Clinical implications of ribonucleoprotein antibody.

Out of 97 patients with circulating ribonucleoprotein antibodies, 44 (45%) satisfied the criteria for systemic sclerosis, systemic lupus erythematosus, polymyositis/dermatomyositis, or rheumatoid arthritis. Forty-two (43%) of the 97 patients whose cases did not fulfill these criteria had at least two of the following three clinical manifestations: arthritis, Raynaud's phenomenon, and swollen or sclerotic fingers. A fifth of the latter group of patients had chronic, restrictive pulmonary disease or myopathy and two thirds had hypergammaglobulinemia, IgM rheumatoid factor, and sensitized epidermal nuclei. Few patients had hypocomplementemia. One patient had nephropathy. Most patients had an unchanged, benign disease course for, on the average, nine years. It is suggested that the term mixed connective tissue disease (MCTD) be reserved for such patients, and that the acronym MCTD be changed to SRA (swollen fingers, Raynaud's phenomenon, and arthritis). Treatment with glucocorticoids is necessary for only a minority of patients.

[Acute vasculitis and arthritis caused by Parvovirus B 19 infection]. / Akut vasculitis og arthritis forårsaget af Parvovirus B 19 infektion.

A 35-year old woman was admitted with fever, polyarthritis and severe vasculitis. The symptoms resolved spontaneously within a week. Two weeks later, her seven year old son developed erythema on arms and legs and the typical "slapped cheek syndrome" characteristic of erythema infectiosum. Both cases were due to acute infection with Parvovirus B 19 as demonstrated by the presence of IgM-antibodies to Parvovirus B 19. The cases are described in order to draw attention to the possibility of Parvovirus B 19 infection as the etiological agent for acute vasculitis in adults.

Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county. A prospective investigation, 1982-1985.

The annual incidence of giant cell arteritis (the term used in this study to encompass the syndromes of temporal arteritis and polymyalgia rheumatica, occurring either together or alone) was prospectively determined in a Danish county that had a population of approximately 200,000. In a single year, 46 new cases of giant cell arteritis were diagnosed, a number which corresponds to an incidence in the overall population of 21.5/10(5), and to an incidence of 76.6/10(5) for individuals age 50 years or older. These rates are higher than those previously reported in retrospective studies. The 3-year followup of all patients showed no onset of other diseases that would require a revision of the original diagnosis. There was no deviation from the age- and sex specific malignancy rate or the mortality rate in the overall population. Women had an incidence rate 4 to 5 times higher than that seen in men. Symptoms, for the most part, were the same as those found in other studies; however, vision loss was not observed during the followup period. Point prevalence at the start of the study was 37.8/10(5), which is below the rates previously reported. This is probably because of failure on the part of participating physicians to record all cases.

Yersinia enterocolitica infections and chronic connective tissue diseases.

The purpose of the investigation was to evaluate a possible relationship between infection with Yersinia enterocolitica and chronic connective tissue diseases. 258 patients with a positive faeces culture in the years 1972-75 were examined in 1978 with regard to the presence of chronic connective tissue diseases. The investigation, which was carried out primarily by a questionnaire followed up by a clinical examination of "the questionnaire-positive" patients, did not reveal any causative relationship between earlier Y. enterocolitica infections and chronic connective tissue diseases.

Lymphocyte subpopulations in Crohn's disease and chronic ulcerative colitis.

Lymphocyte subpopulations in peripheral blood were studied by the sheep red blood cell rosette technique for the identification of T-lymphocytes, and immunofluorescence staining with rabbit anti-human immunoglobulin sera for the identification of B-lymphocytes. In Crohn's disease, the total number of lymphocytes was found to be reduced and an almost equal reduction in all the lymphocyte subpopulations studied was found. In ulcerative colitis neither the number of T-lymphocytes nor of B-lymphocytes were found to differ significantly from normal values and the same was true of all B-lymphocyte subpopulations. However, the number of lymphocytes carrying neither surface immunoglobulin nor sheep red blood cell receptors was found to be significantly increased. The results were correlated to clinical data.

A prospective study of vasculitis patients collected in a five year period: evaluation of the Chapel Hill nomenclature.

OBJECTIVE: To test the usefulness of the Chapel Hill nomenclature, supplemented with surrogate parameters, as diagnostic criteria for primary vasculitides. METHODS: To prospectively evaluate vasculitis patients according to a standardised clinical and para-clinical programme. In accordance with the Chapel Hill publication surrogate parameters were used: proteinuria, haematuria and red blood cell casts (glomerulonephritis), angiographic or ultrasonic demonstration of aneurysms or stenoses (arteritis), radiological lung infiltrates or cavitations of more than one month's duration (granuloma in the lungs), bloody nasal discharge or crusts, chronic sinusitis, otitis and/or mastoiditis, bone and/or cartilage destruction, and acute hearing loss (granuloma in upper airways). RESULTS: The following entities were diagnosed: giant cell arteritis (n=14), Takayasu arteritis (n=1), polyarteritis nodosa (n=2), Wegener's granulomatosis (n=27), Churg-Strauss syndrome (n=2), microscopic polyangiitis (n=12), Henoch-Schönlein purpura (n=2), cutaneous leucocytoclastic angiitis (n=37), and secondary vasculitis (n=21). Giant cell arteritis and cutaneous leucocytoclastic angiitis were in all cases diagnosed by biopsy. Using the Chapel Hill nomenclature supplemented with surrogate parameters, only 8 of 27 patients were diagnosed with Wegener's granulomatosis, and 3 of 12 cases with microscopic polyangiitis. The number of patients in the remaining diagnostic entities were considered to few to evaluate. CONCLUSIONS: The Chapel Hill nomenclature, supplemented with surrogate parameters, failed to act as diagnostic criteria in Wegener's granulomatosis and microscopic polyangiitis. The following diagnostic criteria are proposed for Wegener's granulomatosis: (1) Biopsy or surrogate parameter for granulomatous inflammation in the respiratory system and (2) Biopsy verified necrotising vasculitis in small to medium sized vessels or biopsy/surrogate parameter for glomerulonephritis or positive PR3-ANCA test and (3) Lack of eosinophilia in blood and biopsy samples. The following diagnostic criteria are proposed for microscopic polyangiitis: (1) Biopsy verified necrotising vasculitis in small vessels and/or glomerulonephritis with few or no immune deposits and (2) Involvement of more than one organ system as indicated by biopsy verified vasculitis in small to medium sized vessels or surrogate parameter for glomerulonephritis and (3) Lack of biopsy and surrogate parameter for granulomatous inflammation in the respiratory system. Using these criteria all Wegener's patients and 9 of 12 patients with microscopic polyangiitis could be diagnosed.