Reiter's syndrome and reactive arthritis: a current view

Area of Science:

• Rheumatology
• Immunology
• Microbiology

Background:

• Reactive arthritis is an inflammatory aseptic joint disease.
• It is often preceded by infections from various microorganisms.
• The presence of bacterial antigens in joints of affected patients is established.

Purpose of the Study:

• To review advances in understanding reactive arthritis pathogenesis.
• To discuss the role of microbial components and HLA-B27.
• To explore immunopathogenesis and future research directions.

Main Methods:

• Review of recent literature on reactive arthritis.
• Detection of bacterial antigens (DNA, RNA, lipopolysaccharide) in joints.
• Immunological techniques and polymerase chain reaction (PCR) for pathogen identification.
• Analysis of humoral and cellular immune responses.
• Discussion of HLA-B27's role and molecular mimicry.

Main Results:

• Bacterial components, including DNA and lipopolysaccharide, are confirmed in affected joints.
• Specific pathogens like Chlamydia trachomatis, Salmonella enteritidis, and Shigella flexneri have been detected.
• While viable bacteria are unlikely, chlamydial DNA is found in sexually acquired reactive arthritis.
• HLA-B27 may influence disease susceptibility through mechanisms beyond antigen presentation.
• Evidence for molecular mimicry remains inconclusive.

Conclusions:

• Advances in understanding reactive arthritis pathogenesis have been made.
• Bacterial antigens play a significant role, though viable organisms are rare.
• The interplay between genetic factors like HLA-B27 and microbial triggers is crucial.
• Further research into antimicrobial therapy and immunopathogenesis is warranted.