human prostatic acid phosphatase [orthophosphoric-monoester phospho-hydrolase (acid optimum), EC 3.1.3.2] in serum, with use of monospecific antisera raised in rabbits against highly purified acid phosphatase from human prostates. The antiserum did not cross react with partly purified acid phosphatases from human spleen, erythrocytes, or synovial tissues. 125I-labeled acid phosphatase was prepared by a Chloramine T method, and the bound and free antigen was separated in the assay by use of anti-rabbit gamma-globulin raised in sheep. Uniform low nonspecific binding of the [125I]acid phosphatase was achieved by using acid-phosphatase-free serum to prepare standard curves and diluted samples of serum with high acid phosphatase activities. Concentrations of immunoreactive acid phosphatase in the serum of healthy men ranged from less than 1 to 10 microgram/liter and for 12 patients with advanced prostatic carcinoma between 100 and 500 microgram/liter. The concentrations of the enzyme in sera of patients with benign prostatic hyperplasia were very similar to those in sera of the reference group.