[Value of antigen, antibody and pathogen-specific lymphocyte detection in diagnosis of pathogen-induced arthritis]

In the differential diagnosis of infection-related arthritis (infectious arthritis, viral arthritis, reactive arthritis or Reiter's syndrome, Lyme disease) various laboratory methods are applied for the detection of the inciting antigen, specific antibodies or microbe-specific T-lymphocytes. In infectious (septic) bacterial or fungal arthritis, the definitive diagnosis can be made only by recovering the organism from the synovial fluid or membrane. Also, in reactive arthritis following extraarticular infection with Yersinia, Salmonella, Shigella, Campylobacter, or Chlamydia, one of the major shifts in perception of disease pathogenesis has been the detection of bacterial determinants by immunological methods and polymerase chain reaction (PCR) actually within the joint. In sexually acquired reactive arthritis, the etiologic diagnosis should be based on the direct detection of the pathogen (mainly C. trachomatis) from the urogenital smear specimen. For clinical routine, serological tests for bacteria specific antibodies (IgM and IgA class) are often necessary to show recent or persistent infection with the triggering pathogen. However, a cautionary note regarding the diagnostic significance of antibacterial antibody profiles has been sounded in several studies because of the high prevalence of bacteria-specific antibodies in the healthy population. The same problem may arise in the interpretation of virus-specific antibodies in the differential diagnosis of acute polyarthritis. Antigen-specific proliferation of synovial fluid lymphocytes can confirm the clinical diagnosis in patients with reactive arthritis and Lyme disease, although unspecific proliferation to several bacteria can also be observed in reactive arthritis as well as in many other arthritis.