A man with gonococcal urethritis who developed septic arthritis of both knees is described. The arthritis was complicated by rupture of bilateral synovial cysts. A rise in serum gonococcal complement-fixation antibody titer was demonstrated. Complement-fixing gonococcal antibodies with a high titer were observed in this synovial fluid. The patient responded well to antibiotic treatment and there was no permanent damage to his knee joints.

Adult↗

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Restorative effects of different embryonic cells transplanted into immunodeficient chick embryos.

Cyclophosphamide-treated 18-day chicken embryos were transplanted with cells from different organs of histocompatible embryonic donors. The cells transplanted include cells from the bursa of Fabricius, spleen, bone marrow, thymus or liver of 15- and 18-day embryos and yolk sac cells from 9, 11, 13, 15 and 18-day embryos. To evaluate the reconstitution capacity of the cells transplanted, gain of body weight, weight and microscopic morphology of the lymphoid organs and antibody forming capacity to sheep red blood cells and Brucella were assessed at the age of five weeks. According to all the criteria employed, bursa cells were the only cells capable of a functional and morphological reconstitution of the recipient's humoral immune system. Cells from the embryonic spleen, bone marrow, thymus, liver or yolk sac had no reconstituting effect, indicating that these organs do not harbor precursors for the B-cell lineage. Taken together with other observations, these findings reveal that, as a differentiation site of the B-cell lineage, the bursa of Fabricius precedes the bone marrow during ontogenetic development, and furthermore, that the role of the yolk sac as the first generator of prebursal stem cells must be questioned.

Age Factors↗

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Prevalence of Sindbis-related (Pogosta) virus infections in patients with arthritis.

OBJECTIVE: To determine the role of Pogosta virus as a triggering infection in non-specific arthritis. METHODS: Serum samples of 142 patients with acute arthritis were screened for the evidence of Pogosta virus infection. Serological tests for Chlamydia trachomatis, salmonella, parvovirus B19, and Borrelia burgdorferi were also carried out. As verified later, 78 of the patients had rheumatoid arthritis and 63 seronegative poly- or oligoarthritis, while one had systemic lupus erythematosus. RESULTS: In the early stage of the joint symptoms 4 patients with rheumatoid arthritis, 1 with seronegative polyarthritis and 1 with systemic lupus erythematosus had recent Pogosta virus infection. Four of them had probably had Pogosta disease at the time of the onset of arthritis. In 11 patients with a diagnosis of seronegative arthritis, serological evidence of preceding infection due to salmonella or Chlamydia trachomatis was found, strongly suggesting classical reactive arthritis in these cases. CONCLUSIONS: Our study suggests that also a Sindbis virus infection may be associated both to an acute joint inflammation as a part of Pogosta disease or chronic arthritis. At present, this possibility still needs further research.

Adolescent↗

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Association of tumour necrosis factor a, b and c microsatellite polymorphisms with clinical disease activity and induction of remission in early rheumatoid arthritis.

OBJECTIVE: To study the associations of tumor necrosis factor (TNF) a, b and c microsatellite markers with 1) the clinical disease activity and 2) the induction of remissions in patients with early rheumatoid arthritis (RA) treated with two treatment strategies. METHODS: In the FIN-RACo (FINnish Rheumatoid Arthritis Combination therapy) trial of two years, 195 patients with recent-onset RA were randomly assigned to receive either a combination (COMBI) (sulphasalazine, methotrexate, hydroxychloroquine, and prednisolone) or a single (SINGLE) (initially sulphasalazine with or without prednisolone) disease modifying antirheumatic drug (DMARD) therapy. TNF a, b and c microsatellite and HLA-DRB1 typings were carried out in 165 (79 COMBI; 86 SINGLE) study completers. RESULTS: At baseline the 28 joint disease activity scores (DAS28) of the patients positive for TNFa2, a13 or b1 microsatellite markers were significantly higher than in the other patients. In the SINGLE patients the DAS28 improved comparably in patients with (n = 31) or without (n = 53) the TNFb1 marker (NS), while the DAS28 of the TNFb1-positive COMBI patients (n = 22) improved significantly more than that of the TNFb1-negative cases (n = 57) (p = 0.014). Respective 31.8% (7/22) and 28.1% (16/57) of the COMBI patients with or without TNFb1 allele achieved remission at one year. The corresponding figure in SINGLE patients were 0% (0/31) and 20.8% (11/53) (p = 0.006). At two years the remission frequencies in the TNFb1+/TNFb1- patients in the COMBI and SINGLE were 50.0%/38.6% and 9.7%/22.6%, respectively. CONCLUSION: Early TNFb1+ RA patients have more active disease but respond more favourably to COMBI treatment than the patients without this microsatellite allele. The finding may be of clinical relevance for the choice of DMARDs in early RA.

Adolescent↗

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Serological cross-reactions against Yersinia enterocolitica in patients infected with other arthritis-associated microbes.

In order to investigate arthritis-triggering, serologically cross-reactive antigens, sera from patients infected with arthritis-associated microbes, Salmonellae, Chlamydia trachomatis, and Sindbis-like alphavirus, were reacted against SDS-PAGE separated and immunoblotted Yersinia enterocolitica 0:3 antigens. These sera reacted with Yersinia to the same extent as did the control sera taken from patients with streptococcal, staphylococcal and Bordetella pertussis infections or from healthy blood donors. Moreover, the various sera produced different reactivity patterns, directed against several different antigens. Although sera from test subjects, as well as from controls including healthy individuals, recognized some Yersinia antigens, these patterns differed markedly from those recognized by sera taken from patients with Yersinia infection. Significantly, analysis of the reactivities against the different molecular weight antigen components of Yersinia revealed no dominant band or pattern which could thus have been defined as arthritis-associated.

Adult↗

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IgA anti-Yersinia antibodies and the outcome of Yersinia-triggered reactive arthritis.

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Adult↗

PubMedDate not supplied

Yersinia antibodies in inflammatory joint diseases.

The occurrence of IgM, IgG and IgA class Yersinia antibodies was studied at the beginning of an inflammatory joint disease and one year later in 354 adult patients using an ELISA technique. The control groups consisted of age and sex matched healthy persons living in the same geographical area as the patients, and of 64 patients with chronic rheumatoid arthritis. Yersinia antibodies of any Ig class were found in 9.0% of all the patients at the beginning of the disease, in 4.0% of the healthy controls and in 1.6% of the patients with chronic rheumatoid arthritis. Patients with ankylosing spondylitis, Reiter's disease or other reactive arthritis showed the highest prevalence (19.4%) of Yersinia antibodies, but in the whole material one half of the patients with Yersinia antibodies were clinically classified as rheumatoid or nonspecific arthritis. The elevated prevalence of Yersinia antibodies in patients with probable rheumatoid or nonspecific arthritis may indicate a reactive etiopathogenesis of arthritis also in some cases without previous evidence of gastrointestinal infection. Quantitation of IgG and IgA antibodies to Yersinia is important in the diagnosis of Yersinia arthritis. These antibodies may not be detected by the generally used agglutination test.

Antibodies, Bacterial↗

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Absence of lymphotoxic antibodies in patients with Yersinia-induced arthritis, Reiter's syndrome and ankylosing spondylitis.

Serum samples from patients with Reiter's syndrome, ankylosing spondylitis, Yersinia-induced arthritis and Yersinia infections not followed by arthritis were collected and assayed for complement-dependent cytotoxicity, using a standard dye-exclusion microcytotoxicity technique. A total of eighty-nine serum samples derived from these patients were compared to those of forty control subjects, using as target cells six different cultured cell line cells and peripheral blood mononuclear cells isolated from the blood samples of four subjects. Serum samples from only five of the subjects demonstrated cytotoxicity. This did not depend on whether the target cells were HLA-B27 or not. Hence, if antilymphocytic auto-antibodies are present in these patients, they will require a different technique for their detection.

Adolescent↗

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In vitro lymphoproliferative response to Yersinia: depressed response in arthritic patients years after Yersinia infection.

The persistence of lymphocyte transformation response to Yersinia was studied three to six years after Yersinia infection in subjects who had or had not suffered from reactive arthritis. In persons who had had arthritis, significantly weaker response to Yersinia was found than in those who had recovered without developing arthritis. The same held true also for the response to Klebsiella. These results support and extend our earlier observations of a depressed lymphocyte transformation response to Yersinia during the course of Yersinia arthritis. This phenomenon may be linked to the individual's susceptibility to arthritic complications after Yersinia infection.

Arthritis, Infectious↗

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A preliminary analysis of the membrane proteins of arthritis-causing Yersinia.

The outer membrane proteins (OMP) of fifteen strains of Yersinia were separated from the inner membrane (IMP) and intracytoplasmic (ICP) proteins. The molecular composition of these fractions was then analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The OMP of all fifteen strains exhibited a uniform pattern markedly distinct from the IMP and ICP. There was, however, heterogeneity in the OMP among the various bacteria, based on the apparent molecular weights of several of the major proteins. The two most prominent major proteins are easily distinguished because their apparent molecular weights varied substantially depending on the temperature at which the membranes were solubilized. Using the apparent molecular weights of these two proteins as a basis for comparison, the Yersinia organisms of serotype 3 presented a unique electrophoretic pattern, different from those of non-serotype 3 Yersinia organisms. Four of the nine serotype 3 organisms analyzed here were isolated from patients who developed arthritis subsequent to infection. However, no obviously unique features could be distinguished. A major focus of research effort is currently being devoted to the examination of the immune response generated against the Yersinia organisms by patients with Yersinia-induced arthritis. Most of the studies, so far, have utilized whole bacteria as the antigens. The data presented in this paper provide the basis of future analysis of such immune responses to individual molecules of Yersinia.

Arthritis↗

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Yersinia-associated arthritis in rats: effect of 65 kDa heat shock protein, bovine serum albumin and incomplete Freund's adjuvant.

OBJECTIVE: We have previously shown that the microbial load of rats has a significant effect on their susceptibility to Yersinia-associated arthritis. In this study our aim was to see whether mycobacterial 65 kDa heat shock protein (hsp) could induce the same suppressive effect in experimental Yersinia-associated arthritis as has been reported for arthritides induced by adjuvant, pristane, or streptococcal cell walls (SCW). METHODS: Arthritis was induced by the intravenous injection of Yersinia enterocolitica 0:8 into Lewis rats. Hsp, bovine serum albumin (BSA) or NaCl, administered in incomplete Freund's adjuvant (IFA), was given subcutaneously on day -5 or +5 with regard to the bacterial inoculation. RESULTS: Mycobacterial hsp given in IFA on day -5 significantly suppressed the development of arthritis. However, a similar suppression was observed with BSA or NaCl given in IFA. CONCLUSION: These results, together with those known from the effect of microbial load, suggest that susceptibility to Yersinia-associated arthritis is easily affected by external factors.

Animals↗

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Ten-year follow up study of patients from a Yersinia pseudotuberculosis III outbreak.

A Yersinia pseudotuberculosis serotype III outbreak in 1982 was characterized by a high frequency of post-infectious complications. Ten years later 16 out of the 19 patients originally included in the outbreak were reached for a follow up evaluation. Altogether nine patients suffered from chronic joint symptoms. Four of them were HLA B27-positive. Two of these had ankylosing spondylitis; one with severe erosive polyarthritis and secondary amyloidosis which led to uremia requiring haemodialysis and eventually to death, the other with ankylosis of the lumbar spine and sacroiliitis. None of the patients any longer had detectable anti-Yersinia antibodies. The long-term prognosis of Yersinia-triggered reactive arthritis is discussed.

Adolescent↗

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Electron microscopy and immunolabeling of Yersinia antigens in human synovial fluid cells.

Recent findings have emphasized the involvement of bacterial antigens in synovitis in reactive arthritis. It is still unclear, however, in what form the microbial material exists in the joint. Both antigen-containing cells and intact bacteria have been proposed as candidates on the basis of immunohistochemical studies of the synovial membrane. This study addresses that question by electron microscopy and peroxidase immunolabeling of synovial fluid cells from three patients with reactive arthritis triggered by Yersinia enterocolitica O:3. For all three patients a diffuse reaction in the cytoplasm of phagocytes was interpreted as bacterial material in a degraded form. These results are consistent with our proposal that intact bacteria rarely, if ever, enter the joints of Yersinia-triggered reactive arthritis patients.

Adolescent↗

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Effect of antimicrobial treatment on chronic reactive arthritis.

In a double-blind study comprising 36 patients the effect of a three-month course of ciprofloxacin on chronic reactive arthritis was evaluated. At the end of the follow-up period 6 months after stopping the therapy, arthralgia, pain at movement and morning stiffness had decreased significantly compared to the values before the treatment in the ciprofloxacin group, whereas the Ritchie index and ESR showed a significant decrease in the control group. We conclude that further studies are necessary before the value of prolonged ciprofloxacin treatment of chronic reactive arthritis can be established.

Adult↗