Eighteenth rheumatism review. Review of American and English literature for the years 1965 and 1966.
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Biomedical subjects
Publications and source records attributed to D Hamerman.
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Fluids from joints contain a substance that reacts immunologically like one of two known antigenic components of articular cartilage proteinpolysaccharide. This newly recognized substance occurs in the lining cells of synovial membranes as shown by indirect immunofluorescence. The localization of this substance in tissue culture cells derived from synovial membranes and its identification in the culture medium supports the suggestion that it is synthesized by lining cells. Rheumatoid synovial cells contain less of this substance.
Articular cartilage fragments were added to monolayer cultures of synovial membrane cells. After 3 wk of incubation, the cartilage fragments were examined histologically for metachromasia and basophilia, and for fluorescent staining using a rabbit antiserum to cartilage protein-polysaccharide. Cartilage incubated with cells derived from rheumatoid synovial membranes showed striking loss of metachromasia and basophilia as well as diminished to absent fluorescent staining. Cartilage fragments incubated with cells from normal synovia, or with cells from the synovial membrane of a patient with Reiter's syndrome, did not show these changes and resembled control cartilage incubated in tissue culture medium alone. It appears, therefore, that rheumatoid synovial cells in tissue culture are able to deplete the matrix of articular cartilage.
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Bright fluorescent staining, which indicates the presence of hyaluronateprotein, was observed in the lining cells of the synovial membrane following application of rabbit antiserum to hyaluronateprotein and a fluorescein-labeled antiserum to rabbit gamma-globulin. Staining was shown to be specific and due to antigenic determinants on or closely associated with the protein moiety of hyaluronateprotein.
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Synovial cells from the joint of a patient with rheumatoid arthritis (RA) showed foci of cytopathic effects during their 3rd subculture in vitro. Electron microscopy of these cells revealed findings characteristic for cytomegalovirus (CMV), and immunofluorescent staining using antiserum specific for CMV was positive. The patient had classical seropositive RA, was not taking immunosuppressive agents, and had no clinical manifestations of CMV disease at the time of synovectomy 3 months earlier. Titers of antibodies to CMV were studied in the sera and synovial fluids of 3 additional patients with RA, and in 1, elevated IgM antibodies to CMV were found, indicating recent infection. Additional studies for CMV in RA are indicated.