Lupus erythematosus cells in systemic sclerosis.

The lupus erythematosus cell (L.E. cell) phenomenon is usually regarded, if properly interpreted, as being almost specific for systemic lupus erythematosus (Wilkinson and Sacker, 1957). On the other hand, too rigid an outlook may lead to diagnostic errors or retard progress in the understanding of other diseases. Careful repeated examination of the blood of patients with classical rheumatoid arthritis may reveal the presence of L.E. cells in as many as 27 per cent. of cases (Black, Goldin, Poske, and Malmed, 1960), although most authors report a lower incidence. Dubois (1960) goes so far as to state that systemic lupus erythematosus is a malignant variant of rheumatoid arthritis. Treatment with steroids may increase the incidence of L.E. cells in rheumatoid arthritis (Ishmael, 1955) and L.E. cells have also been found after cortisone withdrawal (Slocumb, 1953). Ogryzlo (1953) reported the presence of L.E. cells in patients suffering from rheumatoid arthritis with visceral involvement, so-called "diffuse systemic rheumatoid disease", and Heaton (1959) found L.E. cells in ten out of 28 patients with Sjogren's syndrome. Lupus erythematosus cells have also been found in cases of polyarteritis nodosa (Lincoln and Ricker, 1954; Ogryzlo, 1956), dermatomyositis (Eaton, 1954; Ogryzlo, 1956), acrosclerosis (Volp6 and Hauch, 1955; Arnold and Tilden, 1957), scleroderma (Miller and Horgan, 1960), and thrombohaemolytic thrombocytopenic purpura (Siegel, Friedman, Kessler, and Schwartz, 1957). The finding of L.E. cells in chronic discoid lupus erythematosus has been reported by Berman, Axelrod, Goodman, and McClaughry (1950), Marten and Blackburn (1956), and Weiss and Swift (1955). In a personal series of 132 cases of chronic discoid lupus erythematosus, L.E. cells were found in three patients. However, two of these patients had associated rheumatoid arthritis (one with Sjogren's syndrome). The question arises whether they are really suffering from chronic systemic lupus erythematosus, and they serve to emphasize the close relationship between the discoid and systemic varieties of the disease. Lupus erythematosus cells have been found in acquired haemolytic anaemia (Dubois, 1952) and the latter is now a well-recognized presentation of systemic lupus erythematosus. Several drugs have precipitated reactions which have been associated with the finding of L.E. cells. The most interesting is hydralazine (Morrow, Schroeder, and Perry, 1953; Dustan, Taylor, Corcoran, and Page, 1954; Perry and Schroeder, 1954; Rheinhardt and Waldron, 1954; Shackman, Swiller, and Morrison, 1954; Ogryzlo, 1956); this causes a syndrome which is indistinguishable from systemic lupus erythematosus, but remits on stopping the drug. Lupus erythematosus cells have also been found with sensitivity to tetracycline (Domz, McNamara, and Holzapfel, 1959), penicillin (Walsh and Zimmerman, 1953), and phenylbutazone (Ogryzlo, 1956). Gold (1951) has discussed the significance of sulphonamides and penicillin in the pathogenesis of systemic lupus erythematosus. Lupus erythematosus cells have been found in hepatitis (Joske and King, 1955; Bettley, 1955; Heller, Zimmerman, Rozengvaig, and Singer, 1956), in cirrhosis (Ogryzlo, 1956; Bearn, Kunkel, and Slater, 1956; Wilkinson and Sacker, 1957), and also in small numbers in cases of the so-called "autoclastic" hepatitis which usually occurs in young women (Mackay, Taft, and Cowling, 1959). Bartholomew, Hagedorn, Cain, and Baggenstoss (1958) considered that the women with hepatitis and cirrhosis and L.E. cells in the peripheral blood described by them, were, in fact, suffering from systemic lupus erythematosus with possibly superadded viral hepatitis. Other conditions in which small numbers of