Abstract
IntroductionBacteria and/or their antigens have been implicated in the pathogenesis of reactive arthritis (ReA). Several studies have reported the presence of bacterial antigens and nucleic acids of bacteria other than those specified by diagnostic criteria for ReA in joint specimens from patients with ReA and various arthritides. The present study was conducted to detect any bacterial DNA and identify bacterial species that are present in the synovial tissue of Tunisian patients with reactive arthritis and undifferentiated arthritis (UA) using PCR, cloning and sequencing.MethodsWe examined synovial tissue samples from 28 patients: six patients with ReA and nine with UA, and a control group consisting of seven patients with rheumatoid arthritis and six with osteoarthritis (OA). Using broad-range bacterial PCR producing a 1,400-base-pair fragment from the 16S rRNA gene, at least 24 clones were sequenced for each synovial tissue sample. To identify the corresponding bacteria, DNA sequences were compared with sequences from the EMBL (European Molecular Biology Laboratory) database.ResultsBacterial DNA was detected in 75% of the 28 synovial tissue samples. DNA from 68 various bacterial species were found in ReA and UA samples, whereas DNA from 12 bacteria were detected in control group samples. Most of the bacterial DNAs detected were from skin or intestinal bacteria. DNA from bacteria known to trigger ReA, such as Shigella flexneri and Shigella sonnei, were detected in ReA and UA samples of synovial tissue and not in control samples. DNA from various bacterial species detected in this study have not previously been found in synovial samples.ConclusionThis study is the first to use broad-range PCR targeting the full 16S rRNA gene for detection of bacterial DNA in synovial tissue. We detected DNA from a wide spectrum of bacterial species, including those known to be involved in ReA and others not previously associated with ReA or related arthritis. The pathogenic significance of some of these intrasynovial bacterial DNAs remains unclear.
Highlights
Bacteria and/or their antigens have been implicated in the pathogenesis of reactive arthritis (ReA)
We detected DNA from a wide spectrum of bacterial species, including those known to be involved in ReA and others not previously associated with ReA or related arthritis
Bacterial 16S rDNA was amplified in synovial tissue (ST) samples from three of the seven patients with rheumatoid arthritis (RA) (43%) and from three of the six with OA (50%)
Summary
Bacteria and/or their antigens have been implicated in the pathogenesis of reactive arthritis (ReA). Many cases of ReA are preceded by infections that are asymptomatic [6]; such cases are clinically classified as undifferentiated arthritis (UA) [7,8]. This term describes patients who exhibit arthritis clinically similar to ReA, with high rates of monoarthritis or oligoarthrithis, and predominance of synovitis in the lower limbs. This has led several investigators to suggest a potential link between these two forms of arthritis, and that UA and ReA are overlapping entities. Several groups have detected C. trachomatis DNA in the synovium of patients with UA [9], suggesting that some of these patients may have a 'forme fruste' of ReA
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