RESUMEN
Parkinsonism is a rare feature of immunological diseases. We describe a 67-year-old man with Caplan's syndrome (CS) and parkinsonism. CS is an immunologic disease characterised by the presence of rheumatoid arthritis associated with a specific form of pneumoconiosis. Parkinsonism as a manifestation of involvement of the central nervous system in this condition has never been reported. Following immunosuppressive treatment both the CS and the parkinsonian signs and symptoms showed a marked improvement. The role of immune mechanisms in these parkinsonian syndromes is discussed.
Asunto(s)
Encéfalo/patología , Encéfalo/fisiopatología , Síndrome de Caplan/complicaciones , Síndrome de Caplan/inmunología , Encefalitis/inmunología , Enfermedad de Parkinson/inmunología , Anciano , Antiinflamatorios/uso terapéutico , Atrofia/diagnóstico , Atrofia/inmunología , Atrofia/fisiopatología , Encéfalo/inmunología , Síndrome de Caplan/tratamiento farmacológico , Encefalitis/tratamiento farmacológico , Encefalitis/fisiopatología , Humanos , Inmunosupresores/uso terapéutico , Pulmón/inmunología , Pulmón/patología , Pulmón/fisiopatología , Imagen por Resonancia Magnética , Masculino , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapia , Silicosis/complicaciones , Resultado del TratamientoRESUMEN
Seventy-nine cases of Caplan's lung were typed for HLA-A and B antigens. The antigen Bw45 was present only in those patients with rheumatoid factor and was of significantly higher frequency (13.6%) when compared to a non-coal dust exposed population of 316 (1.0%). Those patients without rheumatoid factor showed an increase in HLA-A1 and B8 (58.6% and 51.7% respectively) when compared to the rheumatoid factor positive group (29.6% and 25.0% respectively). Clinical and radiological reassessment were performed on 49 of these patients who were also typed for HLA-DR antigens and properdin factor B allotypes. HLA-DR4 was raised in the rheumatoid factor positive group with rheumatoid arthritis (55.2% compared to 25.8% in the non-coal dust exposed group and 37.3% in coalworkers with normal radiographs). The HLA-DR results are comparable to those found in other studies of rheumatoid arthritis not associated with pneumoconiosis. The findings for HLA-A1, B8 and DR4, however, were not significant after correction was made for the number of antigens tested for. No particular Bf allotype was found to be associated with either the lung change or the arthritis. The induction of the pulmonary lesion in Caplan's syndrome is discussed in relation to the HLA findings.
Asunto(s)
Síndrome de Caplan/inmunología , Factor B del Complemento/análisis , Precursores Enzimáticos/análisis , Antígenos HLA/análisis , Antígenos de Histocompatibilidad Clase II/análisis , Neumoconiosis/inmunología , Anciano , Artritis Reumatoide/inmunología , Antígenos HLA-A , Antígenos HLA-B , Antígenos HLA-DR , Prueba de Histocompatibilidad , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Síndrome de Caplan/diagnóstico , Síndrome de Caplan/inmunología , Síndrome de Caplan/patología , Femenino , Humanos , Pulmón/patología , Masculino , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/inmunología , Enfermedades Profesionales/patología , Factor Reumatoide/inmunología , Linfocitos T/inmunologíaRESUMEN
HLA typing was performed on 267 Welsh coalworkers with pneumoconiosis (96 cases of simple pneumoconiosis, 115 cases of progressive massive fibrosis and 56 cases of Caplan's Syndrome) and 134 coalworkers with no abnormality. The presence or absence of rheumatoid factor was also determined. The results fail to confirm a previously reported increase in HLA-A1 and B18 in coalworkers with no pneumoconiosis. When correction was made for the number of antigens typed (i) HLA-Bw21 was significantly increased from 1.1% in the total group with pneumoconiosis to 8.2% in coalworkers with no abnormality (P corrected less than 0.032); (ii) HLA-Bw45 was increased in Caplan's Syndrome (10.7%) and Caplan's Syndrome patients with rheumatoid factor (16.1%) when compared to a non-occupationally exposed control group (0.8%) (P corrected = 0.019 and 0.0064 respectively). These results were not significant when comparisons were made with the coalworker group with no abnormality. The apparent higher frequency of Bw45 in Welsh coalworkers is discussed.
Asunto(s)
Síndrome de Caplan/genética , Antígenos HLA , Neumoconiosis/genética , Síndrome de Caplan/inmunología , Minas de Carbón , Epítopos , Frecuencia de los Genes , Antígenos HLA/análisis , Humanos , Masculino , Neumoconiosis/inmunología , Fibrosis Pulmonar/genética , Fibrosis Pulmonar/inmunología , Factor Reumatoide/análisis , GalesRESUMEN
The authors have studied the incidence of hepatitis associated antigen (HAA) and the homologous antibody in sera of patients with rheumatoid arthritis on the basis of (1) arthritis sometimes associated with viral hepatitis, (2) the possible infectious etiology of rheumatoid arthritis, and (3) observation on the possible pathogenetic role of HAA in some cases of polyarteritis nodosa. The presence of HAA and antibody titer gave constantly negative results in all subjects examined with the exception of one case which showed no signs of serological or histological hepatic involvement. On the basis of the results obtained, the negligible role of HAA in the etiopathogenesis of rheumatoid arthritis is underlined. However, the authors emphasize as suggestive the hypothesis that the characteristic histopathological alterations of rheumatoid arthritis may be mediated by an immunological reaction toward an infectious agent other than HAA, but operating through mechanisms similar to those of HAA in polyarteritis nodosa.
