ARTHRITIS AND HYPOGAMMAGLOBULINEMIA - FAMILY SURVEY

  • 1 January 1976
    • journal article
    • research article
    • Vol. 5  (1) , 17-28
Abstract
Hypogammaglobulinemic patients admitted to the Medical Research Council''s immunoglobulin (Ig) therapy trials up to 1963 were examined for evidence of arthritis, and were compared with population samples from Leigh, Wensleydale and Watford [England] which were used as controls. Of 60 males, 4 had inflammatory polyarthritis compared with an expected 0.4. Three had synovitis limited to the knees, and 4 had polyarthritis in the past, the expected figures being 0.12 and 2.4, respectively. None of the patients had definite rheumatoid arthritis as defined by the American Rheumatism Association Criteria, though 1 satisfied the New York Criteria for Still''s disease. All were seronegative, and none of the patients with polyarthritis had radiological evidence of arthritis. None of the 18 female patients had arthritis. The prevalence of arthritis or synovitis in males was 29% in 1964, but in the following 3 yr varied between 8 and 11% suggesting a strong environmental influence. All of the 7 males with inflammatory polyarthritis had levels of IgG, IgA, IgM and IgD which were less than 30% of the standard normals, and steatorrhea was present in three. Steatorrhea was also noted in 2 of 5 patients with arthritis who died before the start of the survey, compared with 7 of all the males. Clinical inflammatory polyarthritis was no more common in the 1st-degree relatives of patients with hypogammaglobulinemia than in the population as a whole, and they had no excess of erosive arthritis visible in X-rays of the hands or feet nor was sacro-iliitis excessively frequent. Positive tests for rheumatoid factor were found in only 2 of the patients with hypogammaglobulinemia, and the 1st-degree relatives had no more positive sheep cell agglutination or latex fixation tests than expected in random population samples. The seronegative polyarthritis which occurs in patients with hypogammaglobulinemia is unrelated genetically to rheumatoid arthritis or Still''s disease.