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S H Mackiewicz

Publications and source records attributed to S H Mackiewicz.

38 records · Page 3Linked to original sources
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Intravenous cyclophosphamide combined with methylprednisolone in the treatment of severe refractory rheumatoid arthritis: the effect on lymphocytes.

The mode of action of methylprednisolone and cyclophosphamide in the treatment of rheumatoid arthritis still remains unclear. We sought to determine whether methylprednisolone and/or cyclophosphamide affect surface antigens on peripheral blood lymphocytes. Twenty-eight patients with severe refractory rheumatoid arthritis were observed for 12 months. Thirteen patients were treated with an intravenous pulse of methylprednisolone, and fifteen with methylprednisolone combined with cyclophosphamide. The surface antigens of lymphocytes and natural killer (NK) cells isolated from peripheral blood were determined using flow cytometry. The clinical improvement was observed in 16 (57%) patients (8 treated with methylprednisolone and 8 with methylprednisolone/cyclophosphamide). However, after cessation of the treatment in 9 patients, a flare up of the disease was observed. A striking decrease in total lymphocyte count was observed. The percentage of CD3+ and CD3+CD4+ cells remained unchanged. We observed a decrease in the percentage of CD3+CD8+ in patients treated with methylprednisolone/cyclophosphamide. Moreover, the percentage of activated T cells (CD25+ cells and HLA-DR+ cells) was reduced. The depletion of CD8+CD25+ cells was observed after combined treatment. The percentage of CD19+CD5+ was reduced due to the treatment. We also observed a decrease in CD16+CD56+ NK cells. Amelioration of the course of the refractory rheumatoid arthritis was observed in patients treated with both methylprednisolone and methylprednisolone/cyclophosphamide. A stronger effect on lymphocyte phenotype was observed in those given methylprednisolone/cyclophosphamide, but it was not followed by further benefit. On the other hand, the clinical improvement was more stable in methylprednisolone/cyclophosphamide-treated patients. The use of cyclophosphamide should be reserved for patients with rapidly progressing rheumatoid arthritis or life-threatening complications.

Adult↗
PubMedDate not supplied

Immunoglobulin A--alpha-1-antitrypsin complex in rheumatic diseases.

Immunoglobulin A-alpha-1-antitrypsin complex (IgA-AT) is a nonimmune complex formed by disulphide bonding between an active thiol group available on the cysteine residue of alpha heavy chains of IgA and a cysteine in position 232 of alpha l-antitrypsin in single polypeptide chain. The level of the complex can easy be determined using the ELISA method and findings are expressed in arbitrary units. In the healthy adults' sera the IgA-AT complex level is lower than 0.4 arbitrary unit. The elevated levels of the complex were found in a number of rheumatic diseases. In 50% of SLE patients, its levels are increased, particularly in those with current central nervous system involvement. Similarly, in approximately 50% sera derived from RA patients they are also found to be higher. Their presence correlates with anatomical progression of the disease. IGA-AT complex is found in RA (in 90% of cases) but not in the osteoarthritis synovial fluid. Our findings can be applied in clinical praxis in differential diagnosis of early rheumatoid arthritis and osteoarthritis. The IGA-AT complex can be also found in ankylosing spondylitis. The complex has been determined in a relatively large number of IgA myeloma sera. In 30% of the cases its levels were 10-fold higher than the upper limit for healthy adults.

Adult↗