Jerry C. Daniels

Dermatologic conditions reported in patients with rheumatoid arthritis.

Dermatologists, while becoming increasingly involved in the diagnosis and management of patients with connective tissue diseases, have left rheumatoid arthritis relatively unexplored. An increased awareness of possible pathomechanisms of rheumatoid arthritis may allow for generalizations that lead to increased understanding of other connective tissue disorders. The types of cutaneous disorders that occur in association with rheumatoid arthritis include: vasoreactive dermatoses (e.g., various forms of vasculitis), which may occur secondary to the circulating immune complexes present in rheumatoid arthritis; autoimmune bullous disorders, which may occur in the setting of a suppressor T cell defect in rheumatoid arthritis; and various miscellaneous cutaneous associations. Hopefully, this review will lead to an increased understanding of both rheumatoid arthritis and the wide array of cutaneous associations of rheumatoid arthritis.

Complex aphthosis: A forme fruste of Behçet's syndrome?

The evaluation of the rare patient who presents with oral and genital aphthae or almost constant, multiple (greater than 3) oral aphthae, but no systemic signs or symptoms (i.e., complex aphthosis), is difficult because no laboratory test is available to exclude Behçets syndrome. Six patients with complex aphthosis were evaluated. In addition, patients with simple aphthosis, those with seronegative arthritis, and normal controls were assessed for circulating immune complexes (CIC) by in vitro and in vivo assays and for neutrophil migration by subagarose methods, since these tests have given significant results in patients with Behçets syndrome. Patient 1, with complex aphthosis, had Raji cell evidence for CIC (51.2 mg aggregated human gamma globulin Eq/ml), C1q, and C3 in dermal blood vessels 4 hours post intradermal histamine injection and had a Sweets syndrome-like vasculitis 24 hours post histamine injection. In addition, her serum enhanced the migration of patient neutrophils (3.6 +/- 0.6 to 4.6 +/- 0.5; N = 6, p less than or equal to 0.01). All other test and control patients had negative or normal CIC and neutrophil migration determinations. Sixteen-month clinical follow-up has confirmed that Patient 1, but not Patients 2 to 6, has developed overt manifestations of Behçets syndrome.

Ultrastructural and immunohistochemical evidence for release of eosinophilic granules in vivo: Cytotoxic potential in chronic eosinophilic pneumonia

We studied a patient with relapsing idiopathic chronic eosinophilic pneumonia. Each one of four attacks observed during a 4-year period was characterized by dyspnea, wheezing, peripheral blood eosinophilia, elevated serum IgE levels, and pulmonary infiltrates. Glucocorticoid therapy caused prompt resolution of symptoms and disappearance of blood eosinophilia and pulmonary shadowing. Electron microscopy and tissue immunofluorescence studies for major basic protein documented extensive eosinophil degranulation and the presence of free granules within the pulmonary microvasculature. In addition, exfoliation of the alveolar lining cell was observed in association with a clustering of free intact and disintegrating extracellular eosinophil granules against a denuded basement membrane. These findings suggest a cytotoxic potential of the eosinophil at the level of the pulmonary parenchyma in a case of idiopathic chronic eosinophilic pneumonia.

Polymyositis presenting with panniculitis

Although microscopic areas of panniculitis may frequently occur in patients with dermatomyositis and polymyositis, large, clinically obvious plaques are unusual. We report a patient with polymyositis who initially had panniculitis of the thigh. Histologically, a lobular lymphoplasmacytic infiltrate was present in the subcutis.

Antinuclear antibodies in the serum of normal pregnant women: A prospective study

A prospective study was performed to determine the incidence of antinuclear antibodies in 214 normal pregnant women and in 50 age-matched controls. Serum samples of 23 pregnant women (10.7%) yielded positive results (1 + or more at a dilution of 1:20) in contrast with only one sample (2%) in the control group (p less than 0.05). Of the pregnant women found to be positive, five (9.2%) were in the second trimester, and 18 (13.4%) were in the last trimester. Only two also had positive anti-DNA antibodies. A review of their hospital records disclosed no reason to suspect systemic lupus erythematosus or other rheumatologic diseases nor any significant increase in neonatal morbidity of their infants. We conclude that the incidence of antinuclear antibodies in pregnant women is significantly higher than in nonpregnant women and that the finding probably does not correlate with any adverse clinical effect.

Plasma protein patterns in health and disease.

The complex nature of protein metabolism has made interpretation of serum protein data a difficult task. Interpretive efforts can be facilitated by use of protein profiles which consist of quantitative immunochemical data combined with qualitative electrophoretic patterns. These profiles can be designed to clarify physiological relationships and emphasize pathological conditions through pattern recognition. This review will present protein profiles observed in acute, subacute, and chronic inflammation: liver diseases, protein losing disorders, plasma cell dyscrasias, humoral immune deficiencies, autoimmune diseases, genetic deficiency states, and other disorders. The value of consultative interaction and the use of combined profiles in the assessment of a patients protein status will be covered. A discussion of protein patterns in normal individuals will include data on day-to-day, age- and sex-related variation. A section on management of protein data will present various approaches to profile reporting. Graphical report formats which minimize the time required for information transfer and simplify assimilation of results will be emphasized.

Hla type and survival in lung cancer

A significant positive association between antigens HLA Aw 19 and/or HLA B5 and a disease‐free survival time of one year for patients with lung cancer has been reported but not confirmed. We have HLA‐typed 20 white patients with non‐oat‐cell bronchogenic carcinoma who have survived at least a year from the time of diagnosis. Half these patients possessed these antigens (P < 0.08). This highly suggests that the presence of these antigens is associated with prolonged survival time. Now may be the time for performing large scale clinical trials using these antigens as stratification factors. Cancer 46:38–40, 1980.

Effect of thymosin on T-lymphocyte functions in patients with acute thermal burns.

Patients with severe thermal burns demonstrate a decreased cellular immunity. The purpose of this study was to ascertain whether thymosin enhances in vitro T-lymphocyte functions in such patients. Peripheral blood lymphocytes were obtained serially from 22 burned patients and 35 health adults. In vitro lymphocyte functions were evaluated by E-rosette formation, lymphocyte culture responses to PHA, Con A, PWM, PPD, SK-SD, mumps antigen, and tetanus toxoid, and mixed lymphocyte culture reactions. These tests were performed with and without in vitro addition of thymosin. Most of the parameters examined were significantly decreased in patients during the first 2 weeks postburn. The in vitro addition of thymosin significantly restored impaired lymphocyte responses, except in mixed lymphocyte culture reactions. These results demonstrate that thymosin enhances certain in vitro T-lymphocyte functions in burned patients. They further suggest that the administration of thymosin may restore decreased cell-mediated immunity in severely burned patients.

Histamine-triggered localized vasculitis in patients with seropositive rheumatoid arthritis

To gain some insight into the pathogenesis of vasculitis in rheumatoid arthritis, and to investigate its relation to circulating immunoreactants, we injected 50 microliters of histamine intradermally in four seropositive and four seronegative patients with rheumatoid arthritis. Skin biopsies obtained before histamine and at 4 hours after histamine were studied by immunofluorescence microscopy, and skin biopsies 24 hours after histamine were studied by light microscopy. At 4 hours after histamine, all seropositive patients demonstrated deposits of IgM and complement components in dermal vessels; by 24 hours, various degrees of leukocytoclastic vasculitis were noted. Circulating material reactive with Raji cells, C1q, or both, was present in 3/3 seropositive patients. In contrast, none of the seronegative patients exhibited vascular deposits of immunoreactants or vasculitis. The results indicate that patients with rheumatoid arthritis who are seropositive may have circulating complexes with appropriate characteristics to induce vasculitis and that vasoactive substances may be used to trigger their local deposition in vessels.

Coexistent systemic lupus erythematosus and tophaceous gout

Only seven patients with coexistent gout and systemic lupus erythematosus have been reported in the English-language literature. We describe an eighth case, which is the first, to our knowledge, in the dermatologic literature. The patient met four of the eleven new American Rheumatism Association criteria for the diagnosis of systemic lupus erythematosus, and clinical, laboratory, roentgenographic, and histologic assessments confirmed the diagnosis of gout.