alpha(1) Antitrypsin deficiency in a patient with systemic vasculitis and primary Sjögren's syndrome.
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Adult↗
Biomedical subjects
F D Lindström
Publications and source records attributed to F D Lindström.
Iron and vitamin deficiencies, endocrine and immune status in patients with primary Sjögren's syndrome.
OBJECTIVES: To study the prevalence of iron and vitamin deficiencies, endocrine disorders and immunological parameters in patients with primary Sjogren's syndrome (1 degree SS). DESIGN AND SUBJECTS: At the time of the establishment of the diagnosis of 1 degree SS in 43 consecutive patients, a clinical examination including haematological analyses was performed. The patients' medical records were also reviewed. SETTING: Patients referred for diagnosis to The University Hospital, Linköping, a secondary or tertiary referral hospital serving the middle part of southern Sweden. RESULTS: In total, current or previously treated iron and vitamin deficiencies were registered for 63% of the 1 degree SS patients (iron 51%, vitamin B12 25%, folate 9%). Current low ferritin was noted in 24%, low iron saturation in 37%, decreased vitamin B12 in 13% and folate in 9%. Thyroid disease was found in a total of 33% and 30% had had autoimmune thyroiditis. Three patients (7%) had verified diabetes mellitus. Erythrocyte sedimentation rate (ESR) was raised in 65% of the patients and 84% had a polyclonal increase of Ig. Rheumatoid factor (RF) was detected in 85%, antinuclear antibody (ANA) in 74%, anti-SS-A in 88% and anti-SS-B in 73% of the patients. CONCLUSION: Iron and vitamin deficiencies and thyroid diseases are common in patients with 1 degree SS. Since these disorders often are treatable and may affect the patients' distress as well as their immune and exocrine function, an active, recurrent search for deficiencies, endocrine diseases and other frequently recorded disorders is recommended.
Adult↗
IgG2 deficiency in primary Sjögren's syndrome and hypergammaglobulinemic purpura.
Total IgG and IgG subclasses were studied in 34 patients with primary Sjögren's syndrome and 4 with hypergammaglobulinemic purpura. Total IgG was elevated in 30/34 patients with Sjögren's syndrome. IgG1 increase was responsible for the main part of total IgG increase, contrasting with low levels of IgG2. The difference in IgG1/IgG2 ratio between 38 patients as a group and 40 normal controls was statistically highly significant, but was not seen in all patients. Six patients had markedly low levels of IgG2, but only two had severe repeated respiratory infections. These observations probably reflect selective autoantibody restriction to the IgG1 subclass. We conclude that patients with Sjögren's syndrome may be IgG2 subclass deficient despite elevated levels of total IgG, but also that such deficiency in most instances does not cause a tendency to infections. IgG subclass analysis may be of value to characterize polyclonal IgG increase, since IgG1 subclass predominance often indicates autoimmune disease.
Adult↗
IgG subclasses of anti-SS-A/Ro in patients with primary Sjögren's syndrome.
Patients with primary Sjögren's syndrome mostly have high levels of polyclonal IgG, and subclass analysis frequently shows selective IgG1 increase with low IgG2. In this study IgG subclass profiles of anti-SS-A/Ro were examined using ELISA technique. Results show marked IgG subclass restriction of anti-SS-A/Ro autoantibodies (high IgG1/low IgG2). Comparison of the levels of specific IgG subclass autoantibodies with total levels of the corresponding subclass disclosed divergence regarding IgG2, IgG3, and IgG4, but not IgG1. Thus, total levels of IgG1 paralleled the levels of IgG1 anti-SS-A antibodies. Specific autoantibodies of IgG2 subclass could not be detected despite low or normal levels of total IgG2. Elevated levels of specific IgG3 and IgG4 antibodies were seen, although total levels of the corresponding subclasses were within normal limits. These findings may possibly be of relevance with regard to antigen-driven activation of autoantibody-producing plasma cell clones.
Autoantibodies↗
Severe skin necrosis following warfarin therapy in a patient with protein C deficiency.
A female patient with a history of both arterial and venous thrombosis developed extensive skin necrosis following warfarin treatment. When protein C deficiency was diagnosed, successful anticoagulation with warfarin was achieved by prolonging the course of intravenous heparin and introducing warfarin therapy with a low initial dose which was gradually increased. Aspects of the pathogenic mechanism are discussed.
Adult↗
Takayasu's arteritis as a cause of angina pectoris.
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Adult↗
Reactive arthritis after Salmonella among medical doctors--study of an outbreak.
OBJECTIVE: To investigate an outbreak of S. enteritidis enterocolitis which occurred at a radiology symposium in Malmö, Sweden in March, 1990. METHODS: Questionnaires were mailed to the 126 participants after 1 and 6 months inquiring about enterocolitis, joint and eye symptoms and antibiotic treatment. Fifty-one delivered blood samples for serological studies. RESULTS: One hundred thirteen responded to the questionnaire. Enterocolitis was reported by 108 individuals (96%) and 17 (15%) developed reactive arthritis (ReA). Only 3 persons reported conjunctivitis. Antibody response did not differ between patients with uncomplicated enterocolitis or ReA. IgA antibodies had the highest sensitivity to detect infected individuals. Ten out of 65 patients treated with antibiotics (mean 9.1 days) for enterocolitis and 7 out of 48 nontreated reported joint symptoms. At 6 month followup 8 patients had persistent joint complaints. CONCLUSION: Following an outbreak of S. enteritidis dysentery, joint symptoms may be more frequent than previously thought and could not be prevented by early antibiotic treatment. Nor did antibiotics affect the duration of ReA over a 6 month followup period.
Adult↗
Wegener's granulomatosis: treatment failure on conventional therapy.
We report a patient with Wegener's granulomatosis who was initially stabilized, but later relapsed with multiorgan involvement while taking high oral doses of cyclophosphamide (3.7 mg/kg body weight/day) and prednisolone. Remission was achieved with a combined therapy consisting of intermittent intravenous boluses of cyclophosphamide, oral prednisolone, plasmapheresis and oral trimethoprim-sulfamethoxazole. Discussion includes evaluation of the relative beneficial effect of the four treatment constituents.
Adult↗
Evaluation of lip salivary gland biopsy in 21 patients with primary Sjögren's syndrome.
Lip salivary gland biopsy was performed in 21 (20 female) patients, age 26 to 74 years, with primary Sjögren's syndrome. The procedure helped identify a patient group with many autoimmune phenomena, including hypergammaglobulinemia, autoantibodies, autoimmune thyroiditis, vasculitis, and immunocytoma. A marked association with the HLA-DR3 antigen was noted. It is concluded that lip salivary gland biopsy is a simple and safe procedure that makes possible the identification among non-RA patients with sicca symptoms those who have autoimmune disturbance. This patient group deserves close medical supervision in order to detect autoimmune disease that requires treatment, such as autoimmune thyroiditis and lymphoma.
Adult↗
Reiter's syndrome--a comparative study of patients with the complete and the incomplete syndrome.
Eighty patients with Reiter's syndrome (RS) were studied retrospectively. A comparison was made between patients with the complete syndrome and patients with the incomplete syndrome. A comparison was also made between patients with and without HLA-B27. There were no major differences in severity and duration of the arthritic symptoms or in mucocutaneous involvement between the complete and incomplete groups, which indicates that they, in fact, represent the same disease. Most of the patients with sacroiliac joint involvement belonged to the HLA-B27 positive group; otherwise there was no difference in arthritic symptoms between the HLA-B27 positive and the HLA-B27 negative group.
Adult↗
IgG with a deviant conformation in serum and synovial fluid from rheumatoid arthritis patients.
Specific rabbit antisera were prepared against an IgG with a special conformation (IgG spec.) previously detected in some sera from patients with rheumatoid arthritis. The antibodies had no affinity to normal human IgG and were not anti-idiotypic to human rheumatoid factor. The affinity of IgG spec. to the antibodies could not be explained by an antiglobulin activity to rabbit IgG. The amount of protein with affinity to immobilized specific IgG F(ab')2 of the antibodies was determined in serum and synovial fluid from patients with various joint diseases. A relationship between the content of IgG spec. and the diagnosis of seropositive rheumatoid arthritis was found on analysis of serum samples. IgG spec. also occurred in synovial fluid from some individuals with seropositive rheumatoid arthritis. Differences in the serum content of IgG spec. could not be explained by differences in the normal IgG content. Circular dichroism analysis of isolated IgG spec. showed that in the region(s) close to tyrosine residue(s) this polyclonal protein had similarities to heat-aggregated IgG.
Antibodies, Anti-Idiotypic↗
Impaired conA suppressor cell activity in patients with rheumatoid arthritis shows normalization during fasting.
Normal controls and patients with rheumatoid arthritis (RA) were investigated with respect to quantitative lymphocyte proliferation (LP) after concanavalin-A (conA) activation and to conA-induced suppressor cell activity (conA-SC). Measurements and assessment of RA activity were made at the beginning and end of a 10-day fast. The controls showed depressed (p less than 0.05) LP at the end of the fast, but no change in conA-SC activity. The RA group showed subnormal (p less than 0.05) LP and conA-SC (p less than 0.01) at the beginning of the experiment. After fasting they showed clinical improvement, the LP was not further depressed, and the initially low conA-SC had become normal.
Adult↗
Bacteriological findings in 25 patients with Reiter's syndrome (reactive arthritis).
Extensive bacteriological testing was performed in 25 patients with complete or incomplete Reiter's syndrome. In 21 patients (84%), evidence of antecedent infection was found, based on culture and/or serological findings. Thus, infection with Chlamydia trachomatis (17 patients), Yersinia enterocolitica, serotype 3 (4 patients), and Campylobacter jejuni (1 patient) was identified.
Adult↗
Reactive arthritis after campylobacter jejuni enteritis. A case report.
A 36-year-old HLA B 27 positive woman developed reactive type arthritis a week after enterocolitis. Stool culture and serological tests indicated Campylobacter jejuni infection. Serological evidence of previous Chlamydial infection was also obtained. The arthritis ran a benign course of 6 months, leaving no residual symptoms.
Adult↗
Factors affecting IgA related hyperviscosity.
Sera from 14 patients with an IgA M-component, six of whom had myelomatosis and eight with benign monoclonal gammopathy (BMG) were analysed. All six sera from patients with high IgA (greater than 40 g/l) and total protein (greater than 100 g/l) concentrations were hyperviscous (HV). Four of these six patients also had hyperviscosity syndrome (HVS). There was no correlation between the quantity of IgA dimers or polymers and the presentation of HV and HVS. The binding between IgA and albumin and alpha 1-anti-trypsin was not covalent. Differences in the microenvironment of S-S bonds or of aromatic amino acids between isolated monoclonal monomeric and dimeric IgA were demonstrated with circular dichroism. Besides that, differences in hydrophobicity (exposure of aromatic amino acids) between IgA from normal serum and monomeric and dimeric IgA from a myeloma serum were revealed using hydrophobic interaction chromatography. The significance of hydrophobic interactions involving IgA and the influence of such forces on the circulation of the molecules are discussed.
Blood Proteins↗
Autoimmune haemolytic anaemia complicating Mycoplasma pneumoniae infection.
Although a positive direct Coombs' test is common in patients with Mycoplasma pneumoniae infection, manifest haemolysis is rare. A case is presented in which M. pneumoniae infection was followed by severe autoimmune haemolytic anaemia with intravascular haemolysis and haemoglobinuria. The presence of cold haemagglutinins suggests that these autoantibodies caused the haemolysis. Corticosteroid treatment corrected the haemolysis, which was of brief duration. Published data indicate that the mycoplasma agent is capable of altering the I-receptors of normal erythrocytes by haemadsorption and production of a soluble haemolysin.
Adult↗
Skeletal scintigraphy with technetium diphosphonate in multiple myeloma--a comparison with skeletal x-ray.
Twenty-one patients with multiple myeloma were examined in close time relation with skeletal X-ray survey and bone scanning using technetium diphosphonate. Results indicate that X-ray is superior to bone scan in detecting myelomatous bone lesions. Approximately twice as many lesions were detected by X-ray as by bone scan. An exception to this general finding is the lumbar spine and rib cage, in which the two methods are equally reliable. Thus, a negative bone scan does not exclude the possibility of a myelomatous bone lesion.
Bone Neoplasms↗
Occurrence of adult Fanconi syndrome in benign monoclonal gammopathy.
Adult Fanconi syndrome has been described as a manifestation of a latent form of myeloma. Since benign monoclonal gammopathy (BMG) is a latent form of myeloma we studied ten patients with this disease with respect to the adult Fanconi syndrome. These patients were selected from a larger group with BMG because of urinary excretion of monoclonal light chains. In no instance could a complete Fanconi syndrome be shown, but one patient, who also had a diabetic nephropathy, had very high levels of urinary beta 2-microglobulins. Two additional patients showed minor features included in the adult Fanconi syndrome. BMG does not seem to be associated with an increased risk of developing adult Fanconi syndrome.
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