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PubMed1993

Beta haemolytic streptococci and reactive arthritis in adults.

There is an increasing occurrence of reactive group A beta haemolytic streptococci (BHS) phenomena. This review makes a case for considering BHS in the differential diagnosis of adult reactive arthritis. This is based on (a) published reports over the past 45 years describing first attacks of rheumatic fever in adults; (b) the longstanding observation that polyarthritis is the most commonly expressed Jones major criterion in adults; (c) the broad spectrum of clinical expression of disease following streptococcal infection, with the re-emergence of the term 'poststreptococcal reactive arthritis'. The arthritis in adult rheumatic fever is characterised by sequential involvement of large weightbearing joints. Recurrent, severe, prolonged arthritis has been a prominent feature of adult poststreptococcal reactive arthritis. Carditis has been reported in 33% of adult patients with rheumatic fever. Consequently long term antibiotic prophylaxis for adults with reactive BHS phenomena should be strongly considered, and guidelines are suggested for this in individual patients. Further areas for research are discussed, particularly the interrelations between bacteria and host in disease expression, and the possibility that BHS might play a part in chronic arthritides and vasculitides.

Adult↗
PubMed1993

Reactive arthritis induced by Vibrio parahaemolyticus.

We describe a case of reactive arthritis after Vibrio parahaemolyticus infection. V. parahaemolyticus is the principal bacteria involved in the causation of foodborne gastroenterocolitis outbreaks in Japan. Several bacteria have been recognized as being involved in the development of reactive arthritis and this is the first report of reactive arthritis induced by V. parahaemolyticus.

Adult↗
PubMed2003

[Diagnostic and therapeutic problems in SARA syndrome (sexually acquired reactive arthritis) particularly considering the role of Chlamydia trachomatis].

Reactive arthritis triggered by a sexually transmitted infection is referred to as sexually acquired reactive arthritis (SARA). There is no gold standard for the diagnosis of SARA. None of the tests or the clinical symptoms alone are strong enough to make a definite diagnosis of SARA. Tests to identify Chlamydia trachomatis, when respect typical clinical symptoms are helpful to make the diagnosis of ReA.

Arthritis, Reactive↗
PubMed2000

HLA-B27 expression and reactive arthritis susceptibility in two patient cohorts infected with Salmonella Typhimurium.

BACKGROUND: Reactive arthritis (ReA) is an inflammatory arthritis triggered by certain gastrointestinal and genitourinary infections. Single source outbreaks of triggering infections provide an opportunity to elucidate host susceptibility factors in this disease. AIM: To determine the role of Major Histocompatibility Complex (MHC) Class I alleles in ReA susceptibility after two large single source outbreaks of Salmonella Typhimurium gastroenteritis. METHODS: A questionnaire screening for features of ReA and a request for HLA class I typing were sent to all patients affected by two single source outbreaks of S. Typhimurium gastroenteritis. Individuals with arthritis of recent onset were interviewed, examined and diagnostic criteria for ReA applied. RESULTS: Nineteen cases of reactive arthritis, 11 female, were diagnosed in the 424 respondents with S. Typhimurium gastroenteritis from both outbreaks. Clinical features of the arthritis were similar to those described after other large single source outbreaks of Salmonella infection. HLA-B27 was expressed by only two of the 19 ReA patients and therefore did not predict susceptibility to this form of arthritis. Caucasians were, however, more likely to develop reactive arthritis than Asians. CONCLUSIONS: In this study, susceptibility to ReA was not increased in HLA-B27 positive individuals or males but was greater in those of Caucasian descent.

Adolescent↗
PubMed2000

Analysis of the antigen-specific T cell response in reactive arthritis by flow cytometry.

OBJECTIVE: In reactive arthritis (ReA) a bacteria-specific T cell response to the triggering microbe is detected in synovial fluid (SF), and an impaired Th1 cytokine response has been described. The recent identification of immunodominant bacterial proteins/peptides and new technologies make a more detailed analysis of the immune response possible. The aim of the present study was to use these new techniques to determine the antigen-specific T cell frequency and the cytokine secretion pattern on stimulation with bacteria-derived recombinant proteins in the peripheral blood (PB) and SF from patients with ReA. METHODS: In 3 patients with Chlamydia-induced ReA and 2 patients with Yersinia-induced ReA, the SF T cell response was investigated after stimulation with the Chlamydia-derived proteins major outer membrane protein (MOMP) and heat-shock protein 60 (Hsp60) and the Yersinia-derived proteins 19-kd protein and Hsp60. In 3 of these patients, the PB T cell response was investigated in parallel. T cells were stimulated in whole blood or whole SF with antigen plus anti-CD28 for 6 hours, brefeldin A was added after 2 hours, and cells were fixed and stained with antibodies against the surface markers CD4 and CD69 and against the cytokines interferon-gamma (IFNgamma), tumor necrosis factor alpha, interleukin-10 (IL-10), and IL-4. Positive cells were quantified by flow cytometry. RESULTS: In the 3 patients with Chlamydia-induced ReA, the antigen-specific T cell frequency (percentage of IFNgamma CD69 double-positive CD4+ T cells) in response to MOMP (mean +/- SD 1.2 +/- 1.38%) and to Hsp60 (1.21 +/- 1.45%) in SF was about the same. In the 2 patients with Yersinia-induced ReA, the mean +/- SD frequency was 0.66 +/- 0.36% in response to the Hsp60 and 03% +/- 0.22 in response to the 19-kd protein. In the 3 patients whose PB was evaluated, the corresponding T cell response was > or =10 times lower. In 2 patients with Chlamydia-induced ReA, antigen-specific IL-10-positive CD4+ T cells were detected in 0.10-0.23% of the CD4+ T cell subpopulation. CONCLUSION: The frequency of antigen-specific T cells to Chlamydia- and Yersinia-derived antigens in the SF of ReA patients is between 1:200 and 1:50. Both the chlamydial Hsp60 and MOMP are dominant T cell antigens in Chlamydia-induced ReA. In patients with Chlamydia-induced ReA, we detected antigen-specific IL-10 secretion, which might mediate an inhibition of effective bacterial clearance.

Adult↗
PubMed1994

Collagen-specific cytotoxic T lymphocyte responses in patients with ankylosing spondylitis and reactive arthritis.

Both ankylosing spondylitis (AS) and reactive arthritis (ReA) are strongly associated with HLA-B27 although the mechanism for this association is still unknown. Here we examine the hypothesis that B27-restricted, joint antigen-specific cytotoxic T lymphocytes (CTL) may be the driving force of AS and ReA. Type II and type XI procollagens (CII and CXI, respectively), expressed almost exclusively in the articular cartilage of the joints, were chosen as the possible targets of autoimmune CTL. Type I procollagen (CI), expressed in many different tissues, was also included as control. Nineteen nonamer peptides bearing appropriate HLA-B27 binding motifs from human CI, CII and CXI were identified and synthesized. When analyzed for binding affinity to HLA-B27 in assembly assays, four (two from CII, two from CXI) were found capable of binding to HLA-B27 with high affinity. These B27-binding collagen peptides were then used to stimulate peripheral blood lymphocytes from eight B27-positive AS and three ReA patients for identification of possible B27-restricted autoimmune CTL. HLA-B27-restricted CTL specific for one of the CII peptides, P109 were found in one of the ReA patients, but in none of the others.

Adult↗
PubMed2004

Clostridium difficile-associated reactive arthritis in two children.

In adults, reactive arthritis (ReA) following Clostridium difficile-enterocolitis has been documented. In children, only one case of C. difficile-associated ReA has been reported. We now describe two other cases of ReA associated with C. difficile in children. The characteristics of ReA due to C. difficile appear to be similar in adults and children. Both children show polyarthritis after an episode of diarrhoea with positive stool cultures for C. difficile. Arthritis is asymmetrical with a self-limiting course. Nonsteroidal antiinflammatory drug (NSAID) therapy is sufficient. One case is remarkable because of its prolonged course of ReA despite NSAID therapy, and its association with the presence of HLA-B27 antigen.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Reactive arthritis: advances in diagnosis and treatment].

Reactive Arthritis (ReA) is an aseptic synovitis developing after a primary infection distant from the joint, mainly localized in the gastrointestinal (Enteroarthritis) or genitourinary tract (Uroarthritis). Because of either the asymmetric joint involvement, the possibility of involvement of the spine and enthesis, and the HLA-B27 association ReA is considered one of the spondylarthropathies. Recently, bacterial components or viable bacteria were found in joints during ReA. For this reason, the limits between ReA itself and infectious arthritis are now less definite. Generally accepted diagnostic and classification criteria are still lacking but the improvement in techniques for detection of bacteria increase the possibility to identify the triggering agents. Several studies have examined the role of antimicrobial drugs in ameliorating the natural course of ReA, with some positive results for Uroarthritis only. However, more conventional treatments based on NSAIDs, sulfasalazine and steroids are effective in many cases.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Reactive arthritis and its etiopathogenic mechanisms].

The reactive arthritis is an important clinical entity, which is under intense scientific investigation particularly in what concerns to the infective agent and the immunological mechanisms involved in its pathogenesis. The infective agents, as well as the antigens and the cellular immune response lead to arthritis after a sequence of events. Some important aspects, such as the genetic predisposition of some individuals, the intracellular life cycle of the bacteria, the mucosal membranes as the site of penetration of the infectious agent, as well as the lipopolysaccharide as the most important component of the membrane, are extensively discussed. The importance of better understanding this disease will end up in the amelioration of therapeutic approach.

Antigens, Bacterial↗
PubMedDate not supplied

Reactive arthritis: is it a useful concept?

Reactive arthritis (ReA) is one of the most common arthritides affecting young adults. In most cases it follows urogenital or enteric bacterial infection, but its pathogenesis is not fully understood. It is generally considered a sterile arthritis which appears to involve immune response to bacterial organisms and genetic host susceptibility associated with the presence of HLA-B27 antigen. New findings suggest that in some ReA cases, viable bacteria are present inside the joints, and these organisms may cause the disease and trigger the inflammatory response. ReA manifests clinically as a rheumatoid factor negative oligoarthritis associated with enthesopathy and certain mucosal and skin lesions. Laboratory findings in ReA are non-specific. Although concepts of its pathogenesis are still evolving, so-called ReA remains an important condition to be distinguished from rheumatoid arthritis. Prognosis is generally better. Treatments with known effects in some cases include non-steroidal anti-inflammatory drugs, intra-articular corticosteroids, oral tetracyclines and sulphasalazine. The occasional chronic and severe ReA may be very difficult to treat.

Adult↗
PubMed1998

[HLA-antigens and some pathogenetic aspects of reactive arthritis].

AIM: Investigation of associations of reactive arthritis (ReA) with histocompatibility antigens class I and II and determination of new approaches to assessment of association ReA with antigen HLA B27. MATERIALS AND METHODS: 118 ReA patients with associated intestinal and 82 ReA patients with associated urogenital infection were studied. The infection was identified bacteriologically, with agglutination reaction, enzyme immunoassay, direct and indirect immunofluorescence, culturing. HLA-antigens were studied in lymphocytotoxic test: locus A, B and C in all the patients, DR in 65 patients. RESULTS: ReA triggers were intracellularly parasite bacteria: facultative parasites in the enterocolitic variant (Yersinia, as a rule), obligate parasite in the urogenital (Chlamidia, as a rule). HLA B27 antigen was discovered in 77.5% of patients (RR 45.8), HLA DR1--in 48.4% of patients (RR 3.3). In urogenital variant HLA B27 antigen occurred more frequently than in enterocolitic: 87.8% (RR 95.6) versus 70.3% (RR 31.5); p < 0.01). In HLA-B27-positive patients compared to HLA-B27-negative ones there were higher ESR (p < 0.001), leukocyte count (p < 0.05), concentrations of CRP and alpha-2-globulins (p < 0.001). CONCLUSION: In HLA-B27-subjects optimal conditions exist for generalization of obligate parasites and favorable for production of facultative ones. The degree of association of ReA with HLA B27 antigens is dependent on adaptive features of microorganisms appearing in the process of evolution--obligaty and facultativeness of their internal parasitivity.

Adult↗
PubMed2003

Reactive arthritis, psoriasiform lesions and protein loosing enteropathy secondary to Strongyloidiasis.

Reactive arthritis is associated with demonstrable infection at a distant site without evidence of sepsis at the affected joint(s). We present a rare case reactive arthritis where no bacterial or chlamydial infections could be established, rather larvae of Strongyloides stercoralis could be demonstrated in the stool and duodenal biopsy. Reactive arthritis, psoriasiform lesions and malabsorption with hypoproteinaemia, responded to successful treatment with antihelminthic drugs. Early recognition and adequate treatment for gastrointestinal infections and infestations before complications is important.

Adult↗
PubMed2003

[Mycoplasmal infection in patients with reactive arthritis and seronegative spondyloarthropaties].

After investigation of 150 patients with reactive arthritis and undifferentiated spondyloarthropathies, inflammation signs of urogenital tract (uretritis in men and endocervicitis in women) were found in about 2/3 of patients. In those patients with reactive arthritis and undifferentiated spondyloarthropathies Ureaplazma urealyticum was found in more than 1/4 of patients, Mycoplasma hominis - in 1/10 of patients, and both microbes appeared in 1/10 of patients. Micoplasmal infection occurred in equal frequency in patients with reactive arthritis and undifferentiated spondyloarthropathies with a tendency to appear more in women than in men.

Adult↗