Symptomatology and diagnosis in connective tissue disease. II. Evaluations and follow-up examinations in consequence of a speckled antinuclear immunofluorescence pattern.

Antibodies to soluble ribonucleoprotein (sRNP) are by definition a prerequisite for the diagnosis mixed connective tissue disease (MCTD). They are also found in 30--40% of other rheumatic conditions with a high titred speckled IFL reaction. The same is true for the most characteristic clinical features of MCTD, viz. Raynaud's syndrome and polymyositis--polymyalgia. The serological and clinical symptoms mentioned are closely associated. An association between anti-Sm and the SLE symptoms butterfly erythema, nephropathia, other visceropathias and cerebrovascular disease is confirmed by the present study. Although anti-Sm has less diagnostic specificity for SLE than has anti-ds-DNA, it is useful as a diagnostic aid in SLE cases lacking the latter antibody. The results of the present study tend to support the hypothesis that anti-sRNP may be associated with a prophylactive effect against serious vasculitis and nephropathia. When anti-sRNP and anti-Sm occur together they seem to act competitively so that the symptom associated with the antibody having the highest titre tends to dominate the clinical picture. Both anti-sRNP and anti-Sm produce speckled nuclear patterns in the indirect immunofluorescence test. Sera with immunofluorescence titres below 1/25 were not found to react against either sRNP or Sm. On the other hand all sera tested that had a speckled IFL reaction greater than or equal to 1/800 also had anti-sRNP.