Biomedical subjects
Publications and source records attributed to D Alarcon-Segovia.
Antibodies to ribonucleoprotein are the serological marker of mixed connective tissue disease (MCTD). Five patients are presented who had negative or low titer anti-RNP antibodies despite characteristic MCTD. In all 5 patients antibodies to RNP appeared after they had taken prednisone for periods ranging from 3 wk to 15 months.
Fifteen patients with PSS, 4 with CRST syndrome, and 4 with localized scleroderma have been treated with colchicine at the maximum tolerated individual doses for an average of 39 months (range 19--57). All but 2 of the 19 patients with generalized scleroderma and 3 of those with localized scleroderma improved. Patients who had had scleroderma for less than 5 yr when begun on colchicine, and those who received total doses of colchicine of more than 1,438 mg, scored a significantly higher mean response index than those with longer disease duration, or those who received less colchicine.
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We report 5 patients with systemic lupus erythematosus (SLE) who presented with severe protein-caloric malnutrition that overshadowed the clinical picture of SLE. All 5 patients had severe anemia, extreme lymphopenia and hypoalbuminemia, but all 5 also had striking hypergammaglobulinemia with high titers of autoantibodies. These patients show that SLE may occur in subjects with endemic malnutrition and suggest that the production of autoantibodies in SLE patients overrules the requirements for the production of other proteins.
We compared 31 patients who did, and 31 patients who did not, fulfill 4 or more criteria for the classification of systemic lupus erythematosus (SLE) at the time of diagnosis. Twenty-one of the latter 31 patients eventually developed enough manifestations to fulfill classification criteria. Ten never did despite average follow-up of 41 months. Patients who did not fulfill criteria at the time of diagnosis frequently had more thrombocytopenia and/or hemolytic anemia and continued to have fewer manifestations during the course of their disease than those who did. Failure to include this subject of SLE in studies with series of SLE patients may give a distorted picture of the disease.
Chronic interstitial cystitis (CIC) has been thought to result from autoimmune phenomena and its occurrence in systemic lupus erythematosus (SLE) has occasionally been recorded. We report a patient with SLE whose initial urinary symptoms were caused by CIC. Two of 3 patients (including ours) whose cases have been reported also had diarrhea, a common symptom in idiopathic CIC. All 3 patients had cutaneous and/or bladder vasculitis. CIC occurring in SLE seems to be due to immune complex deposition.
Apparent osteoarthritic knee enlargement and severe genu varus is described in a Pre-Columbian ceramic from the classic Colima period of the shaft-tomb culture of West Mexico (AD 0-500).
Fifty of 197 systemic lupus erythematosus (SLE) sera had 2 + positive C-reactive protein (CRP) determinations by precipitation in capillary tubes. All but 3 of these 50 sera had been taken at the time of infection whereas 80 of the 115 sera taken at the time of SLE activity without infection were negative for CRP. Thirty-two of the 35 CRP positive sera from patients with active lupus were obtained during intercurrent infection. CRP determinations in capillary tubes are clinically useful in distinguishing disease reactivation from intercurrent infection in SLE. These findings confirm a study using the same method for CRP determination. Discrepancy with another study may be due to the use of a different method.
HLA typing done in 10 Mexican mestizo patients with Behcet's syndrome revealed that 7 of them had HLA-B5 antigen as compared to a frequency of 31% in a Mexican mestizo control population. These findings are akin to those made in Japan and Turkey but differ from those made in Caucasian populations in the United States and Great Britain. Ethnic groups with a high frequency of HLA-B5 in Asia and America may belong to the same ancestral trunk. The occurrence of Behcet's syndrome in them may be more frequently HLA-B5 positive than in other ethnic groups.
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Heat-treatment of normal human serum (NHS) results in positive seroconversion of IgG anticardiolipin antibodies (aCL) that do not depend on beta 2-glycoprotein-I (beta 2GP-I) for their detection in vitro as do some IgG aCL from patients with primary antiphospholipid syndrome (PAPS). Other IgC aCL from PAPS depend on beta 2GP-I for phospholipid binding. Here, we studied heat-unmasked aCL from 22 PAPS sera and from eight normal individuals. IgG aCL were detected in standard (using new born calf serum [NBCS] that contains beta 2GP-I as blocking agent and to dilute samples) and in a modified ELISA (using beta 2GP-I-free-bovine serum albumin instead of NBCS). Overt and heat-unmasked IgC aCL were purified from CL micelles alone or mixed with purified beta 2GP-I. NHS had no overt IgG aCL. In contrast, aCL titers increased almost ten-fold after heat-inactivation of NHS, a result which was equally detectable in both assay conditions. As expected, PAPS patients had one population of overt beta 2GP-I-dependent IgG aCL. After heat-treatment of all PAPS sera, we detected IgG aCL in both standard and modified aCL ELISA with an approximately three-fold increase in IgG aCL titers when tested in the standard assay. Two PAPS patients also had a second population of beta 2GP-I-independent overt IgG aCL. Purified IgG from these PAPS sera retained both reactivities.(ABSTRACT TRUNCATED AT 250 WORDS)
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The HAQ-Disability Index (HAQ-DI) is a useful instrument to measure health status in rheumatoid arthritis (RA) patients. Translation into another language requires a validation process, however. We have translated the HAQ-DI to be used on Spanish-speaking populations. We administered the questionnaire to 97 RA patients during the course of routine medical care. Reliability, measured by a test-retest with a one-month interval, was high (Spearman's rho = 0.89). Convergent and construct validity was obtained for all comparisons (Pearson's r > 0.4). The instrument was sensitive in detecting clinical improvement. We conclude that the Spanish HAQ-DI retains the characteristics of the original index and can be used to assess outcome in Spanish-speaking patients with RA. The procedure described may be used to translate the instrument into other languages either directly from English or from the Spanish version presented here.