Pleural Fluid Adenosine Deaminase in Rheumatoid Arthritis and Systemic Lupus Erythematosus

Abstract

To the Editor:Our findings concerning adenosine deaminase (ADA) activity in several types of pleural effusion confirm its diagnostic value in tuberculosis.1Ocaña I Martinez-Vazquez JM Segura RM Fernandez de Sevilla T Capdevila JA Adenosine deaminase in pleural fluids: test for diagnosis of tuberculous pleural effussion.Chest. 1983; 84: 51-53Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar The results of Pettersson et al in 14 further patients of tuberculous pleural effusion is in agreement with our experience. We have now tested 350 more cases, including 103 with pleural tuberculosis, and found results similar to our initial report; mean ADA activity in tuberculous fluid is 90.84 ± 29.27, with a sensivity of 1 and a specificity of 0.95.2Martinez-Vazquez JM, Ocaña I, Ribera E, et al. Diagnostico precoz de la tuberculosis pleuroperitoneal mediante la determinación de ADA. Med Clin (Barcelona) (in press)Google Scholar As have Pettersson et al, we also studied ADA levels in 40 patients simultaneously in serum and pleural fluid, and no correlation could be found.The three patients with SLE together with our three seem to demonstrate the value of ADA in the differential diagnosis of lupus pleuritis from tuberculous effusion, although the number of cases is still small.In their six patients with rheumatoid arthritis, they found high levels of ADA as we did in the only case that we have studied at the time of our publication and in two new patients seen recently. The fact that both in tuberculous and rheumatoid pleural fluid ADA activity is high may be due to an activation of T-cell immunity; as it is well known in rheumatoid pleural effusion pleural biopsy may show granulomas.3Martinez-Vazquez JM Miquel C Pujol R Vidal R Esteban R Roca A Derrame pleural en la artritis reumatoide.Rev Clin Esp. 1976; 12: 91-94Google ScholarThe suggestion that ADA activity depends upon the lymphocyte maturative stage is in agreement with our previous work. As they stated, it is possible that in other granulomatous diseases with pleural effusion, such as rheumatoid arthritis, ADA activity may be high; nevertheless, further experience is needed. To the Editor: Our findings concerning adenosine deaminase (ADA) activity in several types of pleural effusion confirm its diagnostic value in tuberculosis.1Ocaña I Martinez-Vazquez JM Segura RM Fernandez de Sevilla T Capdevila JA Adenosine deaminase in pleural fluids: test for diagnosis of tuberculous pleural effussion.Chest. 1983; 84: 51-53Abstract Full Text Full Text PDF PubMed Scopus (202) Google Scholar The results of Pettersson et al in 14 further patients of tuberculous pleural effusion is in agreement with our experience. We have now tested 350 more cases, including 103 with pleural tuberculosis, and found results similar to our initial report; mean ADA activity in tuberculous fluid is 90.84 ± 29.27, with a sensivity of 1 and a specificity of 0.95.2Martinez-Vazquez JM, Ocaña I, Ribera E, et al. Diagnostico precoz de la tuberculosis pleuroperitoneal mediante la determinación de ADA. Med Clin (Barcelona) (in press)Google Scholar As have Pettersson et al, we also studied ADA levels in 40 patients simultaneously in serum and pleural fluid, and no correlation could be found. The three patients with SLE together with our three seem to demonstrate the value of ADA in the differential diagnosis of lupus pleuritis from tuberculous effusion, although the number of cases is still small. In their six patients with rheumatoid arthritis, they found high levels of ADA as we did in the only case that we have studied at the time of our publication and in two new patients seen recently. The fact that both in tuberculous and rheumatoid pleural fluid ADA activity is high may be due to an activation of T-cell immunity; as it is well known in rheumatoid pleural effusion pleural biopsy may show granulomas.3Martinez-Vazquez JM Miquel C Pujol R Vidal R Esteban R Roca A Derrame pleural en la artritis reumatoide.Rev Clin Esp. 1976; 12: 91-94Google Scholar The suggestion that ADA activity depends upon the lymphocyte maturative stage is in agreement with our previous work. As they stated, it is possible that in other granulomatous diseases with pleural effusion, such as rheumatoid arthritis, ADA activity may be high; nevertheless, further experience is needed. Pleural Fluid Adenosine Deaminase in Rheumatoid Arthritis and Systemic Lupus ErythematosusCHESTVol. 86Issue 2PreviewTo the Editor: Full-Text PDF