Wilson Cossermelli

Anticardiolipin antibodies in patients with infectious diseases

SummaryIgG or IgM anticardiolipin antibodies were present in the sera of 67% of 33 patients with Hansen s disease, in 53 % of 30 patients with tuberculosis and in 50% of 16 patients with endocarditis. Despite the high frequency of these antibodies, no patient had a history of thrombosis or abortion. Antidenatured DNA antibodies were tested in patients with tuberculosis and patients with Hansen s disease. Only in the latter group did we observe a statistically significant association between anticardiolipin and antidenatured DNA antibodies. Anticardiolipin binding activity, however, could not be inhibited by preincubation of sera with a variable concentration of denatured DNA. These data suggest that: a) Anticardiolipin antibodies in infectious diseases do not necessarily participate in the pathogenesis of thrombotic or obstetric complications; b) Anti-denatured DNA and anticardiolipin antibodies in the population studied do not have a crossreaction.

Cardiac and skeletal muscle scintigraphy in dermato- and polymyositis: Clinical implications

To determine the role of scintigraphy in the detection of skeletal and cardiac involvement in dermato-and polymyositis (DM/PM), we studied 30 patients with a confirmed diagnosis of DM/PM (23 females, 7 males; mean age: 35 years). Technetium-99m pyrophosphate (99mTc-PYP) and gallium-67 scans showed similar sensitivity, specificity and accuracy in the detection of skeletal muscle involvement when compared with serum enzymes (70%, 100% and 80%, respectively). Compared with the clinical parameters,99mTc-PYP showed 70% and67Ga 65% accuracy. Abnormal PYP cardiac uptake was observed in 57% of patients, whereas abnormal67Ga cardiac uptake was seen in only 15%. Electrocardiography was abnormal in 40%, rest gated blood pool study in 23%, and chest X-ray in 13%. In conclusion, both99mTc-PYP and67Ga can be useful in the detection of the active phase of muscle disease. However,99mTc-PYP seems to be more effective than67Ga in the early diagnosis of cardiac involvement.

Anticardiolipin antibodies in Behçet's syndrome: A predictor of a more severe disease

SummaryA high incidence of anticardiolipin antibodies were detected in 7 of 20 patients (35%) with Behçets Syndrome. Three patients had IgGab, three had IgMab and one had both IgG and IgM antibodies. IgGACA was detected mainly in patients with ocular disease (30%) and one of them also has cerebral vascular disease. A lower incidence of ACA was found in the patients taking steroids compared with the ones taking other drugs. This work draws attention to the more severe disease present in patients with ACA and also the possibility of such tests become negative in patients taking immunosupressive drugs.

Antiganglioside Antibodies in Patients with Neuropsychiatric Systemic Lupus Erythematosus

Antiganglioside antibodies (AGA) were determined in sera and cerebrospinal fluids (CSF) from 50 systemic lupus erythematosus (SLE) patients, and age-matched normal controls. The SLE patients were subdivided according to the type of clinical manifestation into two groups: neuropsychiatric SLE and active SLE without neuropsychiatric manifestation. The presence of these antibodies showed a significant correlation between IgG AGA in the CSF and IgM AGA in the serum and neuropsychiatric SLE. Fifteen patients had this antibody in the CSF without detectable levels in the serum. No correlation was seen between anti cardiolipin antibodies in the serum or CSF and neuropsychiatric SLE. The present work suggests that antibodies against gangliosides may be a marker for neuro psychiatric SLE and that intrathecal antibody production can result in the development of this manifestation.

Lip biopsy in connective tissue diseases: A review and study of seventy cases

The labial salivary glands from seventy patients with systemic lupus erythematosus (twenty cases), systemic progressive sclerosis (twenty-two cases), rheumatoid arthritis (twenty-three cases), and Sjögrens syndrome (five cases) and from fifty subjects without connective tissue diseases were studied by means of light and fluorescence microscopy. The availability of the lip biopsy as a diagnostic tool is stressed, but a differential diagnosis between the different connective tissue diseases was not achieved. Yet some of the latter disclosed peculiar lesions. The role of the inflammatory and degenerative components, as well as the pathogenesis of the lesions, is discussed.

Retrocalcaneal bursitis in juvenile chronic arthritis.

Retrocalcaneal bursitis has been described in various adult rheumatic diseases and septic bursitis unrelated to previous bursal disease has been reported in children. The case is reported here of a girl with juvenile chronic arthritis who developed non-septic retrocalcaneal bursitis; the diagnosis was suggested by a combination of clinical and radiographic studies and was confirmed by ultrasonography.

Complement activation by anticardiolipin antibodies.

A haemolytic assay was used to test the complement fixation ability of 16 serum samples with high concentrations of anti-cardiolipin antibodies. Fourteen patients had clinical complications usually associated with these antibodies--namely, recurrent abortions, thrombosis, or thrombocytopenia. Complement fixation by anticardiolipin antibodies was shown in only four of these patients and was not directly related to the antibody concentration. Because anticardiolipin antibodies in most of these patients did not activate the complement pathway it is unlikely that the complement cascade has an important role in the clinical complications associated with these antibodies.

Anticardiolipin antibodies in patients with rheumatoid arthritis

SummaryAnticardiolipin antibodies (ACA) were assayed by ELISA in 73 patients with rheumatoid arthritis. Twelve (16.48%) patients showed levels of ACA three standard deviations above the value of the control group and were considered positive; these patients were compared to the group with ACA within the normal levels regarding the following clinical and laboratorial characteristics: spontaneous abortions, central nervous system involvement, systematization and activity of disease, alterations in platelet counts, presence of antinuclear antibodies and rheumatoid factor. Significant statistical association could be demonstrated between systematization and presence of antinuclear antibodies (ANA) and positiveness to ACA (IgG, IgM or both). These findings might indicate that ACA in patients with RA could have relevance to morbidity of disease or perhaps to its pathogenesis.

Humoral immunity in Hansen's Disease

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The differences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors.

Mycobacterial subcutaneous arteritis

The authors report three patients with subcutaneous erythematous nodules in different phases of development, unspecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an unspecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.