1034 tal renal anomaly, not the clinical syndrome in question, also showed characteristic but transient ischsemia induced by selective arteriography. Might there be a group of women with intermittent loin pain who have an unusually labile renal vasculature, easily tipped into spasm and transient ischxmia by various stimuli? A renal arteriogram allows just a few seconds’ look at a very dynamic organ. Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Cambridge CB2 2QQ
THOMAS SHERWOOD
LYMPHOCYTOTOXIC ANTIBODIES DURING PREGNANCY IN SYSTEMIC LUPUS ERYTHEMATOSUS
SIR,-Spontaneous abortion and fetal wastage seems to be frequent in patients with systemic lupus erythematosus (S.L.E.) than in healthy women.’-3 Bresnihan et a1.4 found that
more
lymphocytotoxic
antibodies
disappeared during
uneventful
Donaldson, B. L., De Alvarez, R. R. Am. J. Obstet. Gynec. 1962, 83, 1461. McGee, C. D., Makowski, E. L. ibid. 1970, 107, 1008. Fraga, A , Mintz, G , Orozco, J., Orozco, J. H. J. Rheum 1974, F71, 293. 4. Bresnihan, B., Grigor, R. R., Oliver, N., Lewkonia, R. M., Hughes, G. R. V., Lovins, R. E., Faulk. W. P. Lancet, 1977, ii, 1205.
1. 2. 3
in s.L.E. patients, whereas s.L.E. patients whose pregnancy ended in fetal loss continue to have these antibodies. This interesting observation, if confirmed, would support these workers’ contention that lymphocytotoxic antibodies, by cross-reacting with trophoblastic tissues, may play a role in the causation of abortion in s.L.E. We therefore studied 19 S.L.E. patients who had had a total of 27 pregnancies; 185 sera were available stored frozen (-35°C) from both pregnancy (72 sera) and non-pregnancy (113 sera) periods. Lymphocytotoxic antibodies were studied by a method5 similar to that of Bresnihan et al .4 Antinuclear antibodies were studied by complement fixation, counterimmunoelectrophoresis, and immunofluorescence on rat kidney sections. 6, D.N.A.-binding activity was tested as described by Lewkonia et al.,8 and C3 levels were determined in commercial antibody-agar plates (Behringwerke, West Germany). 20 of the 27 pregnancies reached term with normal deliveries. 4 ended in spontaneous abortion, 2 in premature deliveries of healthy children, and 1 in a stillbirth. At the onset of pregnancy 11 patients were symptom-free and received no treatment; 13, who were also symptom-free, received less than 15 mg of prednisone daily; 2 had minor s.L.E. activity (without life-threatening manifestations) and were also on small dose corticosteroids; and 1 had diffuse proliferative glomerulonephritis requiring high-dose corticosteroid and immunosuppressive
pregnancies
treatment.
There were 16 instances of disease reactivation related to the 27 pregnancies. 5 happened in the first six months of pregnancy. 2 of the 5 patients who had S.L.E. reactivation reached term, 2 had premature deliveries, and 1 had a spontaneous abortion. All other instances of disease reactivation happened post partum or after abortion, as has been the experience of others. 9,10 Lymphocytotoxic antibodies were found in at least 1 serum during 11 of the 20 pregnancies that reached term. 7 of these 11 positives were in blood taken during the last trimester of pregnancy. The course of one of these patients is exemplified in the figure (a). Conversely, lymphocytotoxic antibodies were present m only one of the4 S.L.E. patients who had an abortion even though sera available had been sampled less than a month before the abortion. Appearance of lymphocytotoxic antibodies in the patient who aborted coincided with clinical disease reactivation, increase in D.N.A. binding, and fall in C3 levels (figure b). No particular trend was observed in the levels of serum autoantibodies or C3 during the course of pregnancy in these S.L.E. patients. Our findings do not support the contention that lymphocytotoxic antibodies play a role in the pathogenesis of spontaneous abortion in s.L.E. Department of Immunology and Rheumatology, Instituto Nacional de la Nutrición,
HORACIO LOM-ORTA EFRAÍN DÍAZ-JOUANEN
Mexico 22, Mexico
DONATO ALARCON-SEGOVIA
SYSTEMIC LUPUS IN THE NEWBORN your otherwise excellent editorial of April 21 you that "the rarity of neonatal cases is probably explained the families of by the low fertility of such the cases I have studied I certainly do not get this impression. Grigor et al.l report that "over the past 10 years a total of 149
SIR,-In
state
Course of S.L.E., autoantibodies, and C3 levels
during
preg-
nancy.
(a) Normal pregnancy and delivery despite continued presence of
lymphocytotoxic and disease reactivation in first trimester. (b) Although lymphocytoToxic antibodies persisted in this patient their level was lower than it was before pregnancy. Abortion coincided with a fall in C3 and an increase in D.N.A. binding. ANA=antinuclear antibodies; CA=lymphocytotoxic antibodies * -clinical reactivation, shaded area=normal ranges.
patients..." From
5. Díaz-Jouanen, E., Llorente, L., Ramos-Niembro, F.. Alarcón-Segovia, D J Rheuma. 1977, 4, 4. 6. Alarcón-Segovia, D., Fishhein, E. in W H O. Booklet of Immunological
Techniques (edited by G. Torrigiani); p. 31. Geneva 1972. 7. Alarcón-Segovia, D., Fishbein, E. J. Immun. 1975, 115, 28 8. Lewkonia, R. M., Barth, P. T., Hale, G. M., Hughes, G. R. V Ann rheum Dis. 1977, 36, suppl. 1, p. 114. 9. Zurier, R. Clins rheum. Dis. 1975, 1, 613 10. Grigor, R. R., Shervington, P C., Hughes, G. R V, Hawkins, D. F Proi R Soc. Med. 1977, 70, 99. 1. Grigor, R. R., Lewkonia, R. rheum Dis. 1077, 36, 283.
M., Hawkins, D. F., Hughes, G. R V. Ann
THOMAS SHERWOOD
LYMPHOCYTOTOXIC ANTIBODIES DURING PREGNANCY IN SYSTEMIC LUPUS ERYTHEMATOSUS
SIR,-Spontaneous abortion and fetal wastage seems to be frequent in patients with systemic lupus erythematosus (S.L.E.) than in healthy women.’-3 Bresnihan et a1.4 found that
more
lymphocytotoxic
antibodies
disappeared during
uneventful
Donaldson, B. L., De Alvarez, R. R. Am. J. Obstet. Gynec. 1962, 83, 1461. McGee, C. D., Makowski, E. L. ibid. 1970, 107, 1008. Fraga, A , Mintz, G , Orozco, J., Orozco, J. H. J. Rheum 1974, F71, 293. 4. Bresnihan, B., Grigor, R. R., Oliver, N., Lewkonia, R. M., Hughes, G. R. V., Lovins, R. E., Faulk. W. P. Lancet, 1977, ii, 1205.
1. 2. 3
in s.L.E. patients, whereas s.L.E. patients whose pregnancy ended in fetal loss continue to have these antibodies. This interesting observation, if confirmed, would support these workers’ contention that lymphocytotoxic antibodies, by cross-reacting with trophoblastic tissues, may play a role in the causation of abortion in s.L.E. We therefore studied 19 S.L.E. patients who had had a total of 27 pregnancies; 185 sera were available stored frozen (-35°C) from both pregnancy (72 sera) and non-pregnancy (113 sera) periods. Lymphocytotoxic antibodies were studied by a method5 similar to that of Bresnihan et al .4 Antinuclear antibodies were studied by complement fixation, counterimmunoelectrophoresis, and immunofluorescence on rat kidney sections. 6, D.N.A.-binding activity was tested as described by Lewkonia et al.,8 and C3 levels were determined in commercial antibody-agar plates (Behringwerke, West Germany). 20 of the 27 pregnancies reached term with normal deliveries. 4 ended in spontaneous abortion, 2 in premature deliveries of healthy children, and 1 in a stillbirth. At the onset of pregnancy 11 patients were symptom-free and received no treatment; 13, who were also symptom-free, received less than 15 mg of prednisone daily; 2 had minor s.L.E. activity (without life-threatening manifestations) and were also on small dose corticosteroids; and 1 had diffuse proliferative glomerulonephritis requiring high-dose corticosteroid and immunosuppressive
pregnancies
treatment.
There were 16 instances of disease reactivation related to the 27 pregnancies. 5 happened in the first six months of pregnancy. 2 of the 5 patients who had S.L.E. reactivation reached term, 2 had premature deliveries, and 1 had a spontaneous abortion. All other instances of disease reactivation happened post partum or after abortion, as has been the experience of others. 9,10 Lymphocytotoxic antibodies were found in at least 1 serum during 11 of the 20 pregnancies that reached term. 7 of these 11 positives were in blood taken during the last trimester of pregnancy. The course of one of these patients is exemplified in the figure (a). Conversely, lymphocytotoxic antibodies were present m only one of the4 S.L.E. patients who had an abortion even though sera available had been sampled less than a month before the abortion. Appearance of lymphocytotoxic antibodies in the patient who aborted coincided with clinical disease reactivation, increase in D.N.A. binding, and fall in C3 levels (figure b). No particular trend was observed in the levels of serum autoantibodies or C3 during the course of pregnancy in these S.L.E. patients. Our findings do not support the contention that lymphocytotoxic antibodies play a role in the pathogenesis of spontaneous abortion in s.L.E. Department of Immunology and Rheumatology, Instituto Nacional de la Nutrición,
HORACIO LOM-ORTA EFRAÍN DÍAZ-JOUANEN
Mexico 22, Mexico
DONATO ALARCON-SEGOVIA
SYSTEMIC LUPUS IN THE NEWBORN your otherwise excellent editorial of April 21 you that "the rarity of neonatal cases is probably explained the families of by the low fertility of such the cases I have studied I certainly do not get this impression. Grigor et al.l report that "over the past 10 years a total of 149
SIR,-In
state
Course of S.L.E., autoantibodies, and C3 levels
during
preg-
nancy.
(a) Normal pregnancy and delivery despite continued presence of
lymphocytotoxic and disease reactivation in first trimester. (b) Although lymphocytoToxic antibodies persisted in this patient their level was lower than it was before pregnancy. Abortion coincided with a fall in C3 and an increase in D.N.A. binding. ANA=antinuclear antibodies; CA=lymphocytotoxic antibodies * -clinical reactivation, shaded area=normal ranges.
patients..." From
5. Díaz-Jouanen, E., Llorente, L., Ramos-Niembro, F.. Alarcón-Segovia, D J Rheuma. 1977, 4, 4. 6. Alarcón-Segovia, D., Fishhein, E. in W H O. Booklet of Immunological
Techniques (edited by G. Torrigiani); p. 31. Geneva 1972. 7. Alarcón-Segovia, D., Fishbein, E. J. Immun. 1975, 115, 28 8. Lewkonia, R. M., Barth, P. T., Hale, G. M., Hughes, G. R. V Ann rheum Dis. 1977, 36, suppl. 1, p. 114. 9. Zurier, R. Clins rheum. Dis. 1975, 1, 613 10. Grigor, R. R., Shervington, P C., Hughes, G. R V, Hawkins, D. F Proi R Soc. Med. 1977, 70, 99. 1. Grigor, R. R., Lewkonia, R. rheum Dis. 1077, 36, 283.
M., Hawkins, D. F., Hughes, G. R V. Ann
