Henry Ford Hospital Medical Journal


Two different stimuli, tetanus toxoid (TT) and autologous fibrin (AF), were used to investigate the inflammatory response in ten patients with ankylosing spondylitis (AS); in seven persons who had a family history of AS and were HLA-627 positive but had no clinical signs of AS; and in eight nonarthritic controls. The purpose was to determine whether the leukocytic response in an experimental Rebuck skin window lesion was the same or different from that seen in the synovial fluid of AS patients when in vivo-formed fibrin flakes were present. Four lesions were produced on each subject, with TT added to one and AF applied to the other three. The TT-stimulated lesion and one AF lesion were serially sampled after 6, 12, and 24 hours. The other two AF lesions were sampled only once at either 12 or 24 hours. Cells adhering to the coverglass surface were stained with Leishman's stain. A differential count of 500 leukocytes was performed on each of the 192 samples. Our data suggest that exudative neutrophils do not recycle normally either in the experimental skin lesion of AS patients or in asymptomatic but clinically normal kindred of AS patients who are HLA-B27 positive. These findings agree with our previous in vivo observation that persistent fibrin flakes in the synovia of AS patients are associated with low numbers of exudative neutrophils. Diagnostic application of the Rebuck skin window lesion to determine the neutrophil response for ankylosing spondylitis may depend on the inflammatory response not following the HLA-B27 genetic marker.



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