43

patients with proctitis confined to the lower rectum it possible to compare the appearances of inflamed mucosa with relatively normal mucosa above; samples at 5 cm contained many more IgE cells in the lamina propria than did norIn 2

HEPATITIS-B ANTIBODY IN POLYMYALGIA RHEUMATICA

was

SIR,-We read with great interest the finding of Dr Hacon and his colleagues (Sept. 13, p. 476) that 9 of 12 patients with polymyalgia rheumatica had demonstrable antibody to hepatitis-B surface antigen early in the course of the disease. In an effort to confirm this observation, we looked for serological evidence of hepatitis-B exposure in 15 patients with polymyalgia rheumatica, including 2 with polymyalgia and temporal arteritis, followed in the Stanford Immunology Clinic between 1971 and 1975. All patients had constitutional symptoms, shoulder and/or hip girdle myalgias, fever, high erythrocytesedimentation rate, mild anaemia, absence of other rheumatic disease, myopathy, or malignancy; all had striking clinical response to prednisone. All sera tested had been obtained within six months of the onset of symptoms, when patients had clinical evidence of active disease. 4 of the 15 patients were on prednisone therapy at the time the test sample was taken; the others had received no specific therapy. Assays were done for the detection of: (1) antibody to hepatitis-B surface antigen by radioimmunoassay’ (the method used in Dr Bacon’s study), as well as haemagglutination;2 (2)

mal-looking mucosa at

15

cm.

antibody to hepatitis-B core antigen by radioimmunoassay ;3 and (3) hepatitis-B surface antigen by radioimmunoassay.4 2 patients in this group had antibody to hepatitis-B surface antigen by haemagglutination and radioimmunoassay. One of these two patients had antibody to hepatitis-B core antigen, which is thought to be a marker of recent hepatitis-B infection’ and this patient showed elevated liver enzymes. The other 13 patients showed no serological evidence of prior exposure to the hepatitis-B virus in either antibody assay. None of the 15 patients had hepatitis-B surface antigen. As only 2 patients in our series showed surface and/or core antibody to hepatitis B, within expected frequency for a population comparable m age to our patients, there would appear to be no strong associaion between polymyalgia rheumatica and hepatitis B in the Stanford population. Divisions of Immunology and Infectious Diseases, Department of Medicine, Stanford University, Stanford, California 94305, U.S.A.

-

MATTHEW LIANG HARRY GREENBERG THEODORE PINCUS WILLIAM S. ROBINSON

rectal serum.

biopsy from patient with grade-2 proctitis

stained with anti-IgE Fluorescence is greater at cell membrane. Epi-illumination x

300. b: Same section restained for anol. Peroxidase x 300.

peroxidase activity

after Station in meth-

IMMUNOGLOBULIN E IN RECTAL MUCOSA OF PATIENTS WITH PROCTITIS

SIR,-Dr Heatley and his colleagues (Nov. 22, p. 1010) have drawn attention to the possibility of an underlying immediate hypersensitivity reaction in some forms of proctitis. They suggest that IgE-producing cells are significantly increased during relapse of the condition. Their observations, however, can only indicate that certain cells are stained with fluoresceinisothiocyanate-labelled IgE antiserum and we feel that the assumption that IgE is produced locally is premature. Our own observations, with similar techniques, confirm an increase in the number of IgE cells in the lamina propria of rectal mucosa, when graded by subjective "blind" assessment in patients with proctitis: No.

of 19B cellst

No.

of patients

Grade* 1 2 3

(normal)

7 6 7

0

1

33 2

2

3

1 22 1 3

4

5

6

21

.Severity of the proctitis

was graded by sigmoidoscopic appearances according of Watts et al." tNumber of IgE stained cells was assessed by two observers independently and graded on a 0-6 scale (0 indicates absence of IgE staining).

to

the

cntena

1. Lander, J. L., Alter, H. J., Purcell, R. H. J. Immun 1971, 106, 1166 2. Vyas, G. N., Shulman, N. R. Science, 1970, 170, 332. 3. Robinson, W. S., Greenman, R. L. J. Virol. 1974, 13, 1231. 4. Ausria II, Abbot Laboratories. 5. Krugman, S., Hoofnagle, J. H., Gerety, R. J., Kaplan, P. M., Gerin, New Engl. J. Med. 1974, 290, 1331. 6. Watts, J. McK., Thompson, H., Goligher, J. C. Gut, 1966, 7, 288.

IgE cells show increased staining intensity during relapse gradually, as remission ensues following treatment, the intensity of IgE staining diminishes in sequential biopsies from the same patient. In our experience, the staining of the IgE cells on high magnification (using epi-illumination) appears and

more

intense

at

the cell membrane and less intense within the

cytoplasm (fig. la). In addition the IgE cells possess strong peroxidase activity when the same section is subsequently incubated in diaminobenzidine (fig. lb). Thus, these cells are unlikely to be plasma-cells. Counting of cells in any histological preparation of rectal mucosa raises many problems, particularly related to orientation of the section and selection of high-power fields. We feel that the number of IgE cells differs according to the level at which they are counted within the lamina propria. Similar observations have been made by Brandtzaeg and Baklien in relation to IgA, IgM, and IgG cell counts within the lamina propria in inflammatory bowel disease. Department of Pathology, University of Aberdeen, University Medical Buildings, Foresterhill,

S. W. B. EWEN

Aberdeen AB9 2ZD.

Department of Surgery, Woodend General Hospital, Aberdeen AB9 2YS.

A. MUNRO

J. L. 7.

Brandtzaeg, P., Baklien, suppl. 248.

K. Acta

path. microbiol.

scand. Sect.

A, 1974,

Letter: Hepatitis-B antibody in polymyalgia rheumatica.

43 patients with proctitis confined to the lower rectum it possible to compare the appearances of inflamed mucosa with relatively normal mucosa above...
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