Delayed cutaneous hypersensitivity in rheumatoid arthritis: the influence of nutrition and drug therapy

Significant depression of delayed cutaneous hypersensitivity (DCH) to seven common recall antigens was found in 50 patients with rheumatoid arthritis (RA) compared with 50 matched controls. Complete skin anergy was seen in 12 (24%) of the RA patients but in none of the control subjects. In addition, a nutritional assessment of all subjects tested showed significantly lower serum albumin and body mass indices in the RA compared with the control group. Analysis of these 100 subjects showed a significant correlation (r = 0.53, p less than 0.001) between the number of positive skin reactions and the concentration of serum albumin suggesting an association between nutritional status and DCH. No single factor could be identified to distinguish the reactive and anergic RA patients with the possible exception of drug treatment in that a higher proportion of patients on sodium aurothiomalate or immunosuppressive therapy than D-penicillamine was found in the anergic group. It is likely that the cause of impaired DCH in RA is multifactorial and our findings suggest that drug treatment and nutritional status may be an important contributor to it.