Martin D. Lidsky

Cerebral vasculitis in relapsing polychondritis

Recurrent inflammation of cartilage in multiple sites is a hallmark of relapsing polychondritis (RP). Neurologic complications of this disease have begun to attract increasing attention, but the neuropathologic basis of these complications has not been described. We report a patient with RP whose autopsy showed extensive cerebral and systemic vasculitis.

A Study of Adverse Effects of High-Dose Intravenous (Pulse) Methylprednisolone Therapy in Patients with Rheumatic Disease

OBJECTIVE: To determine the frequency of significant adverse effects associated with high-dose intravenous methylprednisolone therapy (HIVMP) given as methylprednisolone 1 g/d for three consecutive days. DESIGN: Retrospective study of consecutive patients. SETTING: Department of Veterans Affairs Medical Center (VAMC), university teaching hospital, and private outpatient clinic. PATIENTS: Eighty-four patients given HIVMP for systemic rheumatic disease. MEASUREMENTS: Subjective complaints were elicited via a standardized questionnaire that identified adverse effects through organ system review. Medical records were reviewed for adverse effects occurring within two weeks of HIVMP therapy. RESULTS: Two hundred seventy-five HIVMP treatments were examined by either patient questionnaire (76 patients) and/or chart review (78 patients). Sixty-five patients described symptoms after HIVMP treatment. Most symptoms were transient in duration, mild in severity, and required no medical treatment. Chart review found 42 possible complications occurring within two weeks of HIVMP therapy. In 18 instances medical intervention was required for problems that included hypertension, seizures, gastric erosions, sepsis, and other infections. It is impossible to attribute all of the complications to HIVMP alone because of underlying disease, use of other medications at the time of therapy, or both. CONCLUSIONS: HIVMP has an acceptably low risk of significant adverse effects.

Cell-mediated immunity in rheumatoid arthritis.

Cell-mediated immunity in rheumatoid arthritis (RA) was assessed by skin testing with six antigens in 107 patients, 94 of whom were age, sex, and race-matched with healthy individuals or patients with diseases unrelated to immunological abnormalities. 20% of RA patients were anergic. Impaired cell-mediated immunity in the RA patients was manifested by a decrease in the magnitude of skin reactivity as well as a decrease in the incidence of positive reactions to multiple antigens. Depression in cell-mediated immunity was related to age but not to sex, duration of disease, or disease activity. A slight correlation was found between absolute peripheral lymphocyte counts and the number of positive skin tests, and was confirmed by finding an association between lymphocyte counts and the size of skin reactions. A correlation was also found between lymphocyte counts and disease activity. Four explanations of the observed depression in cell-mediated immunity in RA were considered: (1) a preoccupation of the immune mechanism of the host with cell-mediated immunity reactions related to the pathogenesis of the disease; (2) a depression of cell-mediated immune reactivity by a virus infection; (3) depression of cell-mediated immunity by therapy; and (4) immune complex suppression of cell-mediated immunity. No effect of gold therapy was found. The near universal use of salicylates or other anti-inflammatory drugs did not permit investigation of the effect of these drugs on cell-mediated immunity.

Malposition of Carpal Bones in Rheumatoid Arthritis

Abstract In a study of the rates of progression of radiographic changes in rheumatoid wrists, several recurring patterns of displacement of carpal bones were observed. Widening of joint spaces, an evidence of subluxation, was observed in three locations—the radioulnar, the navicular capitate, and the navicular lunate joints—and is characteristic. Severe displacements are the result of loss of supportive structure, destruction of bone and cartilage, and muscle tension.

Role of immune complexes in rheumatoid polyarteritis.

Serial clinical and serological observations were made on a patient with necrotising polyarteritis associated with rheumatoid arthritis. Significant levels of circulating immune complexes, as determined by a C1q binding assay, were observed up to 2 years before the clinical manifestations of polyarteritis but rose abrumptly immediately before and concurrently with the onset of polyarteritis. Concomitant serial determinations of C3, latex fixation titres for anti-immunoglobulin, and patterns of fluorescence of antinuclear antibody afforded insight into the nature of these somplexes, as did clinical and serological response to glucocorticoid and cytotoxic therapy. Our data suggest that the antibody involved in the complex was of the IgG class and capable of complement fixation.