Rheumatoid arthritis and sterile corneal ulceration. Analysis of tissue immune effector cells and ocular epithelial antigens using monoclonal antibodies.

Tissue immune effector cells and epithelial surface antigens present in eye tissue of rheumatoid arthritis (RA) patients with sterile corneal ulceration were studied using a large panel of monoclonal antibodies. During periods of active corneal ulceration, conjunctivae and corneas of all RA patients studied contained numerous immune-associated (Ia) antigen-positive tissue macrophages. In 4 of 6 patients, conjunctival or corneal T cell infiltrations were present. In 2 patients, a T cell vasculitis was seen in conjunctival tissue. Conjunctival epithelial cells of all 6 RA patients expressed Ia antigens during active corneal ulceration. These data provide evidence for immune-mediated mechanisms in the pathophysiology of corneal ulceration in RA. Moreover, the expression of Ia antigens by conjunctival epithelial cells may be a useful indicator of disease activity in RA patients with sterile corneal ulceration.

Group B streptococcal arthritis in adults.

Group B beta-hemolytic streptococci (Streptococcus agalactiae) have been a rare cause of septic arthritis in adults. Only 18 cases have been cited in the literature, eight of which were described since 1976. Two additional cases occurring in the last year are described herein. Like other infections caused by group B streptococci, the incidence of septic arthritis due to these organisms appears to be increasing. A review of these 20 cases revealed a history of prior arthritis or trauma to the involved joints in 30 percent, and an additional 30 percent occurred in potentially immunocompromised hosts. Four of the patients had probable oligoarticular group B streptococcal arthritis. Although most deaths occurred in the pre-penicillin era, early recognition and treatment are essential to prevent joint destruction.