IND1AN JouiCNAI

OF PED1A')'Ir .

Vol. 46

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August, 1979

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No. 379

IMMUNOLOGICAL STUDIES IN JUVENILE RHEUM&TOID ARTHRITIS* R . K . CH^m>RA, S. BXATN^O^~ ^St) O.P. Gx,~t New Ddhi

Rheumatoid arthritis is a chronic dBease of unknown aetiology, in which non~appurative inflammation of the joints is frcquen.tly associated with several extraatta~la.r, manifesta::.ons ( R o d n a n et al. ' !973). T h e characteristic symptom complex has been recognized as a humar, dhease for centuries but was christened "rheumatoid arthritis" by Sir Alfred Baring Garrod in 1876. Hi, arguments make interesting reading: ' T h e ~erm rheumatic gout is applied to so m a n y different forms efd:sease that it is exceedingly difficult to define what is intended to be understood by it. The compound character of the n a m e would naturally imply that the disorder itself is complex, and depending on a u , i ~ n of the two separate diseases, gc,ut and rheurealism. It is often employed u , d e r this supposition, but still in m a n y works the term is used to designate a dbease altogether differing, as far as its true p a t h , log,/ is concerned, flora bnth these aff~'clions. Sometimes the t e l m is applied to "From the Department of Paediatricl, All India Institree of Medical Sciences, New Delhi t 10016. ~r to : Profeuor R.K. Ghaodra, Depart. ~ n t of Nutrition and Food Science, Ma~achusetu |attitute of Technolog'y, Cambridge, Man. 0'2139, U.S.A. Received on ,July 27, 1979.

chronic or sub-acute rheumatism~ more especially when not commencing with rheumatic fever; but the term rheumatic 8out i~ given, particularly by the medical profeuion, to a disease having a peculiar, pathology, in no way related to g o u t / ~ n d not necessarily tot:rheumatism (rheumatic fever). A h h o u g h u n w i l l i n g to add to t h e n u m b e r of names, I cannot help expressing a desire that one might be found for this disease, not implying any necessary relation between it and either gout or rheumatism. Perhaps rheumalord d~lhr,lts would answer the object, by which term I should wish to impl 7 an ir.flammatory afDction of the joints, not unlike rheumatism in some of its characters, but differing materially from it." Rheumatoid arthritis affects all age groups of both sexes. In children, however, the syndrome differs from that seen in adults, in clinical, immunoserological and therapeutic aspects. We have reviewed our experience based o , 16 children with rheumatoid arthritis seen over a 3-year period. Patients and Methods Sixteen children were diagnosed to be suffering from .juvenile rheumatoid arthritis ( i R A ) on the basis of criteria modified from

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INDIAN JOUILNAL OF

V~L. 46, NO.

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Grokoest t t a l . (1962A which include (i) polyarticular arthritis for a minimum of 6 weeks or l~ssin the presence of any one of the following: iritis, rash, flexion contraclures, ankylosis, muscle wasting, anaemia, leucocyte count over 20,000 per cu.mm., cervical spine pifin with or without X-tay changes, pericarditis without endocarditis, (ii) Poly-or monoarticular arthritis fi~r 6 weekt or less showing a nonmigratory character for at least one week, little response to blood salicylate level of 20 rag%, preponderance of small joint involvement, morning stiffness, and involvement of tempero-mandibular joints. (iii) fever, weakness or weight loss (iv) elevated RSR (v) exclusion of other differential diagnosis. T h e age ranged from 4 to 13 years. F_,lght were boys. Physical examination showed enlargement of the liver in 5, splenomegaly in 9 ax~ generalized lymphadenopathy in 3. Typical skin rash was observed in 3 patients. T w o children had evidence of associated vitamin A deficiency, and one of congenital aortic stenosis. Painful joints, muscle wasting, anaemia and spiking fever were seen in all the patients The levels of serum immunoglohulins were estimated by the single radial diffusion in agar method using monospecific antisera. The micro-Ouchertolony technique was employed for qualitative detection of the protein using monospecific antisera. Haemolytic complement activity was assayed by the method of Mayer (1961) using red blood cells stored at 4~ iz~ Alsever's solution up to two weeks and rabbit haemolytic serum. Incubation of test serum and sensitized sheep ce||s was carried out for 90 minutes. Anti-complementary activity waslooked for by mixing

the test serum with the seralm from a heal~,~ subject in different proportion, and th~tl assaying the mi^:~,e for c o m p h m e n t ] Complement component C~ was estimat~I! i,nmt,nochemically by the radial i m m u n q diffusion method using monospecific antil serum. Electrophoretically altpr,'d compl~ ment components were detected in EDTA blc~od samples by immunoelectrophore~ll~ and Laurell's cross-over electrophoresis int~ antibody containing gel, using barbiton~ b~;ffer pTi 8.6 and monospec:ific a n t i - ~ antiserum raised in goats (Chandra 1975). Method l i b of Coombs st al. (1961~ was employed for estimation of ~mmuno~J canglutinin, using positive, negative, ani~ specificity controls in each run. SeriJfll dilutions of the test sara in diluted inactlll rated horse serum was tested for thei~l ability to agglutinate sheep erythrocyte~ sensitized with bo'~ine serum containing naturally occurring Fnr~sman antibody and alexlnated with horse complement. Cold precipitable proteins were detected by keeping the fresh plasma in t.he refrigerator at 4~~ for a period of 24 hours (Chandra 1972). The rhe,lmatoid factor was detected by latex fixation and by sensitized slleep red cell agglutina fion. Results The clinical findings have been summarized above. Haemoglobin varied from 6.2 to 11.8 gin. %, leucocyte count from 6,800 to 24,000/cu ram. and ESR from 26 to 110 ram. All the patients showed increased levels of serum gamma globulins The rheumatoid factor (RF) was positive in 3, and LE cell phenomenon was not observed in any.

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Immunological studies in juvenile rheumatoid arthritis.

IND1AN JouiCNAI OF PED1A')'Ir . Vol. 46 . August, 1979 . . . . = ' . . . . . , . . . . No. 379 IMMUNOLOGICAL STUDIES IN JUVENILE R...
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