Correlation of disease activity and drug therapy with the autologous mixed lymphocyte reaction in rheumatoid arthritis.

The response of peripheral blood lymphocytes (PBL) to autologous synovial fluid lymphocytes (SFL) from patients with rheumatoid arthritis and Reiter's syndrome was investigated in an autologous mixed lymphocyte reaction (AMLR). SFL were found to be poor responders but strong stimulators of autologous and allogeneic PBL compared with autologous PBL. The plastic-adherent (macrophage) cells from the SFL were found to be highly stimulatory to autologous PBL, particularly when the adherent cells were removed from the responding PBL. The stimulation of these PBL non-adherent cells by SFL adherent cells follows two main trends: either no stimulation, or higher stimulation than using unseparated SFL and PBL. Patients in the high stimulator group were taking non-steroidal anti-inflammatory drugs while those in the low responder group were taking, in addition, second-line drugs such as D-penicillamine or gold. Autologous serum was found to inhibit the AMLR and this is probably due to drug metabolites in patients' sera. Initial results show that the AMLR in individual patients is highly correlated, over time, with the erythrocyte sedimentation rate (ESR).