Cell-free CD5 in patients with rheumatic diseases.

Since an increased frequency of CD5+ B cells has been reported in rheumatoid arthritis (RA) and primary Sjögren's syndrome (SS), and the expression of the molecule was reduced on the T cells of some SS patients, we hypothesised that there would be an accelerated turnover of CD5 in these disorders. We describe a novel enzyme-linked immunosorbent assay for measuring cell-free (CF) CD5, using rabbit F(ab')2 anti-CD5 antibody as capture agent and monoclonal anti-CD5 antibody as revealing agent. It was established that CF-CD5 was detectable in RA and SS sera, as opposed to sera from patients with ankylosing spondylitis and normal controls. The level of CF-CD5 did not correlate with rheumatoid factor in RA patients but was significantly higher (P less than 0.05) in SS patients with extraglandular manifestations than in those with glandular disease. Three of the latter patients with significantly increased levels of CD5-negative T cells did not have a particularly high proportion of CF-CD5 in these sera.

Serial measurements of anticardiolipin antibodies in primary Sjögren's syndrome.

Twenty-four out of 54 patients with primary Sjögren's syndrome (SS) were shown to be positive for IgG and/or IgM anticardiolipin antibodies (aCL). Extraglandular manifestations were related to the IgG-, but not to the IgM-aCL. Twenty SS patients were examined over a 3 year period. Of these, 6 displayed a marked increase in IgG- and IgM-aCL and, among them, 4 developed extraglandular manifestations of SS throughout the follow-up.

[Respective prevalences and frequencies of Horton's disease and rhizomelic pseudopolyarthritis. Epidemiological study in the Loire-Atlantic department using a general practice research network (RESOMED 44)]. / Prévalences et fréquences respectives de la maladie de Horton et de la pseudo-polyarthrite rhizomélique. Etude épidémiologique dans le département de Loire-Atlantique avec utilisation d'un réseau de recherche en Médecine générale (RESOMED 44).

Using a research network of general practitioners (Resomed 44) representing the 20th of all GP's in the Loire Atlantique region and distributed at random according to district, age and sex made it possible to evaluate the respective prevalences of temporal arteritis (TA) and polymyalgia rheumatica (PMR) in all the systemic immune diseases listed. Among these diseases, rheumatoid arthritis was the most frequent (35.39%). TA (18.8%) and PMR (18.54%) had about the same prevalence. For each of these diseases the year/physician prevalence was evaluated at 0.11, which means that the probability for each GP to see 1 TA and 1 RP at once in 10 years. At the time of the survey, 52.9% of TA patients and 78.8% of PMR patients were surviving. GP's alone follow up more TA's and PMR's than the other systemic immune diseases.

IgA-containing immune complexes in the circulation of patients with primary Sjögren's syndrome.

IgA-, IgM- and IgG-containing immune complexes (CIC) were detected in 48, 19 and 12% of 52 patients with primary Sjögren's syndrome (SS), in 36, 38 and 56% of 45 patients with rheumatoid arthritis, and in 8, 5 and 3% of 40 normal controls. A high proportion of primary SS patients also had considerable amounts of serum IgA and elevated levels of IgA with rheumatoid factor (RF) activity. IgA-CIC and IgA-RF were more frequent (P less than 0.03 and less than 0.001) in the 27 primary SS patients with, than in the 25 without extraglandular manifestations. IgA-CIC could play a role in mediating the tissue injury associated with primary SS.

Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases.

OBJECTIVE: To determine the circumstances, the clinical features and the outcome of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-free patients with connective tissue diseases (CTD). METHODS: Retrospective analysis of all cases referred 10 medical units in the last 10 years. RESULTS: A total of 34 cases of PCP in patients with CTD were studied (Wegener's granulomatosis, n = 12; systemic lupus erythematosus, n = 6; polyarteritis nodosa, n = 4; poly/dermatomyositis, n = 5; others, n = 7). The majority of patients (25/34 patients; 74%) presented PCP during the first 8 months following the diagnosis of CTD. At the time of diagnosis of PCP, most patients (32/34; 94%) were receiving corticosteroids (mean prednisone equivalent dose: 1.2 mg/kg/day) associated in 24 cases with cytotoxic agents (cyclophosphamide, n = 19; methotrexate, n = 5). Most patients were lymphocytopenic at the onset of PCP: 91% (31/34) of patients had fewer than 1.5 x 10(9)/l circulating lymphocytes and 76% (26/34) had fewer than 0.8 x 10(9)/l. The mean duration of prodromal symptoms was 6 days: this is much shorter than for AIDS associated PCP. Half the patients required intensive care for respiratory failure. Mortality was high (11/34 patients; 32%) although deaths were partly due to infections acquired in intensive care units. Among the 23 survivors, 10 (43%) received secondary prophylaxis for PCP and 13 (57%), received the usual therapeutic regimen. No relapse has been observed in either group with a mean followup of 22 months. CONCLUSION: Although rare, PCP must be considered in patients with any type of CTD and receiving cytotoxic agents and corticosteroids, particularly if they are lymphocytopenic. Thus, bronchoalveolar lavage must be rapidly performed in patients with CTD presenting with fever, pulmonary infiltrates, hypoxemia and lymphopenia.