Læknablaðið : fylgirit - 01.10.1980, Blaðsíða 20

14
Table V shows a selection of laboratory
anaiyses, that may be preferred to öbtain
the best possible diagnostic classification of
ICTDs, because they have acceptable ba-
lance between sensitivity and specificity.
Circulating immune complex including
RF-complexes, is a hi'ghly significant fea-
ture of ICTDs and the size and concentra-
tion of circulating immune complexes
ought to be detectable in clinical routine
because they seem closely associated with
clinical course, exacerbations and types of
organ involvement. But determination of
immune complexes is a difficult technical
procedure, and clinical relevant methods
are still under discussion and development.
Several types of assay are competing for
priority, and for the moment, if a useful
picture of circulating immune complexes is
wished in clinical work, at least 3 or 4
assays must be performed in parallell to
get a profile that can be of any clinical use.
Continued experience is close cooperation
between clinicians and laboratory immuno-
logists is highly needed to obtain more
experience.
Future trends
This review has not entered the dis-
cussion on pathogenetic importance and
pathogenetic mechanisms of immunological
processes in ICTDs. The aspects have mere-
ly been mentioned, and the interested rea-
der should turn to the specialized litera-
ture. But a lot of highly important possi-
bilities for research along immunological
lines are Clearly visible, and a few might
be mentioned in the final part of this re-
view.
One quite new field is the very signifi-
cant and highly interesting association bet-
ween some ICTDs and the HLA-system.
Tissue type HLA-B27 is associated with
spondylitis ancylopoietica (Bechterew) in
about 90% of the cases and nearly as
frequently in arthritis urethritica (Reiter).
Rheumatoid arthritis is significantly asso-
ciated with type HLA-DW4 and SLE with
HLA-B8. This association between genetic
factors and human diseases of insufficiently
known etiology and pathogenesis is be-
eoming an important contribution to the
final pattern of understanding, and the
field is at present a fruitful soil for growing
theories.
In clinical work immunological methods
are so far generally applied for examina-
tion of body liquids, but a rich variety of
similar immunological techniques are now
eventually becoming used also for exami-
nation of the solid tissues. Direct and in-
direct immunofluorescense techniques are
creative instruments for this purpose, and
doubtless a lot of valuable new informa-
tion can be acquired by ihcreased immuno-
histopathological research efforts.
Another new and promising field is the
detailed investigation of lymphocyte popu-
lations, lymphocyte functions and lympho-
cyte traffic. These cells can be reached in
material from perpiheral blood, synovial
fluids and tissue and from lymph nodes.
Lymphocyte research in ICTD has been
performed so far on a very moderate scale,
but is beginning to become significant
because of improved cytoimmunological
techniques. In parallel, a close examination
of monocyte/macrophage functions and
cellular interactions in the immune system
is needed since so far research in ICTD has
mainly soluble and precipitable biological
material and less made attempts to mea-
sure and describe cellular events.
In spite of the lack of a sufficiently de-
tailed concept of the pathogenetic role of
immune mechanisms and existing or not
existing abnormalities in the diverse func-
tions of the immune system, clinicians have
tried to obtain therapeutic results in ICTDs
by drugs and other therapeutic measures
which are known to influence the immune
system in some way or the other. However,
it is not possible to conclude anything
about immunopothopenesis on the basis of
observed effects of these types of treat-
ment, since it can generally be said, that
most of the drugs used (e.g. gold, predni-
sone, cytostatics, “immune stimulators”)
all have a very diffuse, badly defined effect
on cell populations both in the normal and
in the pathological immune system, in the
bone narrow, in other organs and on the
cellular functions and irnteractions that
contribute the inflammatory reaction. Pro-
gressive research in the ICTDs, in immuno-
logy and in immuno-pharmacology may