Sixty patients with systemic lupus erythematosus (SLE) were examined: 40 patients with cryoglobulinemia and 20 patients without it. Cryoglobulinemia was observed in patients with SLE, as a rule, in the acute course of the disease ending in renal affection. Cryoglobulinemia in SLE was accompanied by the phenomenon of generalized vasculitis in the form of skin and mucosa lesions with ulcero-necrotic changes and affections of the central and peripheral nervous system and the kidneys. The clinical picture of SLE accompanied by cryoglobulinemia was characterized by a polysyndrome phenomenon and infrequent presence of the ARA criteria. Cryoglobulinemia was accompanied by high titres of anti-DNA. Thus, cryoglobulinemia can be regarded as one of the important factors of immunocomplex damage in SLE.
The authors studied the immunity indices in patients with gout against the background of a long-term (one year) therapy with allopurinol, and in animals with experimental hyperuricemia. During treatment the authors observed normalization of blood immunoglobulin M level, a considerable decrease in circulating immune complexes and anti-renal antibodies, a tendency to a rise in the function of T-lymphocytes, great enhancement of the activity of polymorphonuclear phagocytes in tests with Staphylococci and nitro-blue tetrazolium. Mechanisms of action of the given drug are discussed.
Results of clinico-genealogical and immunogenetic examination of 220 persons including 150 patients suffering from rheumatism and members of their families have been presented. The object of the examination was a B-cell marker carriership to be determined by means of monoclonic antibodies D8/17 with the use of the microlymphocytotoxic method. The marker carriership was detected in 96 per cent of probands-patients with rheumatism and in 40.3 per cent of their relatives and in 6.7 per cent of healthy individuals of the control group. A possible contribution of the B-cell marker to rheumatism liability was suggested. A further study of the role of the given marker in rheumatism has been found advisable.
The authors discuss the effect of exotoxin of beta-hemolytic streptococcus (streptolysin-O) on the chemotactic activity of the peripheral blood leukocytes. 107 children with various forms of rheumatic fever and acute diseases of Streptococcal etiology and 18 healthy children were examined. The absence of the phenomenon of a specific chemotactic deactivation of polymorphonuclear leukocytes in response to streptolysin-O in healthy persons and in those suffering from rheumatic fever has been revealed. Sharply marked sensitization of polymorphonuclear leukocytes to streptolysin-O in patients with rheumatism increasing in the course of the disease and remaining in the inactive phase has been noted. The functional activity of polymorphonuclear leukocytes is characterized by chemotactic deactivation in response to streptolysin O that probably provides a favorable outcome of the disease.
The method of structural analysis was used to study the presence of sexual disorders in 26 male patients with rheumatoid arthritis (RA). The incidence of sexual disorders was 42.3 per cent (11 patients). In this case the ejaculatory and neurohumoral components of the copulative cycle were mostly disturbed. Sexual dysfunction developed during the disease and was often associated with exacerbation of RA. Disorders in pubertal development were revealed in none of the patients. But patients with a disturbed sexual function exhibited a significant decrease in the total cumulative index in the male sexual formula, in the level of total and free testosterone, a rise in the content of prolactin. Possible causes and mechanisms of sexual disorders in male patients with RA are discussed.
A total of 140 patients with reactive arthritis due to Yersinia infection were under observation for 2-10 years. A group of 104 patients with erosive rheumatoid arthritis served as control for analysis of the results of bacteriological and serological studies. The bacteriological analysis of the feces, urine, smears of the feces and blood were made repeatedly. As established the articular syndrome in reactive arthrosis has its specific features depending on the nature of the pathological process: primary, recurrent and chronic. Patients with primary reactive arthritis exhibited recovery without residual phenomena and relapses in 35.8% of the cases; in 86% the disease relapsed; in 36% it was chronic, persisting for a number of years as a non-erosive seronegative arthritis; in 25.3% arthralgia persisted; in 6.2% the clinical picture of secondary osteoarthrosis developed; in 17.3% the disease changed into spondyloarthritis and in 1.2% of the cases it changed into RA. Since in reactive arthritis Yersinia infection was confirmed in 48.5% of the cases and in RA in 14-21%, laboratory diagnosis cannot serve as an absolute criterion for reactive arthritis. It is necessary to take into consideration the anamnesis and the peculiarities of the clinical picture and the course of the articular syndrome.
The authors examined 22 patients with rheumatic fever in whose cells (neutrophils, mononuclear cells, thrombocytes) and in the blood serum they noted the activity of lysosomal enzyme of beta-glucuronidase (BGU) and the concentration of protein in the cells of the peripheral blood. The activity of the enzyme and concentration of protein in neutrophils of mononuclear cells was found to be decreased. Differences in determining the activity of BGU in the blood serum in relation to the clinical manifestations of the disease were also established. A significant rise in the activity of BGU in the blood serum as compared to the norm was observed in patients with a protracted course of rheumatic fever, with the I degree of the process activity, circulatory disorders and complicated cardiac failures. There was a clearly seen direct relationship between the activity of BGU in the blood serum and the level of circulating immune complexes, and an indirect relationship between the mentioned enzyme and alpha 2-globulin. A decrease in the activity of BGU in the cells was caused by degranulation of neutrophils and monocytes induced by immunological factors. A decrease in the level of BGU in the cells of patients with rheumatic fever apparently influences the processes of phagocytosis and aggravates immunological disorders, and, consequently, is connected with the disease pathogenesis. Determination of the BGU activity in the blood serum can be used for detection of the minimum activity of the inflammatory process in a chronic course of rheumatic fever.
A total of 35 patients aged from 5 to 12 years old suffering from the articular, visceral or polyarticular form of juvenile rheumatoid arthritis (JRA) were examined. The functional state of the endocrine glands were determined by means of appliances intended for radioimmunological study. To characterize the immune status of patients the conventional methods of investigation were used. The analysis of the material showed that all the patients with JRA had disorders in the system: hypophysis--adrenal cortex, the system: hypophysis-thyroid gland and pancreas suffer to the least degree. Disorders were mostly marked in patients with the articular- visceral form of JRA and those with a protracted course of the disease (two or more years). Relationship between hormonal and immune parameters was revealed.
A questionnaire including 9 main signs: headache, vertigo, vision and hearing derangement, fatigue, hemorrhage, somnolescence, loss of appetite has been elaborated and introduced into the clinical practice. It was revealed that patients with Sjögren's syndrome had an elevated viscosity of the serum in 30% of the cases. These patients complained of headache and vision derangement more often than those with normal indices, though in the first group it did not reach critical values corresponding to an extended clinical picture of the hyperviscous syndrome. The mentioned questionnaire can be used for early diagnosis of the rheological properties of the blood.
