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Delayed cutaneous hypersensitivity in rheumatoid arthritis: The influence of nutrition and drug therapy

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Summary

Significant depression of delayed cutaneous hypersensitivity (DCH) to seven common recall antigens was found in 50 patients with rheumatoid arthritis (RA) compared with 50 matched controls. Complete skin anergy was seen in 12 (24%) of the RA patients but in none of the control subjects. In addition, a nutritional assessment of all subjects tested showed significantly lower serum albumin and body mass indices in the RA compared with the control group. Analysis of these 100 subjects showed a significant correlation (r=0.53, p<0.001) between the number of positive skin reactions and the concentration of serum albumin suggesting an association between nutritional status and DCH. No single factor could be identified to distinguish the reactive and anergic RA patients with the possible exception of drug treatment in that a higher proportion of patients on sodium aurothiomalate or immunosuppressive therapy than D-penicillamine was found in the anergic group. It is likely that the cause of impaired DCH in RA is multifactorial and our findings suggest that drug treatment and nutritional status may be an important contributor to it.

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References

  1. Azoury, F.J., Hess, J.W. Cutaneous reactivity in rheumatic and non-rheumatic diseases. JAMA, 1967, 201, 357–361.

    Google Scholar 

  2. Curtis, J.E., Sharp, J.T., Lidsky, M.D., Hersh, E.M. Immune response of patients with rheumatoid arthritis during cyclophosphamide treatment. Arthritis Rheum, 1973, 16, 34–42.

    Article  PubMed  CAS  Google Scholar 

  3. Waxman, J., Lockshin, M.D., Schnapp, J.J., Doneson I.N. Cellular Immunity in rheumatic diseases. (I-Rheumatoid Arthritis). Arthritis Rheum, 1973, 16, 499–506.

    Article  PubMed  CAS  Google Scholar 

  4. Adrianakos, A.A., Sharp, J.T., Person, D.A., Lidsky, M.D., Duffy, J. Cell-mediated immunity in rheumatoid arthritis. Ann Rheum Dis, 1977, 36, 13–20.

    Google Scholar 

  5. Bacon, P.A., Cracchiolo, A., Bluestone, R., Goldberg, L.S. Cell-mediated immunity to synovial antigens in rheumatoid arthritis. Lancet, 1973, 699–702.

  6. Whaley, K., Glen, A.C.A., MacSween, R.N., Deodhar, S., Dick, W.C., Nuki, G., Williamson, J., Buchanan, W.W. Immunological responses in Sjorgen’s syndrome and rheumatoid arthritis. Clin exp Immunol, 1971, 9, 721–732.

    PubMed  CAS  Google Scholar 

  7. Hoyeraal, H.M. Impaired delayed hypersensitivity in juvenile rheumatoid arthritis. Ann Rheum Dis, 1973, 32, 331–336.

    PubMed  CAS  Google Scholar 

  8. Kniker, W.T., Anderson, C.T., Roumiantzeff, M. The Multi-Test System: a standardised approach to evaluation of delayed hypersensitivity and cell mediated immunity. Ann allergy, 1979, 43, 73–79.

    PubMed  CAS  Google Scholar 

  9. Chandra, P.K., Scrimshaw, N.S. Immunocompetence in nutritional assessment. Am J Clin Nutr, 1980, 33, 2694–2697.

    PubMed  CAS  Google Scholar 

  10. Law, D.K., Dudrick, S.J., Abdou, N.I. Immunocompetence of patients with protein-caloric malnutrition. The effects of nutrition repletion. Ann Intern Med, 1973, 79, 545–550.

    PubMed  CAS  Google Scholar 

  11. Goodhart, R.S., Shils, M.E. Modern Nutrition in Health and Disease. Philadelphia: Lea and Febiger 1980.

    Google Scholar 

  12. James, W.P.T. The assessment of nutritional status. Int Medicine, 1982, 1, 663–667.

    Google Scholar 

  13. Frisancho, A.R. Triceps skinfold and upper arm muscle size norms for assessment of nutritional status. Am J Clin Nutr, 1974, 27, 1052–1058.

    PubMed  CAS  Google Scholar 

  14. Whitehead, R.G., Frod, J.D.L., Poskitt, E.M.E. Value of serum albumin measurements in nutritional surveys. Lancet, 1971, 2, 787–789.

    Google Scholar 

  15. Lesourd, B.M., Roumiantzeff, M., Moulias, R., Biron, G., Kniker, W.T. Reproducibility of delayed cutaneous hypersensitivity measured by Multi-Test. Allergol Immunopathol, 8, (4) 268.

  16. Kniker, W.T., Anderson, C.T., Roumiantzeff, M. Measurement of delayed cutaneous hypersensitivity in healthy adults by the Multi-Test system. Allergol Immunopathol, 1980, 8, 267–268.

    Google Scholar 

  17. Edelman, R., Suskin, R., Olson, R.E., Sirisinha, S. Mechanism of defective delayed cutaneous hypersensitivity in children with protein-caloric malnutrition. Lancet, 1973, 1, 506–508.

    Article  PubMed  CAS  Google Scholar 

  18. Statny, P., Roenthal, M., Ziff, M. Lymphokines in the rheumatoid joint. Arthritis Rheum, 1975, 18, 237–243.

    Article  Google Scholar 

  19. Honma, T., Nakayama, Y. D-penicillamine enhancement of the delayed hypersensitivity reaction in guinea-pigs. Ann Rheum Dis, 1982, 41, 90–92.

    Article  PubMed  CAS  Google Scholar 

  20. Whitehead, R.G., Cowerd, W.A., Lunn, P.G. Serum albumin concentration at the onset of kwashiorkor. Lancet, 1973, 1, 63–66.

    Article  PubMed  CAS  Google Scholar 

  21. Ballantyne, F.C., Fleck, A., Dick, W.C. Albumin metabolism in rheumatoid arthritis. Ann Rheum dis, 1971, 30, 2165–2170.

    Google Scholar 

  22. Anderson, C.F., Wochos, D.N. The utility of serum albumin values in the nutritional assessment of hospitalised patients. Mayo Clin Proc, 1982, 57, 181–184.

    PubMed  CAS  Google Scholar 

  23. Todesco, S., Punzi, L., Meani, A., Gambari, P.F., Borsatti, A. Retinol-binding protein in rheumatoid arthritis. Arthritis Rheum, 1981, 24, 105.

    Article  PubMed  CAS  Google Scholar 

  24. Shetty, P.S., Watrasiewicz, K.E., Jung, R.T., James, W.P.T. Rapid turnover transport proteins: an index of subclinical protein-energy malnutrition. Lancet, 1979, 2, 239–232.

    Google Scholar 

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Helliwell, M.G., Panayi, G.S. & Unger, A. Delayed cutaneous hypersensitivity in rheumatoid arthritis: The influence of nutrition and drug therapy. Clin Rheumatol 3, 39–45 (1984). https://doi.org/10.1007/BF02715694

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  • DOI: https://doi.org/10.1007/BF02715694

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