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Platelet count (PC) was compared with standard acute phase reactants (ESR, plasma viscosity and C-reactive protein) and clinical measurements to assess its usefulness as a measure of disease activity in 165 patients with active rheumatoid arthritis. Although PC was elevated (greater than 400 X 10(9) 1(-1) in 45% of patients and was seen to fall under the influence of second-line drugs, it was considered to be unsuitable as an indication of disease activity since levels fall for reasons other than disease improvement.

Serum C reactive protein was determined in 30 control subjects, 32 patients with pancreatic cancer, 28 with chronic pancreatitis and 23 with extra-pancreatic diseases of the upper gastrointestinal tract. The aim was to ascertain possible alterations of this index in chronic pancreatic disease and to speculate on some influencing factors. Higher C reactive protein levels were found in pancreatic cancer as compared to controls. Pancreatic cancer patients with systemic metastases had higher levels of this index compared to those with non-metastatic disease. Raised concentrations of C reactive protein were detected in 7/28 subjects with chronic pancreatitis. In this group these higher levels were found in patients in a relapsing phase of the disease; no association was observed with pancreatic pseudocysts. Among all subjects a correlation was found, between C reactive protein and age; patients with abnormal fasting blood glucose levels or increased white blood cell count had higher levels of this protein as compared to the remaining patients. We may conclude that C reactive protein increases in pancreatic cancer, specially in relation to tumour extent; in chronic pancreatitis it reflects the inflammatory status of the gland. While acting in the context of the acute phase response, this test may provide an adjunct in evaluating patients with a chronic pancreatic disease.

A long-term study is being undertaken to classify drugs used as specific agents in the treatment of rheumatoid arthritis in terms of their effects on biochemical and clinical characteristics of the disease. In particular is hoped to establish those indices which are most relevant to the response of RA to treatment. Fifteen patients were treated with D-penicillamine after an initial period of 2 weeks on aspirin alone, when the baseline investigations were made. The dose of penicillamine was increased gradually to a maximum of 500 mg a day over the period of 6 months, and changes in 8 clinical and 25 laboratory indices were measured on 8 separate occasions in the 6-month period. Marked clinical improvement took place, and this was mirrored by changes in a wide range of biochemical parametaers. ESR and C-reactive protein were shown to be the most suitable indices of disease improvement with penicillamine treatment.

Serum C-reactive protein (CRP) levels were measured at presentation to the hospital in 15 children with proven bacterial meningitis (BM) pretreated with antibiotics. CRP exceeded the upper normal limit of 19 mg/l in all cases; the mean value was 195 mg/l (range, 55 to 375 mg/l). On the other hand, CRP levels were normal in 12 patients with viral meningitis or meningoencephalitis. Rapid determination of serum CRP should be performed whenever BM is suspected.

We evaluated C-reactive protein for its ability to predict the occurrence of clinical chorioamnionitis in 51 patients with spontaneous premature rupture of the membranes at less than or equal to 34 weeks of gestational age. All the patients had determinations of C-reactive protein on admission, and then 25 patients were tested daily. Of the total 51 patients, 14 developed clinical signs compatible with a diagnosis of chorioamnionitis. An analysis was conducted to compare the use of C-reactive protein to that of white blood cell count in predicting febrile disease. Our study indicates that C-reactive protein is an accurate and early marker for predicting clinical chorioamnionitis. White blood cell and differential counts are less accurate in such prediction, especially after steroid treatment.

Interleukin-6 (IL-6) is a monokine with a number of biological activities, which are intimately related to inflammatory responses. We have measured IL-6 levels in synovial fluid (SF) and serum (Se) of patients with rheumatic diseases. SF-IL-6 levels were a thousand-fold higher than corresponding Se levels and a positive correlation was found between SF and Se levels suggesting that Se-IL-6 is derived from IL-6 produced in the joint. Se levels of IL-6 were also positively correlated to C-reactive protein (CRP) levels, supporting the in vitro experiments showing that IL-6 stimulates hepatocytes to produce CRP. Finally we observed a positive correlation between SF-IL-6 levels and the local activity score.

Zinc is an essential trace element required for RNA and DNA synthesis and the function of over 200 zinc metalloenzymes. After surgery or trauma, the serum zinc concentration usually decreases. The magnitude and duration of this hypozincemia after thermal injury are unclear, as are mechanisms for this hypozincemia. In this study we evaluated, over the duration of their hospital course, serum zinc concentrations in 23 thermal injury patients. The initial mean serum zinc concentration was significantly depressed (42 +/- micrograms/dl; normal 66-110 micrograms/dl). By the second week of hospitalization, serum zinc concentrations gradually increased into the normal range in the majority of patients. Mechanisms for this hypozincemia were evaluated. Decreases in the serum zinc concentration did not correlate with increased urinary zinc excretion; thus increased urinary zinc excretion was an unlikely mechanism for the observed hypozincemia. Values for albumin, the major zinc binding protein in serum, generally were inversely correlated with the serum zinc concentration. Thus, hypoalbuminemia could not explain the decreased serum zinc concentration. Certain cytokines such as interleukin-1 are known to cause a decrease in the serum zinc concentration as part of the acute phase response. Therefore, we measured serum C reactive protein concentrations as an indicator of the acute phase response. Thermally injured patients initially had markedly elevated C-reactive protein levels which gradually decreased during hospitalization. We suggest that the initial hypozincemia observed in thermally injured patients may be a reflection of interleukin-1 mediated acute phase response. Whether one should vigorously attempt to correct this initial marked hypozincemia requires further investigation.

Serum levels of C-reactive protein (CRP) in 48 children with scald burns were measured at 24-hour intervals. It was found that CRP levels were proportional to the area and depth of skin involved. In longitudinal studies the CRP levels were normal and admission, reached their peak at 48 hours and by 6 days had begun to fall. The response (CRP production) was increased and prolonged by infection. We conclude that sequential estimation of CRP serum levels is helpful in the management of scald burns in children.

We evaluated the diagnostic value of measuring C-Reactive Protein (CRP) in blood and in synovial fluid for the detection of inflammatory articular diseases in 154 patients. High concentrations of CRP in blood were found in microcrystalin arthritis, polymyalgia rheumatica and Horton's disease. Our results show a good correlation between CRP and erythrocyte sedimentation rate for ankylosing spondylitis (p less than 0.01), systemic lupus erythematosus (p less than 0.01), rheumatoid arthritis (p less than 0.05), polymyalgia rheumatica and Horton's disease (p less than 0.05). The CRP measurement in blood did not separate seropositive versus seronegative rheumatoid arthritis, systemic lupus erythematosus versus rheumatoid arthritis and treated versus non-treated rheumatoid arthritis. There was a good correlation between CRP concentration in blood and in synovial fluid but the concentration was lower in synovial fluid than in blood (p less than 0.01). Then, the CRP measurement in synovial fluid does not have a higher diagnostic value than in blood.

Serum lactoferrin concentrations were elevated in almost all children with meningococcal septicemia, in whom the disease had been clinically apparent for less than 18 hours, while the concentrations were normal or only moderately elevated in patients who had had the disease longer before being admitted. Concentrations of C-reactive protein (CRP) were markedly elevated, even with a time lapse of less than six hours, making this the most suitable parameter for the early diagnosis of severe meningococcal infection. Following an operative injury on children the lactoferrin concentrations changed very little. More than six hours after an operation, however, a marked increase in CRP-values was observed, possibly indicating differentiation of this response from that of bacterial infection. The concomitant study of serum alpha 1-antitrypsin, alpha 1-antichymotrypsin, orosomucoid and haptoglobin did not uncover results of great significance with regard to early changes.

In a prospective blind study 380 daily serum samples from 55 women with preterm premature rupture of the membranes were analysed for C-reactive protein (CRP). Although the last CRP before delivery was higher in patients with histological chorioamnionitis (P = 0.007), considerable overlap between infected and non-infected pregnancies occurred, precluding the use of CRP as a diagnostic test if published normal levels were used. When upper limits were set at 30, 35, or 40 mg/l, the last CRP before delivery proved 90, 95 and 100% specific and 88, 92 and 100% positively predictive of infection in singleton pregnancies. Such high specificities are needed to prevent inappropriate intervention based on false positive results. We therefore propose upper limits for single estimations of 30, 35, or 40 mg/l depending on the relative risks of preterm delivery versus infection at various gestational ages. In addition, consecutive values greater than 20 mg/l appeared highly predictive of infection.

Acute phase reactants are nonspecific indicators of tissue necrosis and/or inflammation but may be helpful in determining activity of disease. Rheumatoid factor is likewise rather nonspecific, but its presence is helpful in predicting the course, severity, and complications of rheumatoid arthritis. Numerous antinuclear antibodies have been identified in collagen vascular diseases; perhaps the most specific association is between anti-Sm antibody and systemic lupus erythematosus. Anti-smooth-muscle and antimitochondrial antibodies can aid in differential diagnosis of liver disease, while antithyroid antibodies can perform a similar function in diffuse goiter. Anti-parietal-cell and anti-intrinsic-factor antibodies are quite specific for pernicious anemia.

165 sera of patients suffering from kala-azar were collected before and after treatment (N-methyl glucamine: Glucantime ) and analysed for anti-leishmania antibodies by the counter immunoelectrophoresis and fluorescent antibody techniques. Serum immunoglobulins G, A, M and Complement C4 and C3 were studied as well; and C reactive protein, rheumatoid factor and anti-nuclear, anti-mitochondrial and anti-smooth muscle antibodies were investigated. Before treatment, counter immuno-electrophoresis was positive in 63.88% and immunofluorescent antibody test in 94.6%. The analysis of immunoglobulins has shown an increase of IgG in nearly all cases, an increase of IgM in 78.26% of sera tested. Little change has been noted with IgA. C reactive protein has been found in 87.67% and rheumatoid factor in 76.4% of sera examined. In 4 patients, anti-smooth muscle antibodies have been found at a relatively weak dilution. A decrease of complement C4 has been observed whereas complement C3 was slightly increased. After treatment (2 cures of Glucantime ) counter immunoelectrophoresis was positive in 23.07% of cases whereas immunofluorescent antibody test was still positive in 84.62%. IgG remained increases in the whole cases and IgM in only 43,48%. C reactive protein and rheumatoid factor have been found in 14.81% and 50% of cases respectively. Complement C4 remained low whereas complement C3 showed normal mean value. The relationship between the serological disturbances observed and the prognosis were discussed.

A simple and rapid purification method for human serum C-reactive protein (CRP) was developed. CRP was strongly adsorbed on a DEAE-cellulose column and was easily separated from other serum proteins. CRP was purified approximately 1,000-fold with a high yield (50%). The final preparation showed a single band as judged by SDS-polyacrylamide gel electrophoresis, polyacrylamide gel disc electrophoresis, and polyacrylamide gel isoelectric focusing. The fluorescence of the complex of CRP and 8-anilino-1-naphthalene sulfonate (ANS) changed with change of the pH, suggesting that CRP may show pH-dependent conformational change. This finding could account for the peculiar behavior of the protein in isoelectric focusing; it shows an isoelectric point of 7.4 when the starting pH is 7.0, whereas it shows two isoelectric points, 5.3 and 7.4, when the starting pH is 5.5. Ca2+-dependent change of the fluorescence of the complex of CRP and ANS was also detected. These results suggest a pH- and Ca2+-dependent conformational change of CRP.

Serum C-reactive protein (CRP) levels were measured in 99 patients with definite or classical rheumatoid arthritis (RA). At the same time as the serum was obtained, the activity of the RA was assessed by assigning scores to a comprehensive set of subjective, semi-objective and objective clinical features. The results confirmed that the serum CRP concentration closely reflects activity of RA and is of value in its objective assessment. Erythrocyte sedimentation rate (ESR) followed the same pattern as CRP levels but all of the subjective and semi-objective criteria correlated more significantly with CRP levels than with ESR.

The hematologic status of 265 patients with rheumatoid arthritis was assessed. In the group as a whole, a mild depression in the hemoglobin concentration and mean cell volume (MCV) was associated with an increase in the red blood cell distribution width (RDW), erythrocyte sedimentation rate (ESR), and platelet count. Bone marrow trephine biopsies and further measurements of iron status and disease activity were done in [a further] 38 more anemic patients, and the findings in those with absent marrow iron (iron deficiency) were compared with those having stainable stores (anemia of chronic disorders). The RDW was raised in both, and there was no significant difference between the two groups. The concentrations of nonheme iron in the marrow and of serum ferritin were significantly lower in the iron-deficient group, but the geometric mean serum ferritin of 34 micrograms/L was still a good deal higher than that associated with uncomplicated iron deficiency. This was presumably because of the fact that the serum ferritin, which was significantly correlated with the ESR (r 0.55; P less than 0.0004) and C-reactive protein (CRP) r 0.41; P less than 0.01), was also functioning as an acute phase protein. While there was a weak correlation (r 0.37; P less than 0.04) between the marrow nonheme iron and the serum ferritin concentrations, it disappeared when nonactive patients with normal CRP concentrations were excluded. The absence of a correlation is unlike the findings that have previously been noted in other chronic inflammatory conditions and in neoplasia. This raises the possibility that serum ferritin concentrations in rheumatoid arthritis may reflect, in part at least, another store of iron located in affected joints.

Sequential changes in albumin, transferrin, alpha 1-acid glycoprotein, C reactive protein, fibrinogen, copper, iron, and zinc in plasma up to 24 h after hysterectomy were measured. No increases in the concentrations of the acute phase proteins alpha 1-acid glycoprotein, C reactive protein, and fibrinogen were observed until 6 h after the skin incision. These increases were preceded by significant falls at 2-4 h, and this was shown also by albumin, transferrin, iron, zinc, and copper. The ratios of iron and zinc to their binding proteins, transferrin and albumin, did not decrease until 4-6 h and their concentrations remained low for at least 24 h. These patterns suggest that at least two mechanisms operate after trauma. The early fall in the concentrations of the proteins in plasma is consistent with a prompt increase in microvascular permeability. The later decrease in binding of the metals iron and zinc to their transport proteins and the increase in concentrations of the acute phase proteins could be initiated by a common mediator.

Serum samples from 57 Turkish patients with Behçet's syndrome (BS) were analysed for C-reactive protein, histidine, total sulphydryl concentration and gamma glutamyl transpeptidase. Clinical subgroups did not exhibit biochemical differences, including BS with and without arthritis. When compared with normal controls and with patients with active rheumatoid arthritis (RA), those with BS were shown to be biochemically abnormal in a manner quantitatively similar to RA, but to a lesser degree. Gamma-glutamyl transpeptidase concentrations were found to be normal in BS.

The time course of body temperature (T), white blood cell count (WBC) and serum C-reactive protein (CRP) following uncomplicated open-heart surgery and the value of these three parameters in the diagnosis of postoperative infectious complications were analyzed in 153 patients. Preoperatively, all the patients had a normal T and the WBC level was under 10 X 10(9)/l. The CRP was elevated (over 20 mg/l) in five patients without having an influence on their postoperative courses. Postoperatively, T, WBC and CRP reached their maximum values during the first three days, decreasing gradually thereafter. Great individual variations in this average response to open-heart surgery were seen. Development of minor postoperative infections, mainly wound infection, (in 22 patients) were poorly reflected by these three parameters. However, a temperature exceeding 38 degrees C after the 6th postoperative day suggested presence of infection; less than 5% of patients without an infection had a temperature over this value. A secondary rise in CRP after the third postoperative day occurred in 20 patients and correlated well with postoperative complications; in 14 patients (70%) an infection became apparent, in three instances a probable infection was present, while two patients suffered from non-infectious complications. Only in one case (5%) did the cause for a secondary rise in CRP remain unknown. In major infections, i.e. mediastinitis, a CRP response occurred in all 12 patients, a temperature response in 11 patients (92%) and a WBC response in 10 patients (83%).

Lumbar disc surgery was performed in fifty consecutive patients and variation in erythrocyte sedimentation rate (ESR), complement C 3 d, and C-reactive protein (CRP) levels before and after surgery were recorded. Preoperative values were within normal limits in all patients. Postoperatively, CRP increased immediately, with a maximum of 28.5 mg/l on the 2nd day and were normalized within 6 days. The maximum ESR elevation occurred after the 6th day and was followed by a slow decrease. After 12 weeks some patients still had an elevated ESR. Plasma C 3 varied pari passu with the ESR. Uncomplicated recovery after lumbar disc surgery seems to be indicated by a normalization of CRP, regardless of ESR values. Therefore, ESR may not be so useful as an indicator of disc space inflammation as previously accepted.

This study was undertaken to gain insight into the mechanisms responsible for the hypoferremia occurring after severe exercise. To this end, 18 athletes who were competing in a 160-km triathlon involving canoeing, cycling, and running were evaluated before the race, immediately after the finish, and thereafter at 30 min, 24 h, and 48 h. The evaluation included plasma iron, total iron-binding capacity, lactoferrin, ferritin, haptoglobin, cortisol, various enzymes, and white cell count. The cortisol, white cell count, and lactoferrin were significantly increased immediately after the race, while the plasma iron and transferrin saturation were significantly decreased. There was a 40% but nonsignificant rise in the plasma ferritin at the completion of the race, while the C-reactive protein was raised by nearly 300% at 24 h. In contrast, haptoglobin declined significantly by 24 h but was normal again 24 h later. Quantitative considerations suggested that the lactoferrin was not responsible for removing transferrin iron from circulation and hence causing the hypoferremia. Instead, it seemed more likely that the iron-related changes were occurring as part of an acute phase response initiated by muscle injury.

The erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were measured in 74 patients with polymyalgia rheumatica (PMR)/giant cell arteritis (GCA) on presentation, in the first month of treatment, and at long term follow up (up to 177 weeks). Before treatment the ESR was raised (greater than 30 mm/h) in all cases and the CRP was raised (greater than 6 mg/l) in 49/55 cases. The ESR was a better indicator of clinical disease activity except in patients who felt completely well at week 1. 'False positive' increases of ESR or CRP were rare. During relapses ESR was normal in 37/77 (48%) of cases and CRP in 41/73 (56%). It is suggested that ESR is the most useful laboratory parameter in assessing PMR/GCA.

We have measured ferritin concentrations in healthy women, and ferritin, C-reactive protein, iron and total iron-binding capacity in patients undergoing hysterectomy or major gastrointestinal surgery. Pre-operative serum ferritin concentrations in patients awaiting hysterectomy were significantly lower than those for patients awaiting gastrointestinal surgery and also lower than those for healthy women of similar age. Healthy women aged between 51 and 60 years had significantly higher ferritin levels than women aged 35-50 years. All patients studied showed large increases in serum ferritin and C-reactive protein concentrations after surgery and approximately similar decreases in iron and in total iron-binding capacity.

The alkaline phosphatase in leukocytes (LAP) was measured in patients who had undergone various types of total arthroplasty of the hip, in patients who had undergone synovectomy and in whom tibial fractures had been treated conservatively. The LAP-Score increased rapidly and reached a maximum within a few days and returned to original levels after 14 days both after soft tissue trauma and skeletal trauma. The size of the maximal increase appears to vary only with the severity of the trauma. LAP was not found to be correlated with the increase in alkaline phosphatase in the serum. The increase in serum alkaline phosphatase occurred much later and decreased much slower and occurred only after skeletal trauma. The increase in alkaline phosphatase in the serum appears to vary with severity of skeletal trauma. A significant difference in LAP (P less than 0.05) was found between patients operated upon with total arthroplasty with success and those with deep infection. The difference between these two groups was, however, larger (P less than 0.01) regarding ESR and CRP.

Sequential daily measurements of erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were performed for one week after an I.V. injection of 7.5-13 mg methotrexate (MTX) in 18 patients with rheumatoid arthritis. Early decreases of ESR and CRP were observed. Serum CRP was more sensitive than ESR, displaying more pronounced falls from baseline to both the minimal and to the 7th day levels. Patients receiving their first dose of MTX (n = 9) exhibited a more prominent reduction of CRP levels in comparison to veteran MTX users (n = 9). The prompt response of acute phase reactants to MTX may correspond to the relatively rapid clinical effect of the drug in RA. It may also support an antiinflammatory mechanism of action of low dose MTX.

1. The permeability of the synovial membrane for proteins is larger in rheumatoid arthritis than in osteoarthrosis, in rheumatoid arthritis with high CRP activity larger than in rheumatoid arthritis with low CRP activity. 2. The diffusion by the synovial membrane in most plasma proteins takes place depending on their molecular weight. Of the 14 proteins tested only haptoglobin and fibrinogen did not follow this regularity. 3. While the non-immune proteins proved in the synovial fluid only come from the blood plasma, the immune globulins IgG, IgA, and IgM as well as lysozyme are partly also locally synthetized and enriched in rheumatoid arthritis. In rheumatoid arthritis lysozyme is present in the synovia not only in free, but in most cases also in cell-bound form.

We measured tumor-associated trypsin inhibitor (TATI) and C-reactive protein (CRP) in serum of 29 patients with proven pelvic inflammatory disease (PID). TATI values were increased in seven (24%), paralleling increases in CRP. TATI was increased by about 3.5-fold in seven of eight patients with CRP concentrations greater than 90 mg/L, but in none of 21 patients with CRP concentrations less than 90 mg/L. TATI concentration and severity of PID as determined by laparoscopy or endometrial biopsy were not correlated. These results suggest that, in severe infections, regulation of TATI synthesis resembles that of acute-phase proteins.

This is an improved assay of C-reactive protein in serum, for use with the Baker "Encore" centrifugal analyzer. Features of this assay include: 250-specimen throughput per hour, within-batch CV 2.2%, between-batch CV 2.7%, no antigen-excess problems up to 1000 mg/L, negligible interference from rheumatoid factor, and good correlation (r = 0.99) with radial immunodiffusion. The method is inexpensive and automated, involving no predilution steps. It can be adapted for use in a wide range of systems and can be used for single urgent estimations.

The behaviour of the C-reactive protein--an acute phase reactant=-in sera from pregnant women and women with different applications of hormonal contraceptives was analysed. A significant increase of the CRP as a consequence of the effect of the sexualsteroids in 627 single measurements could be shown.

1. Rainbow trout, Salmo gairdneri, produce elevated amounts of a serum acute phase (C-reactive) protein (CRP) when administered a variety of chemicals of environmental importance. 2. Compounds administered in doses which induce the cytochrome(s) P450 catalytic enzymes in trout hepatic microsomes also induce serum CRP. 3. However, an interferon-inducing virus does not induce CRP. Interferon induction by the virus is not significantly inhibited by chemicals which induce trout cytochrome(s) P450. 4. Simultaneous administration of chemicals and virus or virus alone results in depression of P450 protein production and only minor induction of CRP. 5. Thus, as with mammals, a reciprocating relationship appears to exist between the hemeprotein monooxygenase and immune systems of this freshwater teleost, and C-reactive protein appears to fit the reciprocating scheme closer to the cytochromes P450 response.

Marked effects on C reactive protein, circulating immune complexes, rheumatoid factor and immunoglobulin levels were demonstrated in a group of 40 patients with rheumatoid arthritis, who received pulse methylprednisolone therapy, either as sole treatment or in combination with a disease modifying agent. The only patient groups in which these serological changes were maintained were the groups taking disease modifying agents, with the more significant and sustained changes occurring in the group of patients who started a disease modifying agent at the time pulse therapy was begun. No significant effect of pulse therapy on neutrophil or lymphocyte counts or lymphocyte subsets could be demonstrated. Pulse therapy, per se, did not have a significant effect on the results of intradermal delayed hypersensitivity testing in any patient group.

The purpose of the study was to determine the temporal relationship between lymphocyte activating factor (LAF) activity and the acute-phase response, as measured by plasma fibronectin (Fn), C-reactive protein (CRP), and albumin levels in adjuvant arthritic rats. LAF activity as measured in the thymocyte costimulator assay, and plasma Fn, CRP, and albumin levels were measured during the acute (Day 3), intermediate (Day 10), and systemic (Day 17) phases of arthritic disease. On Day 3, supernatants from whole spleen cells of adjuvant-injected rats did not exhibit abnormal LAF activity. By Day 10, LAF activity in splenic supernatants from arthritics was significantly (P less than or equal to 0.05) higher than normal, although the increase was no greater than 60%. On Day 17 the LAF activity from arthritic rats had increased an average 300% compared to normals. In contrast to the time course of IL-1 activity, Fn and CRP levels in the arthritic rat were significantly higher than normal at all three time points, although there was a transient fall in Fn and CRP concentrations on Day 10. Plasma albumin levels in arthritic rats were subnormal (P less than or equal to 0.01) on Days 3, 10, and 17, although the concentration of plasma albumin on Day 10 was significantly higher than that measured on Day 3. The acute, intermediate, and systemic phases of adjuvant arthritic paw inflammation paralleled the abnormal profile of Fn, CRP, and albumin concentrations over time. However, LAF activity from arthritic rat spleen cells increased gradually and more closely coincided with the systemic appearance of the disease. Since the appearance of abnormal plasma protein levels in arthritic rats preceded the appearance of increased splenic LAF activity, it appears that there is no causal relationship between enhanced splenic LAF activity and early alteration of plasma Fn, CRP, and albumin levels.

Previously it had been shown that there is a sharp increase in C-reactive protein (CRP) serum concentration during the first few days after severe exercise. To evaluate the effect of physical training on the CRP levels, a sensitive enzyme immunoassay was developed and used to assess the basal CRP concentrations in 356 male and 103 female athletes, who trained at least 4 times per week in various disciplines, in 45 male and 40 female untrained controls, and in 35 elderly coronary patients. In male athletes the lowest CRP values were found in swimmers (median: 102 ng/ml, n = 59), which were significantly lower (P less than 0.001) than those of male controls (median: 502 ng/ml, n = 45). The CRP concentrations in rowers (median: 260 ng/ml, n = 108) were also significantly lower (P less than 0.01) than in the control group. CRP levels in middle- and long-distance runners (median: 315 ng/ml, n = 53), racing cyclists (median: 620 ng/ml, n = 111), and soccer players (median: 660 ng/ml, n = 25) did not differ significantly from those of the controls. In female athletes the lowest CRP concentrations were also found in swimmers (median: 110 ng/ml, n = 49), which were significantly lower (P less than 0.001) than those of the female controls (median: 396 ng/ml, n = 40). Female middle- and long-distance runners (n = 36) and female rowers (n = 18) had median CRP values of 250 and 285 ng/ml, respectively. This results suggest that training induces a suppressive effect upon CRP, responsible for the low serum levels in athletes (particularly swimmers) when compared to controls.(ABSTRACT TRUNCATED AT 250 WORDS)

The complement (C) profile was investigated in an adult patient with combined IgG2, IgG4 and IgA deficiency and recurrent pneumococcal infections. The analysis revealed no gross impairment of the classic and alternative pathways of C activation. However, the concentrations of circulating C1q were persistently decreased, and the sera contained an excess of C1r-C1s complexes, resembling the C1 aberrations previously found in children with recurrent acute otitis media. The concentrations of C4 in the patient were persistently low. This could be ascribed to partial C4 deficiency with lack of C4A variants. The patient's IgG and IgM antibody responses to pneumococcal capsular polysaccharides and to other bacterial carbohydrate antigens were very poor. Interestingly, pneumococcal C-polysaccharide (CPS) could be detected in serum obtained during infection-free periods. Since CPS has been shown to bind C1q without causing C1 activation, the possibility was considered that the C1 aberrations in serum were due to circulating CPS. After administration of intramuscular gammaglobulin to the patient, the serum C1q levels were observed to return to normal.

A patient who presented with bilateral adhesive capsulitis of the shoulder, oligoarthropathy and rapidly progressive proximal myopathy is described. Although clinically euthyroid, autoimmune and biochemical hypothyroidism was the only predisposing factor found. Clinical deterioration after initiation of thyroxine replacement was followed by delayed improvement with reduction in initially elevated ESR and CRP.

Neopterin is a marker for activation of cellular immunity. Urinary neopterin levels were measured in 106 patients with rheumatoid arthritis (RA) and in 45 patients with osteoarthritis. Levels were significantly higher in RA patients than in osteoarthritis patients and were strongly dependent on stage and activity of RA. Correlations with other laboratory parameters were weak. Multivariate analysis demonstrated that urinary neopterin levels reflected clinical activity better than did other laboratory findings. Thus, urinary neopterin determination might be useful in monitoring RA patients.

Intralipid elimination patterns were compared in 25 healthy controls, 12 patients recovering from uncomplicated cholecystectomy, and 25 critically ill patients. The intravenous fat tolerance test revealed a similar fractional removal rate (k2) in healthy controls and critically ill patients, but k2 was increased in cholecystectomy patients. The concentration of cross-reactive protein (CRP) correlated positively to the concentration of total triglyceride and low-density lipoprotein-triglyceride, and negatively to low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol. The extrapolated zero-time concentration of Intralipid in the critically ill patients was only one-third of the value in healthy controls. After this initial loss, however, Intralipid was removed from the circulation after first-order kinetics. These low concentrations of Intralipid were not correlated with concentrations of CRP. Possible explanations for this phenomenon include a change in the configuration of the lipid particles, the so-called creaming phenomenon, and/or immediate and substantial uptake of the emulsion by certain organs.