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Results for “Arthritis, Reactive”

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PubMed1996

Reactive arthritis: characteristics in southern New Zealand.

AIM: To review the clinical characteristics of patients with reactive arthritis and their associated triggering infections in a New Zealand community. METHOD: We reviewed the records of 60 patients with reactive arthritis. For comparison data was also collected on 30 randomly selected patients with psoriatic arthritis. RESULTS: Reactive arthritis affected a young age group. Half the episodes occurred in the age range 16-24 years and the mean age, (SD) of affected patients was 27(10) years cf psoriatic arthritis 40 (17) years, p<0.001. Almost half had a disease course longer than 2 yr and erosive joint damage in one quarter. Two thirds required treatment with sulphasalazine or methotrexate and patients with reactive arthritis were admitted to hospital frequently: 37% vs psoriatic arthritis 7%, p<0.001. Antecedent diarrhoea was documented in 23 episodes whereas a diagnosis of sexually acquired reactive arthritis was made in 11. CONCLUSION: Reactive arthritis has a significant impact on a young age group in this community. This provides a further reason for action to contain the rapidly increasing prevalence in the community of gastrointestinal infections known to trigger reactive arthritis.

Adolescent↗

PubMed1994

Etiopathogenesis of ankylosing spondylitis and reactive arthritis.

In ankylosing spondylitis and reactive arthritis, an interplay of microbe and major histocompatibility complex initiates a sequence of events resulting in chronic inflammation. With the use of molecular probes as direct evidence and immune response patterns as indirect evidence, a strong case has been made for a central role of local microbial antigen in reactive arthritis. Cofactors such as gender, persistent gut inflammation, and antibiotic treatment may contribute to this process. Studies of transgenic rats and of familial spondylitis implicate B27 itself as the critical host variable. The results of recent studies point to intimate B27-bacteria interrelationships. HLA-B27 and proteins from enteric bacteria are structurally related, in a manner that may affect T cell response to enteric pathogens. B27 also may directly affect host-microbe interactions by modulating the invasive potential of these bacteria into target cells. Studies are in progress to apply the predictions of these in vitro systems to the in vivo situations of these diseases. The insights of research in the spondyloarthropathies may find broad applications in the rheumatic diseases.

Animals↗

PubMed1999

Helicobacter pylori--a trigger of reactive arthritis?

Four cases of reactive arthritis (ReA) related to Helicobacter pylori (HP) are presented. These were identified by IgG, IgM and IgA ELISA tests performed on sera obtained from a 2-year prospective study on 186 patients with a clinical picture suggesting ReA as a possible diagnosis. If anti-HP IgM and IgA or IgG were positive, the case was considered related to HP. Three out of four HP ReA patients were originally classified as "possible ReA", i.e. having a clinical picture of ReA but without any identified triggering microorganism. IgG antibodies against cagA and vacA were detected in three and two cases respectively. The HP ReA patients did not present with typical clinical or laboratory features differentiating them from ReA induced by Chlamydia trachomatis (N = 25) or enteropathogenic bacteria (N = 27). However, compared to findings in patients with ReA due to enteropathogenic bacteria the number of active joints was higher (six versus two), duration of arthritis longer (3.9 weeks versus 2 weeks) and the CRP (C-reactive protein) lower (43 versus 59). Our findings suggest that HP may be included in the list of possible arthritis triggering microbes.

Adult↗

PubMed1983

[Clinical aspects of reactive arthritis caused by Chlamydia].

The authors compare a multicentered study of chlamydial reactive arthritis with their own personal series of 99 cases consisting of 58 cases of chlamydial reactive arthritis and 41 cases of non-chlamydial reactive arthritis. In the group with chlamydial reactive arthritis, mono-arthritis is more frequent and involvement of the knees, hands, wrists, the sausage appearance of the fingers and toes and heel pain are rarer than in non-chlamydial reactive arthritis. However, the genetic predisposition, in particular the presence of the HLA-B27 antigen, has an essential influence on the clinical features of reactive arthritis.

Adolescent↗

PubMedDate not supplied

Reactive arthritis. Immune-mediated synovitis or joint infection.

Reactive arthritis is one form of the seronegative Spondyloarthropathies. Susceptibility to reactive arthritis is closely linked to individuals who have the genetic predisposition to the HLA-B27 allele (gene form). Although there is a reactive-inflammatory joint reaction present, the synovium is not damaged by infectious agents (bacteria, fungi, or virus). This article discusses the pathogenesis of reactive arthritis.

Arthritis, Reactive↗

PubMed1997

Experimental Yersinia-triggered reactive arthritis: effect of a 3-week course of ciprofloxacin.

Lewis rats were injected i.v. with live Yersinia enterocolitica, resulting in 1-2 weeks in an arthritis greatly resembling human reactive arthritis. Starting on day 3, 5, 10 or 13 after the bacterial inoculation, the rats were treated for 3 weeks with 20 mg/kg/day of ciprofloxacin. The development of arthritis was completely prevented if the antibiotic treatment was started on day 3. In a group of rats treated with ciprofloxacin from day 5 onwards, 2/14 rats already showed mild arthritis at the time when the treatment was started. Antibiotic treatment cured the arthritis of these rats as well as that of one additional individual in this group which developed arthritis. No later exacerbations occurred. If the antibiotic treatment was started on day 10 or 13, i.e. at the time of well-developed arthritis, no effect on arthritis was observed; rather, increased faecal excretion of Yersinia occurred following the antibiotic treatment. We conclude that experimental Yersinia reactive arthritis can be cured by antibiotics introduced at an early phase of arthritic development. Regarding acute human enterogenic arthritis, the decision on antibiotic treatment is not a straightforward matter. Our experimental results indicate that the earlier the treatment is started, the better the result, whereas late treatments seem to favour bacterial persistence.

Animals↗

PubMed1989

[Forms of reactive arthritis].

This review describes the term reactive arthritis and Reiter syndrome. We enumerate all our patients with reactive arthritis in the years 1980 to 1985.

Arthritis, Infectious↗

PubMed1993

Reactive arthritis associated with Clostridium difficile pseudomembranous colitis.

Reactive arthritis is associated with several gastrointestinal pathogens, particularly Shigella, Salmonella, Campylobacter, and Yersinia. Another, less well recognized bowel infection leading to reactive arthritis is pseudomembranous colitis, caused by Clostridium difficile. An illustrative case is presented, and the clinical features and characteristics of all reported patients with this association are reviewed. The pathogenesis of the reactive arthritis seems to be related to an immunological response in joints and other tissues against bacterial antigens, which gain access to the systemic circulation through increased intestinal permeability. Therapy with nonspecific antiinflammatory drugs, anticlostridial agents, or a combination of the above is effective. Despite the possibility of persistent articular involvement after gastrointestinal symptoms have subsided, the long-term prognosis seems to be excellent.

Arthritis, Reactive↗

PubMed2006

Poncet's disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature.

OBJECTIVE: Reactive arthritis (ReA) in tuberculosis (TB) is known as Poncet's disease. It is a rare aseptic form of arthritis observed in patients with active TB. We present two such patients and review the literature on Poncet's disease. METHODS: Two patients who were identified with Poncet's disease at the Department of Rheumatology of Erasmus MC, Rotterdam University Hospital, during the last 5 yrs are reported. In addition, a review of the literature on Poncet's disease is given: the PubMed/MEDLINE database was studied up to December 2005 using the term 'Poncet's disease' and the terms 'arthritis', 'reactive' and 'tuberculosis'. RESULTS: After careful work-up, the polyarthritis and erythema nodosum in both presented patients with active TB could be diagnosed as Poncet's disease. Resolution of the arthritis with anti-TB drugs occurred in just a few days. Reviewing the literature, 50 case reports were found. In most reports 'Poncet's disease' was described as an aseptic polyarthritis, presumably ReA arthritis developing in the presence of active TB elsewhere. However, no uniform characterization of the term 'Poncet's disease' could be abstracted from these reports. CONCLUSION: Both presented patients and the review of the literature demonstrate that active TB may be complicated by ReA known as Poncet's disease. Early recognition of this rare complication of TB is of major importance to avoid delayed initiation of appropriate treatment.

Adult↗

PubMedDate not supplied

Poststreptococcal reactive arthritis: report of one case.

Poststreptococcal reactive arthritis (PSRA) is a clinical syndrome of reactive arthritis. It is associated with recent streptococcal infections, but could not fulfill the revised Jones criteria for acute rheumatic fever (ARF). The incidence of PSRA cardiac complications to develop was as high as the ARF's developing into rheumatic heart disease. A 9-year-old boy presented with limping gait. He had pain in his left knee for 4 days but no fever. His right knee was swelling with a limitation of movement. A throat culture showed positive growth for group A streptococcus, and consequently antistreptolysin-O serum titer and C-reactive protein were elevated. A synovial fluid examination was turbid but sterile. After 3 days the arthralgia subsided rapidly. A cardiac color Doppler and electrocardiogram showed no evidence of valvular disease. Under the threat of high incidence of rheumatic heart disease in PSRA, we treated this patient with prophylactic antibiotics as acute rheumatic fever. A clinic follow up one year later showed neither sequels nor heart murmur on physical examination.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1996

Synovial fluid and serum antibodies against Chlamydia in different forms of arthritis: intra-articular IgA production in Chlamydia sexually acquired reactive arthritis.

Since the presence of Chlamydia has been shown in synovial fluid (SF) from some patients with Chlamydia reactive arthritis, we investigated whether anti-Chlamydia antibodies present in the joint are derived from the circulation or are locally produced. We compared titres of IgG, IgM and IgA antibodies against Chlamydia, and against a control antigen (tetanus toxoid), by an enzyme-linked immunosorbent assay (ELISA), in paired samples of serum and SF from Chlamydia trachomatis sexually acquired reactive arthritis (CT-SARA) patients and from patients with other forms of arthritis. The ratio of serum/SF IgA anti-Chlamydia antibodies was significantly decreased in CT-SARA patients. It is concluded that, in our experimental conditions, we found evidence for intra-articular production of IgA anti-Chlamydia antibodies.

Adolescent↗

PubMed1992

Salmonella-triggered reactive arthritis.

Clinical significance of Salmonella-triggered reactive arthritis is rising, because the frequency of Salmonella infections is increasing all over the world. In this study reports on Salmonella-triggered reactive arthritis have been reviewed. A summary of clinical, epidemiological and laboratory data, as well as triggering serotypes, is presented. Diagnostic and therapeutic aspects are also discussed.

Arthritis, Reactive↗

PubMed2004

[Diagnosis of reactive arthritis].

For the diagnosis of reactive arthritis, there is no single test. A combination of different parameters such as clinical presentation and laboratory parameters is necessary. Here we suggest a procedure for clinical practice of which tests should be performed when, based on the individual situation. To assess the clinical value of a test, it is not only necessary to know the specificity and sensitivity of a test but also the assumed likelihood of the disease (pretest probability).

Algorithms↗

PubMed1997

Enterobacteria-infected T cells as antigen-presenting cells for cytotoxic CD8 T cells: a contribution to the self-limitation of cellular immune reactions in reactive arthritis?

In enterobacteria-induced reactive arthritis (ReA), different T cell subsets play a role in the induction and maintenance of the synovitic process. Synovial fluid-derived alphabeta CD4, alphabeta CD8, and gammadelta T lymphocyte clones (TLC) that recognize Yersinia or Salmonella antigens on professional antigen-presenting cells (APC) have been characterized, and T cells themselves can function as nonprofessional APC. T cells were infected with the facultatively intracellular, arthritogenic enterobacterium Yersinia enterocolitica O:3. A CD8 TLC isolated from a patient with Yersinia-induced ReA recognized and efficiently lysed autologous and allogeneic Yersinia-infected T cells. Infected cytotoxic T lymphocytes (CTL) had a reduced lytic capacity against syngeneic and allogeneic infected target cells, suggesting that the infection of CTL by bacteria may represent a mechanism of immune escape. In ReA, antigen presentation by T cells may modify the antibacterial immune response and may also contribute to network control mechanisms of T cell-mediated cytotoxicity.

Animals↗

PubMed2000

Ciprofloxacin v placebo for treatment of Yersinia enterocolitica triggered reactive arthritis.

Patients with yersinia triggered reactive arthritis were double blind randomly allocated to receive treatment with ciprofloxacin 500 mg twice daily orally or placebo during three months. The diagnosis was made by serology (specific IgA and IgG antibodies to yersinia outer membrane proteins (yops)), positive culture, and/or demonstration of Yersinia enterocolitica antigen in colon biopsy specimens. Patients were evaluated monthly during and after treatment up to 12 months. Of 18 patients enrolled, all could be evaluated for safety, 16 for efficacy. There was a tendency towards faster remission and relief of pain in those receiving ciprofloxacin. Y enterocolitica was eliminated from the gut associated lymphoid tissue in six of seven patients receiving ciprofloxacin compared with none of nine patients receiving placebo. Patients receiving placebo had more and prolonged circulating IgA antibodies against yops than patients treated with ciprofloxacin.

Adolescent↗

PubMed2001

Bacteria-Triggered reactive arthritis: implications for antibacterial treatment.

Reactive arthritis (ReA) is definitely caused by an infection. Several observations suggest that the triggering microbe may persist in the tissues of the patient for a prolonged time. The obvious conclusion is to consider antibacterial treatment. In two instances antibacterial agents are of definite value: in the primary and secondary prevention of rheumatic fever and for early eradication of Borrelia burgdorferi in order to prevent development of the arthritis associated with Lyme disease. Altogether, clinical and experimental data exist to indicate that if antibacterial treatment of ReA can be started very early during the pathogenetic process, the disease can be prevented or the prognosis improved. In fully developed ReA, the value of antibacterial agents is less certain. All available evidence indicates that short term antibacterial treatment has no effect on the prognosis and final outcome of ReA, and the results with long term administration of antibacterials are also overall poor. In some instances sulfasalazine appears useful, rather as a result of its antirheumatic effect or influence on an underlying inflammatory bowel disease than its action as an antibacterial agent. Tetracyclines have also been found to have an effect on ReA, but again, this is probably due to their anti-inflammatory action rather than any antibacterial effect.

Anti-Bacterial Agents↗

PubMed1994

Reactive arthritis and Reiter's syndrome.

Reactive arthritis is an important source of morbidity. It is acquired through infectious agent diarrhea (food poisoning) or from sexual contact. Recognition is important because it allows a therapeutic approach that usually results in improvement of quality of life.

Arthritis, Reactive↗

PubMed1993

Release of cartilage macromolecules into the synovial fluid in patients with acute and prolonged phases of reactive arthritis.

OBJECTIVE: Extensive changes in articular cartilage metabolism occur during the acute phase of reactive arthritis, as indicated by altered release of cartilage macromolecules into synovial fluid (SF) demonstrated immunochemically. Nevertheless, permanent cartilage lesions are rare in this disease. To monitor specific events during the evolution of reactive arthritis, we investigated the content of cartilage macromolecules in sequentially obtained SF samples from 22 patients. METHODS: Two groups of proteoglycan epitopes, the glycosaminoglycan-rich region of aggrecan (referred to as proteoglycan) and its hyaluronan-binding region (HABr), as well as one matrix protein, cartilage oligomeric matrix protein (COMP), were quantified by immunoassay. RESULTS: SF proteoglycan concentrations, which were initially elevated, decreased significantly with prolonged arthritis, whereas COMP levels changed less markedly and levels of HABr remained stable. There was a positive correlation between SF and serum concentrations of COMP in samples obtained during the early phase of the disease. CONCLUSION: Cartilage involvement in reactive arthritis is transient, in contrast to findings in rheumatoid arthritis. Reactive arthritis should therefore be a suitable model for studies of repair processes in cartilage, which will facilitate understanding of the pathophysiology of cartilage involvement in arthritis.

Adult↗