Total and differential protein levels in the blood and cerebrospinal fluid in rheumatoid arthritis.

The results obtained by accurate chemical estimation of the blood and cerebrospinal-fluid (C.S.F.) proteins in 23 cases of severe chronic active rheumatoid arthritis are described in the following paper. Boland and others (1948) reviewed the subject authoritatively, pointing out that very few studies on the C.S.F. proteins in cases of rheumatoid arthritis had been published. They were able to quote only four, and only one other additional study (Sundelin, 1947) appears to exist apart from our own. Graber-Duvernay and Gerbay (1939) studied the C.S.F. in eighteen cases of " chronic polyarthritis " (most, if not all, probably being cases of rheumatoid arthritis), and found a raised protein level in the C.S.F. of all but one. They concluded that the protein level in the C.S.F. paralleled the activity of the disease and that the estimation of it was more useful as a guide to progress and therapy than the erythrocyte sedimentation rate. Piaggio Blanco and Sciuto (1941) studied the C.S.F. in 21 cases of " sciatica of vertebral origin ". Boland and others (1948) consider that seven of these cases were probably suffering from " rheumatoid spondylitis " (ankylosing spondylitis). In five the protein level in the C.S.F. was raised, with results ranging from 59 to 100 mg. per 100 ml. Ludwig and others (1943) did various biochemical estimations on the C.S.F. in 101 patients, 59 ofwhom had rheumatoid arthritis and 42 ankylosing spondylitis with or without peripheral joint involvement. Taking 45 mg. protein per 100 ml. C.S.F. as the upper limit of normal, they found a raised total protein (46 to 70 mg.) in 6 8 per cent. of the rheumatoid arthritics, and in 28 * 6 per cent. of the ankylosing spondylitics (range 47 to 105 mg.). They found no correlation between the level of protein in the C.S.F. and the erythrocyte sedimentation rate, the severity of the disease process, and its duration, although there seemed to be some correlation with the activity of the disease. Polley (1945) found a raised C.S.F. protein level in three out of 24 cases of "rheumatoid spondylitis ". Boland and others (1948) studied fifty cases of ankylosing spondylitis, seventeen with peripheral joint involvement. The C.S.F. protein estimations were done