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Chlamydia trachomatis in reactive arthritis.

A Keat¹, B Thomas, R Hughes

¹Department of Rheumatology, Westminster Hospital, London, UK.

Rheumatology International

|January 1, 1989

Summary

Chlamydia trachomatis antigen was detected in the joints of patients with reactive arthritis, suggesting a role for this bacterium in the disease's development. This finding supports the hypothesis that genital Chlamydia infections can trigger joint inflammation.

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Area of Science:

Immunology
Microbiology
Rheumatology

Background:

Reactive arthritis is a form of inflammatory arthritis that affects joints.
Sexually acquired reactive arthritis (SARA) is a specific type of reactive arthritis.
The role of Chlamydia trachomatis in the pathogenesis of reactive arthritis is debated.

Purpose of the Study:

To investigate the presence of Chlamydia trachomatis antigen in the synovial fluid and biopsies of patients with reactive arthritis.
To determine the association between Chlamydia trachomatis infection and reactive arthritis.

Main Methods:

Direct immunofluorescence test using a monoclonal antibody to Chlamydia trachomatis major outer membrane protein.
Analysis of synovial fluid cell smears and synovial biopsies.

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Serological testing for high titers of serum chlamydial antibody.

Genital-tract cultures for Chlamydia trachomatis isolation.

Main Results:

Chlamydial antigen was detected in the joints of 6/10 patients with SARA and 5/15 women with unclassified oligoarthritis.
High titers of serum chlamydial antibody were found in all antigen-positive SARA patients and 3/5 women with unclassified arthritis.
Chlamydia trachomatis was isolated from the genital tract of 3 SARA patients.

Conclusions:

Chlamydia trachomatis antigen can be deposited in the joint during acute genital-tract infection.
The presence of chlamydial antigens in the joint is associated with reactive arthritis.
Processing and presentation of chlamydial antigens may be critical in initiating reactive arthritis in susceptible individuals.