Mixed leukocyte reaction in rheumatoid arthritis

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Antigen‐specific suppressor cell activity of peripheral blood mononuclear cells was investigated in 20 patients with rheumatoid arthritis (RA) and 16 age and sex‐matched healthy controls. Suppressor cell activity was generated by priming peripheral blood mononuclear cells with high dose antigen (ovalbumin) and adding the washed primed or control (unprimed) cells to autologous, optimally stimulated, target plaque forming cell (PFC) cultures. The ability of the primed cells to interfere with an optimal ovalbumin specific PFC response in the target culture was used as a measure of antigen‐specific suppressor cell activity. The results demonstrated that the mean (± SE) PFC response of the rheumatoid patients (669 ± 76 PFC/106 cells) was not statistically different from that of the normal controls (722 ± 83 PFC/106 cells), P = 0.1. However, reduced suppressor cell activity was observed in the rheumatoid patients relative to controls (46.4 ± 4.2% versus 64.6 ± 2.7% suppression, respectively; P < 0.001). No correlation was demonstrated between suppressor cell activity in rheumatoid patients and disease activity or therapy.

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 87%

Impaired antigen‐specific suppressor cell activity in patients with rheumatoid arthritis

Keystone

Gladman

Buchanan

et al. 1980

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T‐Lymphocyte Subpopulation in Untreated SLE

Rivero

Llórente

Díaz-Jouanen

et al. 1977

An active subpopulation of T lymphocytes characterized by their ability to form early rosettes with sheep erythrocytes (active E‐RBL) was studied in the blood of 50 patients with untreated systemic lupus erythematosus (SLE) and in 50 normal controls. The findings were related to the absolute number of circulating lymphocytes and total E‐receptor‐bearing lymphocytes (total E‐RBL). Lupus patients with active disease had markedly decreased absolute lymphocyte counts, but the decrease of both the total and the active E‐RBL surpassed what would be expected from the lymphopenia. Patients with inactive disease had moderately decreased absolute lymphocyte counts with a marked and disproportionate decrease in total E‐RBL and a moderate decrease in active E‐RBL, which seemed to reflect only the absolute lymphopenia. Patients with active disease had significantly lower active E‐RBL than those with inactive disease. The changes of these and other lymphocyte subpopulations in relation to disease activity in SLE may reflect the influence of factors leading to T‐cell depletion and immaturity. Circulating thymic products may be one of those factors.

Double‐blind placebo controlled crossover evaluation of levamisole in rheumatoid arthritis

Miller

Merieux

Srinivasan

et al. 1980

During levamisole therapy, 14 of 20 patients with previously unresponsive rheumatoid arthritis had significant improvement (P < 0.05) in clinical measures of disease activity, erythrocyte sedimentation rate, and rheumatoid factor titer in a 32-week double-blind placebo controlled crossover trial. Levamisole was shown to alter antibody responses to tetanus and typhoid antigens, lymphocyte blastogenesis to phytohemagglutinins, and the number of null cells in peripheral blood. Agranulocytosis and rash resulted in discontinuation of the drug in one patient in each group. Though clearly effective, routine use of levamisole as a disease suppressant in rheumatoid arthritis must await more complete clarification of its association with agranulocytosis.Recent reports suggest that dysfunction of the cellular limb of the immune system may be of significance in the pathogenesis of rheumatoid arthritis (1-13).Levamisole is an agent capable of potentiating the activity of a suppressed immune system with preferential effects on the cellular limb (14-19). It has been reported to be of benefit in the treatment of patients Address reprint requests to Harold E. Paulus, MD, 1000 Veteran Avenue, Los Angeles, California 90024.Submitted for publication June 28, 1979; accepted in revised form October 22, 1979. whose rheumatoid arthritis has been refractory to conventional modes of therapy. Twenty patients with rheumatoid arthritis were studied to evaluate the effects of levamisole on clinical and laboratory parameters of efficacy and on immunologic variables and their correlation with clinical effect. The frequency and types of adverse reactions were also evaluated.The study was designed not only to assess the overall efficacy of levamisole, but also to evaluate the utility of the crossover design. The spectrum of effects of levamisole versus placebo was assessed in a parallel fashion during the initial 16 weeks of the study. Crossover from levamisole to placebo permitted careful evaluation under controlled double-blind conditions of the duration of effects of levamisole after its discontinuation.