Clinical Significance of the L.e.-cell Phenomenon in Rheumatoid Arthritis.

In the first few years immediately following the discovery of the L.E.-cell phenomenon by Hargraves, Richmond, and Morton (1948), L.E.-cells were found to be closely correlated with the clinical diagnosis of systemic lupus erythematosus (SLE) (Dubois, 1953; Harvey, Shulman, Tumulty, Conley, and Schoenrich, 1954; Lee, 1955; Wilkinson and Sacker, 1957; Louis and Limarzi, 1958). These early experiences with the L.E.-cell test indicated that L.E.-cells were highly specific for SLE and of great diagnostic value in this disease. Subsequently, there were sporadic reports of finding L.E.-cells in patients with such disorders as acquired haemolytic anaemia (Lee, Michael, and Vural, 1951), glomerulonephritis (Parelhoff, 1953), and penicillin hypersensitivity (Walsh and Zimmerman, 1953). Some considered these patients to have had "false-positive" L.E.-cell tests. The interpretation of others was that these patients were merely demonstrating the initial manifestations of SLE. In later series of patients with rheumatoid arthritis, L.E.-cells were demonstrated in a significant proportion of cases (Kievits, Goslings, Schuit, and Hijmans, 1956; Ross and Clardy, 1956; Friedman, Sickley, Poske, Black, Bronsky, Hartz, Feldhake, Reeder, and Katz, 1957; Sigler, Monto, Ensign, Wilson, Rebuck, and Lovett, 1958; Goslings, Kievits, Hazevoet, Hijmans, and Cats, 1961; Monto, Rizek, Rupe, and Rebuck, 1961). Numerous attempts to correlate the presence of L.E.-cells in rheumatoid arthritis with systemic (or "lupus-like") complications have led to variable conclusions. The question whether the L.E.-cell phenomenon in these patients represented a "false-positive" reaction or was indicative of SLE remained unsettled. In a recent study from this hospital (Stevens, Abbey, and Shulman, 1963), a clinical analysis of patients with positive L.E.-cell tests was presented; after SLE, which was the most common diagnosis, rheumatoid arthritis proved to be second in frequency. The finding of L.E.-cells in patients with rheumatoid arthritis did not correlate well with systemic complications. However, the design of the study was such that too few patients with rheumatoid arthritis appeared in the randomly-sampled control group with negative L.E.-cell tests to permit an adequate comparison with those who had L.E.-cells. The present study was designed, therefore, to determine in a controlled manner the clinical implications of a positive L.E.-cell test in patients with rheumatoid arthritis. The clinical features of 22 patients with rheumatoid arthritis and positive L.E.cell tests are presented and compared with those of 41 patients with rheumatoid arthritis and negative L.E.-cell tests and of 22 rheumatoid arthritis patients in whom no test had been performed. The data show that the L.E.-cell phenomenon in rheumatoid arthritis is not associated with an excess of extraarticular systemic manifestations either of the type seen in lupus erythematosus or that described in rheumatoid disease.