A gel diffusion precipitin method for the estimation of C-reactive protein

Plasma and synovial fluid concentrations of sulphasalazine and two of its metabolites in rheumatoid arthritis

A study was made of plasma and synovial fluid levels of sulphasalazine, one of its dissociation products--sulphapyridine and a metabolite of the latter--acetyl sulphapyridine in patients with rheumatoid arthritis (RA) who were in a steady state on sulphasalazine therapy. Combined sulphapyridine levels were significantly higher than those of sulphasalazine both in plasma and synovial fluid. Synovial fluid levels of both drugs correlated with their plasma levels and were generally slightly lower. Some patients accumulated sulphasalazine and sulphapyridine in the synovial fluid and the mean concentration of sulphasalazine was higher in the fluid than in the plasma. The explanation for this is uncertain. The concentration of combined sulphapyridine in synovial fluid was related to local joint inflammation and more active systemic disease. No consistent association was found between sulphasalazine levels and local or systemic activity. The higher sulphapyridine levels in synovial fluid found in this study suggest the possibility that this moiety could play a more active role in RA than it does in inflammatory bowel disease.

Incorporation of 14C-thymidine by cultures of erythrocytes from rheumatoid arthritis patients and normal subjects, suggesting the presence of an L-form

Cultures of washed erythrocytes from rheumatoid arthritis patients and normal subjects were found to incorporated 14C-thymidine, suggesting the presence of an L-form. The extent of the incorporation by erythrocytes from rheumatoid patients was more variable than that by erythrocytes from normal subjects, and correlated negatively with IgG measurements and white cell counts performed on the patients' bloods, although not with the clinical activity of the patients.

A biochemical comparison of alclofenac and D-penicillamine in rheumatoid arthritis

In view of the claim that alclofenac has a specific antirheumatoid action a detailed biochemical study has been made over a 6-month period of 2 groups of patients with rheumatoid arthritis receiving either alclofenac or D-penicillamine for the first time. We found no biochemical evidence and little clinical evidence that alclofenac had a 'penicillamine-like' effect in rheumatoid arthritis.

A comparison of clinical assessments of disease activity in rheumatoid arthritis

Six clinical assessments of disease activity, including a new summated change scale (SCS), have been compared in a group of 30 patients with rheumatoid arthritis seen on 8 separate occasions during their first 6 months of therapy with either D-penicillamine or hydroxychloroquine. Articular index and grip strength correlate best with erythrocyte sedimentation rate and C-reactive protein, pain score and early morning stiffness less well, and summated change score and joint circumference least well. Articular index and grip strength also correlated well with the other clinical parameters and are therefore judged to be the best clinical indices of change in treatment with these drugs.

Gamma glutamyl transpeptidase levels in arthritis: a correlation with clinical and laboratory indices of disease activity

Gamma glutamyl transpeptidase (GGTP) was measured in 62 patients with rheumatoid arthritis (RA) and 27 with osteoarthrosis (OA). The values for GGTP were significantly higher in the subjects with RA compared with the OA group. The prevalence of elevation of GGTP was higher in the RA subjects (77%) than in the OA patients (33%). Levels of GGTP correlated significantly with a number of objective indices of activity of RA in a separate group of 28 patients. Following treatment with penicillamine, GGTP levels showed a significant drop towards normal levels.

Rheumatoid arthritis: relation of serum C-reactive protein and erythrocyte sedimentation rates to radiographic changes

Serum C reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were measured in 56 patients with rheumatoid arthritis. Radiographical damage, based on a count of erosions, was significantly more likely to occur when serum CRP and ESR were persistently raised, irrespective of the presence or absence of rheumatoid factor. Measurements of both CRP and ESR were more helpful than either alone, but CRP was probably the more informative. Serial measurements of CRP and ESR provide a reliable means of discriminating between drugs that provide symptomatic relief only and those with a more profound effect in rheumatoid arthritis.

Detection by electron microscope of rod-shaped organisms in synovial membrane from a patient with the arthritis of Whipple's disease

Rod-shaped organisms identical to those present in the jejunal mucosa have been found in the synovial membrane of a patient with Whipple's disease. These probably caused inflammatory changes which sere reflected in an increase of the cellular content and high enzyme levels (acid phosphatase and 5-nucleotidase) of the synovial fluid. Tetracycline was effective in controlling the bowel lesion but only had a temporary effect upon the arthritis. Erythromycin controlled both the bowel lesion and the arthritis.

Assessment of rheumatoid activity based on clinical features and blood and synovial fluid analysis

Joint inflammation in rheumatoid arthritis has been assessed, and the most useful guides to disease activity were determined by analysis of synovial fluid and blood together with the history of joint disability. The patient's own evaluation of the amount of pain suffered was the most useful clinical assessment. Differential cell count and glucose estimations were the most helpful guides in the synovial fluid, while C-reactive protein in the serum most accurately reflected disease activity. The effects of systemic steroids on these indices were studied, and the differences between seronegative and seropositive patients noted.

The influence of alclofenac treatment on acute-phase proteins, plasma tryptophan, and erythrocyte sedimentation rate in patients with rheumatoid arthritis

Alclofenac and D-penicillamine were compared under controlled, double-blind conditions in the treatment of 35 patients with active rheumatoid arthritis over a period of 26 weeks. The principal aim of the study was to investigate any relationships between changes in clinical status and changes in concentrations of three serum acute-phase proteins (fibrinogen, C-reactive protein, and haptoglobin), plasma free and protein-bound L-tryptophan, and the erythrocyte sedimentation rate. Both alclofenac and D-penicillamine were clearly effective: all patients showed steady improvement on the seven clinical indices of response employed. Drug management was easiest with alclofenac. Both drugs produced a significant reduction in acute-phase proteins, E.S.R. and protein-bound plasma tryptophan. Since it has previously been established that the course of rheumatoid arthritis is reflected in the acute-phase protein levels and the extent to which L-tryptophan is bound to plasma protein, it is suggested that drugs, such as D-penicillamin and alclofenac which profoundly affect these parameters, provide not only symptomatic relief but also possible beneficial effects on the disease process itself.

Reactive haemolysis--a distinctive form of red cell lysis

This paper describes a form of red cell lysis differentiated from classical complement haemolysis by its occurrence in the absence of antibody on the cells and in the presence of EDTA. This type of haemolysis has been called reactive haemolysis. It is the result of the interaction, in the presence of red cells, of at least two serum factors called `reactor' and `indicator', respectively.

Reactor only becomes active after incubation at 37° of serum with certain agents, notably antibody-coated bacteria, zymosan and agarose, in conditions similar to those required for complement activation. The potential for the formation of activated reactor could be demonstrated infrequently in healthy subjects but more frequently in sera from hospital patients. Activated reactor behaved as a protein sedimenting between 7S and 19S, and of α₂—β₁, electrophoretic mobility in agar.

Indicator factors were present in all human sera studied, as well as in the sera of a number of mammalian species. They were demonstrable at high dilutions of the serum and required no prior activation for their action. They occurred maximally in the 7S fractions of serum proteins and migrated in the β₂ position on electrophoresis.

Reactive haemolysis was first observed and can most conveniently be demonstrated in a red cell—agarose gel. It can also be demonstrated in the test tube following partial purification of activated reactor and indicator factors. Studies in the test tube indicated that a soluble labile lytic factor was responsible for this type of haemolysis.

Alpha-2-macroglobulin levels in disease in man

Serum alpha(2)-macroglobulin levels were measured in normal subjects and in patients with various diseases by an immunochemical method. The values for normal men were 284 mg./100 ml. (+/-89.6 mg./100 ml.) and for normal women 350 mg./100 ml. (+/-94.5 mg./100 ml.). Men with rheumatoid arthritis had normal levels, but the levels in women were depressed. There was no relationship to the concentrations of the acute phase reactive proteins, haptoglobin, and C-reactive protein. In chronic liver disease, the levels in men were significantly higher than normal and were slightly higher than normal in women.A small group of patients with nephrotic syndrome had very high levels. No significant variations from the normal were found in sera from a group of patients with miscellaneous diseases.