The frequency of sicca syndrome in an elderly female population.

In a population of 103 elderly Caucasian women, 39% had sicca symptoms and 24% had abnormal Schirmer's tear tests. Two (2%) satisfied criteria for Sjögren's syndrome and 12 (12%) were felt to have possible Sjögren's syndrome. Fifty percent of those with sicca were taking medications that might induce mucosal dryness. Fibrosis was noted on all 23 labial minor salivary gland biopsy specimens obtained. Mucosal drying medications and senile salivary gland atrophy seemed to contribute to the high frequency of sicca in this population with a lesser proportion of the subjects demonstrating previously undiagnosed Sjögren's and possible Sjögren's syndrome.

Pulmonary involvement in mixed connective tissue disease.

To determine the frequency of pulmonary function abnormalities in mixed connective tissue disease (MCTD), we studied 16 consecutive patients. Spirometry, total lung capacity (TLC), diffusing capacity (Dco), static lung compliance (Cst), and tests of respiratory muscle function (peak inspiratory pressure [PIP] and the maximum change in transdiaphragmatic pressure [delta PDI] during a diaphragmatic Müeller maneuver) were obtained. Airway resistance (RAW) and frequency dependence of compliance were also measured. Static lung compliance was less than 0.2 L/cm H2O in four of nine patients. The PIP was less than 75 cm H2O in only one patient and delta PDI was greater than 45 cm H2O in all ten patients evaluated. Frequency dependence of compliance was abnormal in seven of ten patients, whereas RAW was increased in only three of eight patients. The TLC and DCO were less than 80 percent of the predicted values in ten of 16 and 14 of 16 patients respectively. There was no correlation between the level of extractable nuclear antigen and pulmonary function abnormalities. The study did not identify significant abnormalities in respiratory muscle function.

Direct stimulation of neutrophil oxygenation activity by serum from patients with systemic lupus erythematosus: a relationship to disease activity.

Sera from patients with systemic lupus erythematosus (SLE) directly stimulate polymorphonuclear leukocyte (PMNL) oxygenation activity as measured by luminol dependent chemiluminescence (CL). The stimulatory capacity of a serum, expressed as percent PMNL chemiluminescence (%CL), was calculated by dividing the integral CL response to the serum by the integral CL response to a standard stimulus, opsonified zymosan. Testing was performed on 50 sera obtained serially from 8 SLE patients and on 14 sera from 11 controls. Sera from SLE patients in remission and controls were nonstimulatory with mean %CL +/- SE values of 3.1 +/- 0.7 and 3.5 +/- 0.9, respectively. Sera obtained from the SLE patients during active disease yielded a mean %CL value of 26.6 +/- 9.0. The stimulatory capacity of SLE serum was concentration dependent and enhanced by adding normal serum complement. The CL response correlated with serological measures of SLE activity such as antibodies to double stranded DNA (p less than .0001) and Clq binding immune complexes (p less than .001). Thus, during active SLE, PMNL may become metabolically activated by exposure to serum containing immune complexes and possibly other factors. PMNL activation may contribute to the development of vasculitis, leukopenia, and susceptibility to infection. Our CL approach allows sensitive in vitro assessment of the phlogistic properties of serum to monitor SLE disease activity.

Values of the U.S. National Reference Serum for human antibodies to native DNA obtained with commercial immunoassays for anti-DNA in systemic lupus erythematosus.

The Arthritis Foundation and the Centers for Disease Control have recently prepared a "U.S. National Reference Serum" for human antibodies to native DNA. We tested this serum with 13 commercial assays for antibodies to native DNA, to permit comparisons of the values obtained in each test. Titers ranged from 10 to 2560 in Crithidia luciliae immunofluorescence assays. The serum produced 794 int. units/mL in the Cordis ELISA assay, 136 Amersham units/mL in a radioimmunoassay, and 88 FIAX units in a fluorometric immunoassay. These results can be used for interlaboratory comparisons of differing methodologies for measuring anti-DNA.

Temporal arteritis presenting with jaw claudication and normal erythrocyte sedimentation rate.

We have described a case of sudden blindness of the right eye in an 81-year-old white woman with a one-month history of increasingly severe jaw claudication and a normal Westergren sedimentation rate. Isolated jaw claudication in the elderly is of diagnostic importance, and the need for temporal artery biopsy and rapid institution of high-dose steroid therapy to prevent blindness is emphasized.