Biomedical subjects
Publications and source records attributed to D A Isenberg.
Many different factors combined cause an autoimmune disease like Sjögren's syndrome. In this review a new analogy is described to represent the relationship between Sjögren's when it occurs on its own, compared to its existence against the background of another autoimmune condition. The issue of whether Sjögren's should really be thought of as a syndrome or a disease is also highlighted.
Polymyositis and dermatomyositis are serious inflammatory muscle disorders which may present life-threatening complications. It is important to recognise and treat the condition in the early stages of the disease. Corticosteroids remain the mainstay of treatment, and their resistance and other forms of immunotherapy are discussed.
In this study we report that circulating antibodies recognising a 56kD protein, which is a component of large nuclear ribonuclear particles, are commonly found in children with juvenile onset dermatomyositis (JDM). These autoantibodies, as detected by Western blotting, were present in over 90% (24/26) of sera from JDM patients, which exceeds the number of patients with adult onset myositis who express this antibody (up to 85%). In addition, they were not found in healthy controls. Serial bleeds taken during the course of the disease in eleven children with JDM enabled us to follow the titre of anti-56kD autoantibodies. Sera were also tested by indirect immunofluorescence for anti-nuclear antibodies (ANA) using Hep2 cells as substrate. These studies revealed two distinct patient groups: Group 1 with anti-56kD antibody positive and ANA positive; and Group 2 with anti-56kD antibody positive and ANA negative. In Group 1 there was some correlation between disease activity and anti-56kD levels which was absent among patients in Group 2.
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Autoantibodies are the hallmarks of autoimmune diseases. They are not, however, necessarily pathognomonic and interpretation of autoantibody results must be considered in the light of the clinical history. This article highlights the clinically relevant autoantibodies associated with autoimmune rheumatic diseases, and introduces the concept of autoantibody disease imprinting.
OBJECTIVE: To determine the incidence of anti-hsp90 and 70 antibodies in children with SLE, juvenile dermatomyositis and juvenile chronic arthritis. METHODS: We utilized a previously described ELISA to detect the presence of antibodies to mammalian hsp90 and 70 in 33 children with SLE, 55 with juvenile chronic arthritis (JCA) and 11 with dermatomyositis. Sera from 19 children with non-autoimmune conditions served as controls. RESULTS: Antibodies reactive with hsp90 and/or 70 were detected in 35% of the children with SLE, and the numbers of children with SLE who have raised IgG anti-hsp90 antibodies (24%) is very similar to our adult onset cases, although the prevalence of IgM antibodies is much smaller. However, serum antibodies to hsp70 were as infrequent in children with SLE or JCA as in adults with SLE or RA, although IgG antibodies to hsp70 were detected in 50% of the synovial fluid of JCA patients. CONCLUSION: The incidence of antibodies to hsp90 in childhood-onset SLE resembles that described in adult onset disease suggesting that, despite clinical differences between the two, a subset of each may share a similar pathological mechanism of disease.
Humoral abnormalities are a significant feature of rheumatoid arthritis (RA) even if, as seems likely, they do not represent primary phenomena. Thus, autoantibodies including rheumatoid factor, anti-perinuclear factor and anti-RA33 antibodies are important serological features of RA, although none are truly disease-specific. In addition, it has been shown that serum IgGs from RA have an increased number of oligosaccharide structures attached to the Fc region whose outer 'arms' lack galactose [i.e. increased Gal (0)]. Measurement of Gal (0) has been shown to have clinical utility in the assessment and follow-up of patients with RA.