Levels of plasma lipid peroxide products and antioxidant status in rheumatoid arthritis.

Oxygen free radicals have been implicated as mediators of tissue damage in patients with rheumatoid arthritis. The aim of our study was to assess the lipid peroxide products and antioxidant status in rheumatoid arthritis patients (RA). The study involved determination of two plasma lipid peroxide products, malondialdehyde (MDA) and conjugated dienes (CD), two plasma antioxidant vitamins (C and E) in 91 RA patients and 26 healthy subjects. The results showed that rheumatoid patients had increased plasma CD but not MDA and decreased plasma vitamin E, when properly expressed per unit cholesterol and triglyceride. This finding suggested that RA patients had increased oxidant stress that might play a role in the tissue damage and inflammation process of this disease.

Age-related differences on clinical and immunological manifestations of SLE.

The clinical and immunological manifestations of 51 children with onset of systemic lupus erythematosus (SLE) before the age of 15 were compared with those of 308 adult patients with disease onset between the age of 15-49 and another 27 elderly lupus patients whose disease onset occurred at or after the age of 50. Overall disease activity determined by mean SLEDAI score was highest in the childhood group followed by the adult and the elderly group respectively. More severe form of cutaneous involvement, adenopathy, hypertension, renal involvement with renal insufficiency and anti-nDNA antibodies occurred predominantly in the childhood lupus. The clinical features distinguishing old-age lupus were chronic disease with a long interval between the time of onset and diagnosis, higher incidence of discoid rash and lower incidence of malar rash and renal involvement. Frequencies of anti-nDNA antibodies and renal involvement gradually decreased from childhood, to adulthood and to elderly lupus respectively. Anti-Sm antibodies were predominant in the adult onset group. Genetic markers, sex hormones and senility of the immune system may play a role in these age-related differences in clinical and immunological manifestations in SLE.

Antinucleolar antibodies and their disease association.

The prevalence of the antinucleolar antibodies (ANoA) demonstrated by indirect immunofluorescence technique in 1,662 sera of patients with a known or suspected rheumatic disease increased from 1.97% when mouse kidney (MK) was used as substrate to 4.9% when HEp-2 cells were used as substrate. However, an appropriate commercial HEp-2 substrate must be selected in order to increase the sensitivity of ANoA positivity. There were 3 distinct staining patterns of the nucleolar immunofluorescence: homogeneous speckle, and clumpy. Irrespective of the patterns, the most common diagnoses among patients who had ANoA were systemic sclerosis (PSS) and systemic lupus erythematosus (SLE); 36% and 35%, respectively). On the contrary, the incidence of these antibodies in PSS was 41% while it was only 3% in SLE patients. Almost all patients with speckled nucleolar staining had PSS as their underlying disease while most of the patients with homogeneous nucleolar staining had SLE. No distinct correlation between the different nucleolar staining patterns and specific organ involvements in our lupus and PSS patients was found except for the higher frequency of clumpy staining in male scleroderma with no joint involvement. This study demonstrates that: 1) ANoA are uncommon in unselected sera although use of a cell line substrate doubles the rate of positivity; 2) the proper HEp-2 substrate is critical in the detection of ANoA; 3) PSS and SLE are the most frequent diseases associated with ANoA but the frequency of these antibodies in SLE patients was very low.; 4) there are 3 distinct nucleolar staining patterns which may be associated with different rheumatic diseases; and 5) compared with ANoA negative scleroderma, clumpy nucleolar staining had significantly higher incidence in men with no joint involvement but a tendency towards more lung manifestations.

Anti-Sm: its predictive value in systemic lupus erythematosus.

The clinical manifestations of 131 rheumatic disease patients with anti-Sm antibody were studied. A variety of standard tests was utilized in the study, namely, the FANA test with mouse kidney as substrate for the assay of ANA, the Crithidia test for anti-double stranded DNA (anti-dsDNA) and double immunodiffusion for detecting antibodies to extractable nuclear antigens. The patients were grouped according to the presence of anti-Sm alone, or anti-Sm with some other antibodies. There were 17 with anti-Sm alone; 55 with anti-Sm+anti-RNP; 15 with anti-Sm+anti-dsDNA; and 44 with anti-Sm+anti-RNP. The result of our study showed that although anti-Sm could be found in other diseases, it was exclusively detected in SLE only if anti-dsDNA was also present. Further, the SLE patients with anti-Sm alone had more frequent central nervous system manifestations than other groups of patients. The renal manifestation was observed more frequently in the group of SLE patients with anti-Sm+anti-dsDNA (92.9%). Among other major manifestations, haematologic involvement had a tendency to be less common in the group of patients with anti-Sm alone. The study concludes that the presence of anti-Sm antibody may be of some value to predict the clinical outcome.

Serum IgE levels: correlation with skin test reactivity in Thai adults with respiratory allergy.

A history of respiratory allergic disorders was obtained in 68 patients. Allergic skin testing was performed with measurement of total IgE by enzyme immunoassay (EIA). The mean level of total IgE from the control group of 13 healthy adults with no history of allergic diseases was 24.7 IU per ml. The average serum IgE level among the allergic patients with positive skin tests was 97.6 IU per ml and it was significantly higher than that of the controls (p less than 0.005). It was also found that the positive skin test patients had significantly a higher mean serum IgE level than that of patients with negative skin test results (97.6 vs 33.6 IU per ml, p less than 0.01). Since 73.2% of the allergic patients with positive skin tests had serum IgE levels over 45 IU per ml while only 23.1% of the control group had IgE levels exceeding this figure, we consider that a patient with clinical symptoms and a serum IgE level over 45 IU per ml is likely to be suffering from allergic disease.

A comparison of passive haemagglutination test and immunofluorescent test for antibody to native deoxyribonucleic acid.

Antibody to double-stranded DNA is a specific marker for systemic lupus erythematosus. The recommended method for detection of this antibody is immunofluorescence. Haemagglutination was developed and the results of antibody detection were evaluated with those obtained by immunofluorescence. Human group O erythrocytes were treated with glutaraldehyde and coated with DNA from calf thymus. Testing in 169 active and inactive SLE sera, 59 sera were positive and 91 sera were negative by both methods. Five sera were negative by haemagglutination but positive by immunofluorescence. Fourteen sera with low haemagglutination titer were negative by immunofluorescence. The correlation between the results obtained by both methods were highly significance with contingency coefficient of 0.61 and correlation coefficient between the results of 78 sera positive by both or either method was 0.74 (p less than 0.001). Sixty-three sera from blood donors and seventy sera from pregnant women were negative by the two techniques. PHA is simpler, quicker and can be assayed in laboratories without the use of fluorescent microscope. It can be established as a very useful alternative test to immunofluorescence.

Antinuclear antibodies in Thai patients with connective tissue diseases.

A study of antinuclear antibodies (ANA) among Thai patients with various connective tissue diseases revealed that the prevalence of ANA was similar to that in other countries, but that the ANA patterns showed interesting contrasts in most diseases. Rather than the predominant homogeneous pattern seen elsewhere in systemic lupus erythematosus and rheumatoid arthritis, the speckled pattern was commonest among Thai patients with these two diseases (67.9% and 76.9% respectively). Patients with scleroderma exhibited a much lower percentage of the nucleolar pattern (17%) than reported elsewhere. The discrepancy between our findings and those from other studies may reflect differences in genetics, the environment or the severity of disease.