Wakhlu A, Gupta D, Aggarwal Amita, Misra R
Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Indian J Med Res. 2003 Nov;118:204-7.
BACKGROUND & OBJECTIVES: Early onset pauciarticular disease with uveitis is distinctly uncommon in Indian children with juvenile rheumatoid arthritis (JRA). The occurrence of anti-histone antibodies (AHA) in serum is strongly associated with presence of uveitis. There is a paucity of information from India on the levels of AHA in patients of JRA. In this study, an attempt was made to evaluate the levels of IgG and IgM antibodies to histones in children with JRA in north India.
Serum samples of 148 children with JRA (84 boys, 64 girls) were collected. Clinical details including onset, symptoms and course of the disease in each patient were recorded. Detailed eye examination including slit lamp examination was done in all patients at presentation and yearly thereafter to rule out uveitis. The presence of antihistone IgG and IgM antibodies was studied by ELISA. Antinuclear antibodies (ANA) were measured by indirect immunofluorescence using HEP-2 cells as substrate at a screening dilution of 1:40.
Of the 148 children, 54 had pauciarticular (12 early onset and 42 late onset), 64 polyarticular and 30 systemic onset disease respectively. ANA were present in two children. AHA were raised in 15 (10%) children, of whom 10 had IgM antibodies, 3 had IgG and 2 had both isotypes. None of the children with early onset pauciarticular disease had uveitis, ANA or AHA.
INTERPRETATION & CONCLUSION: The low occurrence of AHA and uveitis in our subset of patients with JRA is in contrast to that reported from Western countries. The low occurrence is unlikely due to technical reasons as the antigen that has been used consistently showed significant binding to serum from patients with systemic lupus erythematosus (SLE). This is in accordance with the rarity of early onset pauciarticular disease and chronic uveitis in these patients. More studies from other parts of the country are required to validate this observation.
在患有幼年类风湿关节炎（JRA）的印度儿童中，伴有葡萄膜炎的早发性少关节疾病极为罕见。血清中抗组蛋白抗体（AHA）的出现与葡萄膜炎的存在密切相关。关于印度JRA患者中AHA水平的信息较少。在本研究中，我们试图评估印度北部JRA儿童中抗组蛋白IgG和IgM抗体的水平。
收集了148例JRA儿童（84例男孩，64例女孩）的血清样本。记录了每位患者的临床细节，包括疾病的起病、症状和病程。所有患者在就诊时及之后每年都进行详细的眼部检查，包括裂隙灯检查，以排除葡萄膜炎。通过酶联免疫吸附测定（ELISA）研究抗组蛋白IgG和IgM抗体的存在情况。使用HEP-2细胞作为底物，通过间接免疫荧光法在1:40的筛查稀释度下测量抗核抗体（ANA）。
在这148名儿童中，分别有54例患有少关节疾病（12例早发性和42例晚发性）、64例多关节疾病和30例全身发病型疾病。两名儿童存在ANA。15名（10%）儿童的AHA升高，其中10名有IgM抗体，3名有IgG抗体，2名同时有两种同种型抗体。早发性少关节疾病的儿童中无一例患有葡萄膜炎、ANA或AHA。
我们JRA患者亚组中AHA和葡萄膜炎的低发生率与西方国家报道的情况形成对比。低发生率不太可能是由于技术原因，因为一直使用的抗原与系统性红斑狼疮（SLE）患者的血清显示出显著的结合。这与这些患者中早发性少关节疾病和慢性葡萄膜炎的罕见情况相符。需要该国其他地区进行更多研究来验证这一观察结果。
