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Rheumatoid arthritis in an urban South African Negro population.

(1) An epidemiological study of an urban South African Negro community has been carried out in Johannesburg. Altogether 964 respondents were examined and in each case radiographs of the hands and feet were obtained. Rheumatoid factor tests were carried out on 404 serum samples. (2) Rheumatoid arthritis (RA) was graded 'definite' or 'probable' on the basis of a modification of the Rome criteria (Kellgren, Jeffrey, and Ball, 1963a). (3) In marked contrast to the findings in rural Africans the prevalence of RA in this community was similar to that in Caucasian populations. Five respondents (all elderly women) had 'definite' RA, giving a prevalence of 1.4% of the females and 0.9% of the total population sample over 15 years old. The prevalence of 'definite' and 'probable' RA combined was 2.6% for males, 3.7% for females, and 3.3% for all individuals over 15 years old. Prevalence increased with age, reaching a maximum in the 65- to 74-year cohort. (4) The form and severity of the clinical and radiological features were unlike the mild manifestations seen in rural African peoples and closely resembled the usual clinical picture of rheumatoid disease. (5) The latex fixation test was positive in 12.1% of the sera tested, which is similar to the high titres found in other African populations. No obvious cause for this phenomenon was found. (6) Several reasons for the marked difference in prevalence of RA between this urban African population and a rural African population are considered. Marked intraracial differences such as this point to the importance of sociological and environmental factors in the pathogenesis of rheumatoid arthritis.

Adolescent↗

Chlamydia psittaci latex agglutination antigen for rapid detection of antibody activity in avian sera: comparison with direct complement fixation and isolation results.

Cell-culture-grown Chlamydia psittaci of turkey origin was treated with phenol and partially purified by differential centrifugation. The most stable antigen/latex mixture occurred with crude antigen precipitated by dimethyl sulfoxide and digested with trypsin. Agglutination reactions occurred within 2 minutes when antigen/latex and antibody-positive serum mixtures were rotated to facilitate contact of the reagents. Nonspecific agglutination of control latex occurred with 1.2% of clinical sera. When C. psittaci was isolated from feces from individual birds, latex agglutination (LA) and direct complement fixation (DCF) together detected antibody activity (titers greater than or equal to 8) in significantly more cases than did DCF alone. It follows, then, that an LA titer alone is highly indicative of a currently active infection or one that has occurred only recently. The isolation rate from birds that had no antibody activity detectable by LA or DCF was 3.8%. In tests on paired clinical sera, LA and DCF agreed in 72.5% of the cases regarding increased, decreased, or stable titers. For detection of antibody activity in single sera, LA had a sensitivity of 39.1% and a specificity of 98.8% relative to DCF detection of antibody activity. The high specificity corroborates the usefulness of LA as an indicator of current or very recent infection.

Animals↗

IgM, IgA and IgG rheumatoid factors in patients with rheumatoid arthritis and normal donors.

IgM, IgA, and IgG Rheumatoid Factors (RF) were measured by ELISA assay in serum from 26 patients with definite rheumatoid arthritis (RA) and 11 normal controls. IgM-RF was assayed by ELISA, radioimmunoassay, and also by the standard latex fixation test in all sera from RA patients. In patients with RA quantitative amounts of IgM, IgA, and IgG-RF as estimated by ELISA were highly correlated. Significant correlations were found between a physician's rating of disease activity and IgG-RF (r = 0.44; p less than .02) and IgA-RF (r = 0.38; p = .06 but not for IgM-RF as measured in any of the three assays.

Adult↗

Rheumatoid factor: correlation with recurrence in transitional cell carcinoma of the bladder.

The serum rheumatoid factor was measured by the latex fixation test in different titrations in 100 cases of bladder tumors. The rheumatoid factor was found in transitional and squamous cell carcinoma of the bladder. The percentage of positive studies correlated well with the clinical staging of the tumors. The rheumatoid factor activity also correlated with the recurrence of transitional cell carcinoma. A high recurrence rate was found when the rheumatoid factor was present in contrast to a low recurrence rate when it was absent at the initial examination. The percentage of recurrences correlated with the titration of the rheumatoid factor. The mechanism of production of the rheumatoid factor and its correlation with tumor recurrence are discussed.

Carcinoma, Squamous Cell↗

Lupus-like syndrome associated with pulmonary reaction to nitrofurantoin. Report of three cases.

A systemic lupus erythematosus-like syndrome developed simultaneously with pulmonary reactions of the chronic type in three female patients after treatment with nitrofurantoin for 12, 27 and 38 months, respectively. The syndrome was characterized by elevated ESR, polyclonal hypergammaglobulinaemia, the presence of IgG antinuclear antibodies and a positive latex-fixation test. Two patients had severe arthralgia and one of them peripheral lymphadenopathy. Pleural effusion and a chronic active hepatitis were present in the third patient, in whom interstitial cystitis also developed. All signs and symptoms of the lupus-like syndrome disappeared, without corticosteroid or other medication, when nitrofurantoin was omitted. The diminution of pulmonary infiltrates and the reversal of interstitial cystitis also appeared to be directly related to cessation of nitrofurantoin therapy. Our findings indicate that long-term medication with nitrofurantoin may cause, in addition to pulmonary changes, a simultaneous lupus-like syndrome our data also raise the possibility that interstitial cystitis may occur as an adverse reaction to nitrofurantoin therapy.

Aged↗

Sjögren's syndrome in women presenting with chronic dyspareunia.

OBJECTIVE: To identify cases of Sjögren's syndrome among women with chronic dyspareunia who did not already have a diagnosed rheumatological disorder. DESIGN: Prospective recruitment over 12 months. SETTING: Tertiary referral service for the assessment of vulval disease. PARTICIPANTS: Women with chronic dyspareunia who had musculoskeletal symptoms, Raynaud's phenomenon or symptoms of ocular or oral dryness. METHODS: The women underwent a Schirmer tear test and a comprehensive auto-antibody screen including latex fixation test for rheumatoid factor, antinuclear, anti-Ro, anti-La and anti-salivary duct antibodies. A labial salivary gland biopsy and vaginal biopsy were taken for routine histological analysis. MAIN OUTCOME MEASURES: Cases of definite and probable Sjögren's syndrome were identified using the European criteria. RESULTS: Eleven women were assessed for features of Sjögren's syndrome. Four had definite primary Sjögren's syndrome, two had probable primary Sjögren's syndrome and one had probable secondary Sjögren's syndrome. Among these seven women the median duration of vaginal symptoms was seven years (range 0.25-20), of ocular symptoms was one year (range 0.25-2) and of oral symptoms was 1.5 years (range 0-6). In all but one woman dyspareunia presented before ocular or oral symptoms, often by many years. CONCLUSIONS: Although well-recognised as a feature of established Sjögren's syndrome, this study emphasises that chronic dyspareunia can be a presenting feature in these women, antedating the emergence of ocular or oral symptoms by many years. Symptoms of ocular or oral dryness, Raynaud's phenomenon or musculoskeletal symptoms should be sought in women with chronic dyspareunia to identify those who merit further investigation.

Adult↗

Serological and clinical diagnosis of hydatid disease in schistosomal patients.

Indirect haemagglutination test (I.H.A.T.), Latex test (L.A.), and Complement Fixation test (C.F.T.), were performed on 100 serum samples obtained from Egyptian patients suspected clinically to have Hydatid disease and 50 healthy controls. The results of clinical, laboratory and serologic investigations revealed Hydatid infection in six cases.

Adolescent↗