Autoantibodies and autoimmune disease in Jamaica

This study investigated the repertoire of autoantibodies found in normal healthy Jamaicans as it relates to the efficacy of laboratory diagnosis of autoimmune disease. Clinical, immunological and genetic features of certain autoimmune diseases as they occur in Jamaicans were also examined. A number of immunological techniques were applied. There was no marked female preponderance of thyroid autoantibodies in the normal population although autoimmune thyroid disease was found predominantly in females. This indicates that gonadal hormones may be important in the development of disease. The low frequency and concentrations in which islet cell autoantibodies occur in Jamaican type 1 diabetics (3.2 percent) supports a non-pathogenetic role for these antibodies (Chapter 6). The bimodal clinical distribution of myasthenia gravis found elsewhere was not observed in Jamaicans (Chapter 10). There was no female preponderance in the ocurrence of rheumatoid factors. The frequency of certain ARA criteria were statistically significantly lower in Jamaican systemic lupus erythematosus (SLE) patients compared with American patients. Several HLA associations were found with myasthenia gravis, SLE and rheumatoid arthritis although these were mostly weak. The data obtained herein will contribute to the improvement in diagnosis and management of autoimmune diseases in Jamaica and the lack of understanding of the pathogenesis of autoimmune diseases

Diagnosis of neurosyphilis: a critical assessment of current methods

Clinical features of 74 patients with neurosyphilis and 38 syphilitic patients with nonsyphilitic neurologic disorders were correlated with results of their serum and cerebrospinal fluid (CSF) VDRL and FTA tests, and with the WBC count and total protein level in the CSF. The most common clinical features in those having neurosyphilis were reflex changes (53.9 percent), peripheral neuropathy (44.5 percent), ataxia (38 percent), and cranial nerve palsies (24.3 percent). In 27 percent of the patients with neurosyphilis the CSF was VDRL-reactive, while in 77 percent the CSF was FTA-reactive. The frequency of elevated WBC counts in various serologic categories ranged from 23 percent to 27 percent; neither the mean WBC count nor the protein level differed significantly among the different serologic categories (P less than .05). Only two of the 74 patients with neurosyphilis and elevation of both the WBC and protein level. None of the syphilitic patients without neurosyphilis had an elevated WBC or protein level, though the CSF was FTA-reactive in all 38. Among the neurosyphilis patients whose CSF was VDRL-nonreactive but FTA-reactive, 21 percent had an elevated protein level and 26 percent had an elevated WBC count. These results support the view that patients having neurosyphilis will not necessarily have either VDRL-reactive CSF or the other expected CSF abnormalities. (AU)