To learn whether the removal of immune complexes from the circulation by plasma exchange could effect an improvement in disease activity in rheumatoid arthritis (RA) patients, we performed a controlled study of 20 patients with severe progressive disease which had not responded to previous therapy. Ten patients (Group 1) were hospitalized, continued on their regular antiinflammatory medication, and given a graded course of physiotherapy. A further 10 patients (Group 2) received the same treatment as the first group with the addition of a concurrent course of plasmapheresis. Clinical measurement of disease activity after treatment revealed little difference between the two groups with a statistically significant improvement in four measures in Group 1 and in five in Group 2. Laboratory studies suggested that the intensity of plasma exchange was sufficient to remove circulating immune complexes in these patients. Our results confirm that hospitalization in itself is of benefit in the treatment of acute exacerbations of rheumatoid arthritis. The marginal improvement achieved by the addition of plasma exchange in the management of these patients (despite the removal of circulating immune complexes) makes its short‐term use of questionable value in the treatment of severe rheumatoid arthritis.

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SUMMARY Sera were tested from 23 patients with systemic lupus erythematosus followed over a period of 1 to 5 years. Antibodies to native DNA were measured and correlated retrospectively with clinical evidence of disease activity. The overall degree of correlation between the presence of DNA antibodies and evidence of disease activity was good (P<0001). Of 206 sera tested, only 4 had a normal DNA antibody at a time when significant clinical activity was noted. In contrast, 34 sera had mild to moderately raised DNA antibody levels at times of clinical remission. Although DNA antibodies are a useful investigation in the monitoring of disease activity, changes in therapy should not necessarily be made on DNA antibody levels alone.Systemic lupus erythematosus (SLE), although a relatively uncommon disease, provides one of the best examples of an immune complex disease in man. An antigen of major importance in SLE is doublestranded native DNA (n-DNA), and the ability to measure antibody to n-DNA by various techniques has proved particularly useful in diagnosing and monitoring disease activity (Koffler et al., 1971;Koffler, 1974). This paper presents our evaluation of DNA antibody measurements in monitoring disease activity in 23 cases of SLE followed-up over a period of 1-5 years. Materials and methods206 sera from 23 cases who satisfy the ARA criteria for the classification of SLE were studied. All cases have been studied serially over at least one year. Serum samples were not taken more frequently than at 2-weekly intervals.Antibodies to n-DNA were measured using a millipore filter technique (Ginsberg and Keiser, 1973) and 3H labelled n-DNA extracted from a human amnion cell line (HAE 70) (Russell and Percy, 1974). Normal levels in our laboratory are 0-10% (<3-7 ,ug DNA bound/ml serum). This Accepted for publication July 8, 1976 Correspondence to Dr. P. Davis, Department of Medicine, 9-112 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada method using a uniform DNA gives reproducible results: 2 SD=4 9 %. Internal control is obtained by including three standard reference sera. The purity of the extracted DNA was checked using the following parameters. (1) Reduction in fluorescence with ethidium bromide at increased pH showed less than a 5% contamination with single-stranded chains or breaks (Morgan and Pulleybank, 1974 Hippel, 1975). (4) Single-stranded DNA was removed from the double-stranded DNA by millipore filter due to the affinity of singlestranded DNA for nitrocellulose (Riggs et al., 1970).Clinical evidence of disease activity was assessed by the presence of the following clinical signs or laboratory tests: active dermal manifestations, mouth ulcers, active hair loss, synovitis, pleurisy, pericarditis, urinary cellular casts, rising or persistently raised (>3 5 g/24 h) proteinuria, mental deterioration or recent neurological signs, myositis, thrombocytopenia, or persistent unexplained fever. Emphasis was placed on the presence of an actively changing clinical status rather than si...

SummaryLaboratory diagnosis of antiphospholipid antibodies is important in patients with clinical features of the antiphospholipid syndrome, such as thrombosis and fetal loss. We have developed a novel method for the detection of antiphospholipid antibodies using flow cytometry. Anionic phospholipids cardiolipin, phosphatidylserine and phosphatidylinositol are coated onto polystyrene beads of different sizes, allowing detection and semiquantitation of their respective phospholipid antibody isotypes. The results of the flow cytometric method closely correlate those of the standardised anticardiolipin enzyme-linked immunosorbent assay (ELISA), but the method is quicker and is versatile in its ability to detect IgG, IgM and IgA antibody isotypes at the same time. The method promises to be useful in evaluating the significance of phospholipid specificity and antibody isotypes in patients with the antiphospholipid syndrome.

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