Positive Antinuclear Antibody Titer Research Articles

Incomplete Lupus Erythematosus

Thirty-eight patients with incomplete lupus erythematosus (ILE) (defined as the presence of fewer than four of the criteria of the American College of Rheumatology for systemic lupus erythematosus [SLE]) were identified and compared with 42 patients with SLE. Both groups were comparable with respect to age, sex, and race. Patients with ILE had symptoms for an average of 38 months before seeking rheumatologic care and were followed up for a mean of 19 months; patients with SLE averaged 9 months with symptoms before their diagnosis was made and were followed for a mean of 30 months. Characteristic clinical features of patients with ILE included positive antinuclear antibody titers (83%), polyarticular nonerosive arthritis (47%), and cutaneous findings (61%). These were comparable with findings in the the SLE group. However, patients with ILE had significantly fewer systemic manifestations than did those with SLE. Patients with ILE were treated with nonsteroidal anti-inflammatory drugs more frequently (47%) than were patients with SLE, while the latter group received more topical and oral corticosteroids and immunosuppressives. Only two of the patients with ILE went on to have typical SLE. Thus, ILE may be frequent, mild, and relatively stable or benign, apparently evolving slowly if at all into SLE or other rheumatic disease.

Alveolar hemorrhage associated with a membranoproliferative glomerulonephritis and smooth muscle antibody

Alveolar hemorrhage along with glomerulonephritis developed in a 31-year-old black man. Renal biopsy demonstrated a granular pattern of immunofluorescence along basement membrane glomeruli, suggesting an immunologically mediated illness; however, light microscopy revealed a pure membranoproliferative glomerulonephritis, which has not been described to date in association with the alveolar hemorrhage syndromes. The patient's immunologic profile revealed a positive anti-nuclear antibody titer along with the presence of smooth muscle antibodies.

Minoxidil-Induced Systemic Lupus Erythematosus

A patient treated for two months with the antihypertensive agent minoxidil developed pleural and pericardial effusions in association with a positive antinuclear antibody titer. No evidence of central nervous system or renal involvement was present, and results of specific tests for idiopathic systemic lupus erythematosus, including anti-double-stranded DNA and anti-Smith antibodies, were negative. Complement levels were normal. The patient's clinical picture improved and titers of antinuclear antibody decreased after discontinuation of minoxidil therapy, suggesting that minoxidil induced a lupus-like syndrome in this patient.

Failure to find disease similarity in sibling pairs with rheumatoid arthritis.

Clinical and laboratory measures of disease expression were compared within and between 33 families with two or more affected siblings with rheumatoid arthritis (RA). None of the variables studied--age and calendar year of disease onset, pattern of joint involvement, the presence of rheumatoid nodules, Sjögren's syndrome, a positive latex or antinuclear antibody (ANA) titre--showed a greater concordance within the families than between them. The families were then divided into those in which the affected sibling pairs were and were not HLA identical. Such a division did not alter the conclusion, with the possible exception of a positive latex titre. These results suggest that genetic or unique environmental factors within families may have only a limited role in explaining disease heterogeneity in RA. Conversely, the absence of homogeneity within the families justifies their use in genetic linkage studies and the extrapolation of results obtained from affected siblings to the commoner sporadic disease.

Acute anterior uveitis and conjunctivitis following Yersinia infection in children.

We studied characteristics of ocular inflammation associated with yersinia infection in six children, three boys and three girls, ranging in age between 4 and 14 years. Four patients developed acute anterior uveitis with aqueous flare and cells, small keratic precipitates, cells in the vitreous, and occasionally with fibrinous exudates, posterior synechiae and macular edema. The uveitis was unilateral in two patients and bilateral in two. In three 10- to 14-year-old patients the uveitis resolved during corticosteroid treatment in 3 to 8 (mean 6) weeks. In a 4-year-old girl with positive antinuclear antibody titers bilateral uveitis lasted for 17 weeks. Two uveitis patients had recurrent episodes. Two patients had mucopurulent bilateral mild conjunctivitis which resolved in 3 to 5 days. All patients had symptoms of reactive arthritis and one had sacroiliitis. All tested patients were HLA-B27 positive. Our results indicate that in HLA-B27 positive children, especially after the age of 10 years, yersinia infection may occasionally trigger reactive iritis or conjunctivitis which often occur together with other HLA-B27 associated rheumatic diseases.

Chlorpromazine-induced lupuslike disease: Case report and review of the literature

A lupuslike disease with cutaneous manifestations secondary to the use of chlorpromazine (Thorazine) is presented. Skin biopsy specimens demonstrated classic findings consistent with lupus erythematosus and abundant mucin deposition in the cutaneous lesions--a finding not previously reported to occur in drug-induced lupuslike disease. Laboratory and serologic examinations included a positive antinuclear antibody titer, presence of single-stranded deoxyribonucleic acid (DNA), absence of double-stranded DNA, presence of antihistone antibodies, normal complement level, increased IgM level, and prolongation of partial thromboplastin time. These data confirmed our clinical and histologic diagnosis. Cessation of the medication (chlorpromazine) led to resolution of the skin abnormalities. Electron microscopy revealed electron-dense drug metabolites in vascular endothelial cells, as well as tubuloreticular inclusion bodies. This is only the second reported case of chlorpromazine-induced lupuslike disease with cutaneous manifestations.

Comparison of acebutolol and propranolol in essential hypertension

A multicenter, double-blind study compared oral acebutolol (n = 186) with propranolol (n = 190) in the treatment of mild to moderately severe essential hypertension (diastolic ≥95 to 129 mm Hg). Both beta blockers produced significant and comparable reductions in diastolic, systolic, and mean arterial blood pressures of 16%, 12%, and 14% on acebutolol and 15%, 12%, and 14% on propranolol (all p < 0.01). At equipotent, antihypertensive doses, acebutolol induced significantly less reduction in resting heart rate than propranolol (13% on acebutolol, 17% on propranolol, p = 0.02). The mean effective doses of acebutolol and propranolol were 738 mg and 231 mg, respectively. Significantly fewer acebutolol patients experienced central nervous system side effects (acebutolol, n = 50; propranolol, n = 75; p = 0.01) or withdrew from the study prematurely due to side effects (acebutolol, n = 11; propranolol, n = 29; p < 0.01). No clinically significant trends in abnormalities of laboratory parameters were seen, and there were no statistically significant differences in the development of positive antinuclear antibody titers between the two treatment groups. It is concluded that acebutolol is as effective as propranolol in the treatment of hypertension, and acebutolol was better tolerated on the basis of heart rate and central nervous system side effects.

Use of the HEp-2 cell substrate in the detection of antinuclear antibodies in juvenile rheumatoid arthritis.

Presence and titer of antinuclear antibodies (ANA) were determined in 217 juvenile rheumatoid arthritis (JRA) patients, by indirect immunofluorescence using HEp-2 cells as substrate. Positive ANA titers (greater than or equal to 1:40) were present in 131 (60%) of the JRA patients. All 3 JRA onset types demonstrated increased percentages of ANA positivity compared with healthy children. Sixty-seven percent of the patients in the polyarticular onset group had positive titers; titers were positive in 62% of the pauciarticular onset group and in 32% of the systemic onset group. ANA were also found in 45% of control patients with other connective tissue diseases. In JRA patients, the speckled pattern occurred most commonly (72%). Fourteen patients (8 with pauciarticular onset and 6 with polyarticular onset) had iridocyclitis; all of them had high titers (greater than or equal to 1:80) of ANA. The use of HEp-2 cells provided a sensitive substrate for detecting ANA in JRA. It proved to be of value in differentiating JRA patients from healthy controls, but not from patients with other connective tissue diseases.

Endralazine, a new peripheral vasodilator. Evaluation of safety and efficacy over a 3 year period.

Nineteen out-patients with moderate to severe essential hypertension were treated daily for 3 years, with an average dose of 13 mg endralazine, a new peripheral vasodilator, in free combination with pindolol 3 x 5 mg. The blood pressure showed a statistically significant reduction from 172/110 mmHg to 154/92 mmHg after treatment for 3 years. Tachyphylaxis was not observed during the 3 years period. Oedema was the most frequent side-effect, but it disappeared spontaneously. No difference in efficacy and tolerance between slow and fast acetylators was found. Only 2 patients developed a weak positive antinuclear antibody titre, which disappeared spontaneously from one during continued treatment. No clinical evidence of a systemic lupus erythematosus-like syndrome was noted. It is concluded that the differences between endralazine and hydralazine in dosage and metabolism may explain the lower immunogenic activity of endralazine.

A Systemic Lupus Erythematosus-Like Syndrome Induced by Procainamide

A syndrome that resembles Systemic Lupus Erythematosus both clinically and on laboratory studies may be induced by procainamide. It is associated with multisystemic involvement, positive Antinuclear Antibody titers (ANA), and positive LE cell preparations. In patients on procainamide therapy the syndrome must be differentiated from osteoarthritis, myocardial infarction, and pulmonary embolism. When procainamide is discontinued, this Lupus-like syndrome is usually reversible. Other drugs, including hydralazine and isoniazid have also been implicated in provoking this Lupus-like syndrome.