Chronic Reactive Arthritis Research Articles

Bull's head sign in chronic reactive arthritis.

Bull's head sign in chronic reactive arthritis.

Diffusion Tensor and Dynamic Contrast-Enhanced Magnetic Resonance Imaging Correlate with Molecular Markers of Inflammation in the Synovium.

It is difficult to capture the severity of synovial inflammation on imaging. Herein we hypothesize that diffusion tensor imaging (DTI) derived metrics may delineate the aggregation of the inflammatory cells and expression of inflammatory cytokines and dynamic contrast-enhanced (DCE) imaging may provide information regarding vascularity in the inflamed synovium. Patients with knee arthritis (>3-months duration) underwent conventional (T2-weighted fast spin echo and spin echo T1-weighted images) as well as DTI and DCE MRI and thereafter arthroscopic guided synovial biopsy. DCE and DTI metrics were extracted from the masks of the segments of the inflamed synovium which enhanced on post-contrast T1-weighted MRI. These metrics were correlated with immunohistochemistry (IHC) parameters of inflammation on synovium. Pearson's correlation was performed to study the relationship between DTI- and DCE-derived metrics, IHC parameters, and post-contrast signal intensity. Linear regression model was used to predict the values of IHC parameters using various DTI and DCE derived metrics as predictors. There were 80 patients (52 male) with mean age 39.78 years and mean disease duration 19.82 months. Nineteen patients had tuberculosis and the rest had chronic undifferentiated monoarthritis (n = 31), undifferentiated spondyloarthropathy (n = 14), rheumatoid arthritis (n = 6), osteoarthritis (n = 4), reactive arthritis (n = 3), ankylosing spondylitis (n = 2), and juvenile idiopathic arthritis (n = 1). Fractional anisotropy (FA), a metric of DTI, had significant correlation with number of immune cells (r = 0.87, p < 0.01) infiltrating into the synovium and cytokines (IL-1β, r = 0.55, p < 0.01; TNF-α, r = 0.42, p < 0.01) in all patients and also in each group of patients and adhesion molecule expressed on these cells in all patients (CD54, r = 0.51, p < 0.01). DCE parameters significantly correlated with CD34 (blood flow, r = 0.78, p < 0.01; blood volume, r = 0.76, p < 0.01) in each group of patients, a marker of neo-angiogenesis. FA was the best predictor of infiltrating inflammatory cells, adhesion molecule and proinflammatory cytokines. Amongst the DCE parameters, blood volume, was best predictor of CD34. DTI and DCE metrics capture cellular and molecular markers of synovial inflammation in patients with chronic inflammatory arthritis.

P34 A case of Entamoeba histolytica infection in a patient with polymyalgic-onset inflammatory arthritis

P34 A case of Entamoeba histolytica infection in a patient with polymyalgic-onset inflammatory arthritis

In Vitro Modelling of Chlamydia trachomatis Infection in the Etiopathogenesis of Male Infertility and Reactive Arthritis.

Chlamydia trachomatis is an obligate, intracellular bacterium responsible for a range of diseases of public health importance, since C. trachomatis infection is often asymptomatic and, hence, untreated, leading to chronic complications, including prostatitis, infertility, and reactive arthritis. The ample spectrum of diseases caused by C. trachomatis infection is reflected in its ability to infect and multiply within a wide range of different cell types. Cervical epithelial cells, to date, have been the most studied cellular infection model, highlighting the peculiar features of the host-cell inflammatory and immune responses to the infection. Herein, we provide the up-to-date evidence on the interaction between C. trachomatis and human prostate epithelial, Sertoli and synovial cells.

COMMON ORAL MUCOSAL LESIONS IN PATIENTS WITH OR WITHOUT CHRONIC VIRAL HEPATITIS

<h3>Background</h3> Oral mucosal bullous, desquamative ulcerative diseases involve immunopathologic mechanisms that account for loss of adhesion between contiguous keratinocytes or to structures within the basal lamina. <h3>Objective</h3> To study and understand the etiology and pathogenicity of the oral mucosal lesions in patients with or without chronic viral hepatitis. <h3>Methods</h3> Five patients were selected to make the clinical and morphopathologic diagnosis by biopsy of the affected tissue. Three had chronic viral hepatitis. <h3>Results</h3> Five patients (4 female and 1 male) were diagnosed with oral mucosal lesion. Three had oral lichen planus, 1 had a lichenoid reaction, and 1 had focal (frictional) hyperkeratosis with nicotine stomatitis of hard palate and smoking-associated melanosis. Common lesions were minimal clinical symptomatic lesions on the cheeks, extending to the lateral parts of the tongue, gums, and lips. General status of the patients is distinguished by numerous general chronic diseases including viral chronic hepatitis, erythematous gastritis, reactive arthritis, and vegetative nervous dysfunction. <h3>Conclusions</h3> Oral lichenoid reactions represent a common endpoint in response to extrinsic agents, altered self‐antigens, or superantigens. Oral lichen planus, a common inflammatory disorder with an unidentified etiology, shares many clinical and histopathologic features with oral lichenoid drug reaction and oral lichenoid contact reaction. Oral lichenoid reactions represent a common endpoint in response to extrinsic agents, altered self‐antigens, or superantigens. Clinical presentation can vary from asymptomatic white reticular striae to painful erythema and erosions. Most immunopathologic oral mucosal diseases have the risk of malignancy and require special attention.

Spondyloarthritis Associated with Inflammatory Bowel Disease: Study of 15 Observations in Guinea

Objective: Rheumatologic disorders of chronic inflammatory bowel disease (IBD) and reactive arthritis with a digestive origin are part of the spondyloarthritis family. In black Africa, the prevalence of SpA associated with IBD is not clearly established. Thus the objective of our study was to describe the clinical and radiological characteristics of spondyloarthritis associated with IBD. Patients and Method: We carried out a prospective study in the rheumatology department of CHU Ignace Deen between January and December 2019. The diagnosis of SpA was based on clinical and biological arguments in accordance with the criteria of Amor and ASAS. Results: Fifteen observations of spondyloarthritis associated with IBD were collected in patients mean age 52 years with extremes of 32 and 65 years. 9 (53.33%) were female. Ten patients had Crohn’s disease (CD) and 5 had ulcerative colitis (UC). The mean number of pushes was 2.5 ± 1.2. The average diagnostic time was 46 months. Sacroiliitis was present in 73.3% of cases and the mean mSASSS score at diagnosis was 32.11/72. In total, corticosteroids were used in 9 (60%) of patients, NSAIDs in 26.6% while DMARDs salazopyrine and methotrexate in 33.3% and 20% of patients, respectively. Conclusion: The MICI and SpA association is undoubtedly underestimated in our regions. Better collaboration between rheumatologists and gastroenterologists could facilitate diagnosis and improve care.

Evolving patterns of reactive arthritis.

To characterize rheumatologists' perspectives on evolving trends of reactive arthritis (ReA). After ethics approval, 548 members of the Canadian Rheumatology Association were surveyed with 37 questions covering their demographic information, subspecialty, level of experience, practice setting and opinions on prevalence, treatment, and causes of ReA. Results were analyzed with descriptive statistics. Ninety-seven responded to the survey (18% response rate); 66 fully completed it. Nearly half of respondents believed that the incidence of ReA is declining and causes of ReA may be changing. Physicians reported that most of the ReA cases in their practices were caused by an unknown organism, sexually transmitted, or gastrointestinal infection. Full triad ReA increased the chance of recurrence according to their impressions. Common investigations in ReA included inflammatory markers, HLA-B27, chlamydia and gonorrhea testing, stool cultures, synovial fluid analyses, SI joint imaging. ReA treatment included NSAIDs, intra-articular corticosteroid injections, and DMARDs. Two-thirds said they used TNF alpha inhibitors in chronic ReA occasionally or more frequently. ReA may be decreasing in frequency and severity in Canada. Changes could be due to less food borne illness, cleaner water, or more rapid treatment of sexually transmitted infections. The cause is often unknown in clinical practice.Key Points• Reactive arthritis (ReA) is likely decreasing in prevalence and severity.• Patients with classic trial of arthritis, urethritis, and conjunctivitis are more likely to have recurrent and/or chronic ReA.• The causal organisms are often not detected and seem to be changing over time.

A retrospective case series of 12 patients with chronic reactive arthritis with emphasis on treatment outcome with biologics.

Patients with reactive arthritis frequently present to dermatologists. However, there is paucity of information regarding its clinical aspects and management in dermatological literature. To review the clinical features and management of patients with chronic reactive arthritis admitted to the dermatology department of a teaching hospital. This was a retrospective analysis of patients with reactive arthritis admitted to the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India from January 2016 to February 2018. There were 12 males (disease duration 9-180 months). Biologics were used in 9 (75%) patients on 16 different occasions, the most frequent being infliximab (n = 10 times), followed by adalimumab (n = 3), etanercept, secukinumab and itolizumab (n = 1 each), in combination with other systemic agents. Response rate with treatment regimens including biologics (69% responders, 31% partial responders) was statistically significantly better than those without biologics (27% responders, 46% partial responders, 27% nonresponders; P = 0.036), using a composite measure assessing improvement in skin and joint symptoms. Biologics were discontinued on 50% of the occasions, after a median of 3.5 months (range 1.5-7.5 months) because of satisfactory response (n = 4), therapeutic fatigue (n = 3) or adverse event (n = 1). After biologic discontinuation, the response was sustained for a median of 5 months (range 3-6 months) before disease exacerbation. The number of treatment switches increased with the follow-up duration (median three switches per patient, range 1-8). The median follow-up duration was 10.5 months (range 4-76 months). Biologics produce rapid improvement in skin and joint symptoms in chronic reactive arthritis, but the response is not long-lasting. Patients with chronic reactive arthritis have a waxing and waning course despite regular treatment. The limitations are retrospective design, small sample size and lack of a validated outcome measure.

Optimization of the method for predicting clinical outcomes of reactive arthritis in children

The comparative analysis of content of cytokine and significant local antimicrobial factors (IL-6, IL-8, IL-17, INF-γ, TNF-α, IL-10, CRP, lysozyme, lactoferrin) in the coprofiltrates and serum of patients with acute and chronic reactive arthritis (ReA) made it possible to determine the markers predicting the course and outcomes of arthritis. It is established that the method of predicting ReA involving the analysis of the parameters characterizing coprofiltrates of children is the more accurate and effective method.

Алгоритм ультразвуковой дифференциальной диагностики острого и хронического течения реактивного артрита

Алгоритм ультразвуковой дифференциальной диагностики острого и хронического течения реактивного артрита

Chlamydia trachomatis Is Present and Metabolically Active During the Remitting Phase in Synovial Tissues From Patients With Chronic Chlamydia-induced Reactive Arthritis

BackgroundPatients with chronic Chlamydia-induced reactive arthritis (ReA) often show a remitting-relapsing disease phenotype. Some information regarding bacterial and host responses to one another during active disease is available but no information for quiescence. This article presents the first molecular genetic insight into the behavior of bacterium and host during remitting ReA. MethodsSynovial biopsies were procured from the knees of 4 patients with quiescent ReA by the Parker-Pearson technique. Nucleic acids prepared from them were analyzed by real-time polymerase chain reaction (PCR) and reverse transcription–PCR, and results were compared with data averaged from the knee synovial tissue samples of 10 patients with active ReA. ResultsReal-time PCR indicated that bacterial load in remitting samples was approximately 20% of that in active disease samples. Transcripts from the p60-encoding gene were equal to or higher than those seen in active disease. Messenger RNAs (mRNAs) from the paralog p60-encoding genes were equal to or lower than those of active disease. Host mRNAs encoding interleukin-10, tumor necrosis factor-α and interferon-γ were 4-fold lower than those in active disease samples, whereas monocyte chemotactic protein 1 and regulated upon activation, normal t-cell expressed, and secreted mRNA levels were equal to or higher. ConclusionsBacterial load in synovial tissue of patients with remitting disease is lower than that of active disease, but mRNAs encoding proinflammatory proteins are equal to or higher than those of active disease. Transcription in the host is attenuated for cytokines and chemokines. These initial results demonstrate that organism is present and metabolically active in synovium during the remitting phase of chronic Chlamydia-induced ReA and that the genetic events characterizing quiescence are complex.

FRI0533 Marked differences in occurrence of co-existing diseases at the time of diagnosis of various inflammatory rheumatic diseases

BackgroundCo-existing diseases increase the burden caused by inflammatory rheumatic diseases (IRDs). Comorbidities may be associated with IRD-related factors or are independent.ObjectivesTo examine the occurrence of comorbidities among incident patients with...

Nafamostat mesylate, a serine protease inhibitor, demonstrates novel antimicrobial properties and effectiveness in Chlamydia-induced arthritis

IntroductionEffective treatment of reactive arthritis would ideally achieve both control of inflammation and eradication of persisting arthritogenic pathogens. We use a model of experimental Chlamydia trachomatis-induced arthritis (CtIA) to evaluate the effectiveness of nafamostat mesilate (NM), a serine protease inhibitor with complement-modifying effects and anticoagulant properties. To date clinical use of NM has largely been in Asia and has been primarily confined to inflammatory states such as pancreatitis.MethodsIn vitro studies examined inhibition of Chlamydia proliferation using fibroblast cell lines as targets and phase contrast microscopy. In vivo studies used an established protocol, experimental CtIA, induced in Lewis rats by injection of synoviocyte-packaged C. trachomatis. NM was dissolved in water and administered by daily intraperitoneal injection at a dose of 10 mg/kg beginning the day prior to the administration of Chlamydia. Readouts in vivo included (i) joint swelling, (ii) histopathology scoring of severity of arthritis, (iii) host clearance of the pathogen (by ELISA, the IDEIA PCE Chlamydia).ResultsNM exerted a dose-dependent inhibition of chlamydial proliferation in vitro. Without NM, the mean number of inclusion bodies (IB) per well was 17,886 (± 1415). At 5 μg/mL NM, there were 8,490 (± 756) IB, at 25 μg/mL NM there were 35 IB and at 50 μg/mL NM no IB was observed. Chlamydial antigens in each well along the concentration gradient were assayed by ELISA, demonstrating that at 25 μg/mL NM inhibition of Chlamydia was almost complete. In the experimental arthritis model, joint swelling was significantly reduced with NM treatment: average joint width for the NM-treated animals was 8.55 mm (s.d. ± 0.6578, n = 10) versus 11.18 mm (s.d. ± 0.5672, n = 10) in controls (P < 0.001). Histopathology scoring indicated that NM resulted in a marked attenuation of the inflammatory infiltration and joint damage: mean pathology score in NM-treated animals was 10.9 (± 2.45, n = 11) versus 15.9 (± 1.45, n = 10) in controls (P < 0.0001). With respect to persistence of Chlamydia within the synovial tissues, NM treatment was accompanied by a reduction in the microbial load in the joint: mean optical density (O.D.) for ELISA with NM treatment was 0.05 (± 0.02, n = 4) versus 0.18 (± 0.05, n = 4) in controls (P < 0.001).ConclusionsNM is a protease inhibitor not previously recognized to possess antimicrobial properties. The present study demonstrates for the first time that NM exerts significant impact on C. trachomatis-induced arthritis and suggests that such approaches may prove clinically useful in chronic reactive arthritis.

Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial

Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial

Reactive arthritis

Reactive arthritis (ReA) can be defined as the development of sterile inflammatory arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. Although no generally agreed-upon diagnostic criteria exist, the diagnosis is mainly clinical, and based on acute oligoarticular arthritis of larger joints developing within 2-4 weeks of the preceding infection. According to population-based studies, the annual incidence of ReA is 0.6-27/100,000. In addition to the typical clinical picture, the diagnosis of ReA relies on the diagnosis of the triggering infection. Human leucocyte antigen (HLA)-B27 should not be used as a diagnostic tool for a diagnosis of acute ReA. In the case of established ReA, prolonged treatment of Chlamydia-induced ReA may be of benefit, not only in the case of acute ReA but also in those with chronic ReA or spondylarthropathy with evidence of persisting chlamydia antigens in the body. In other forms of ReA, there is no confirmed evidence in favour of antibiotic therapy to shorten the duration of acute arthritis. The outcome and prognosis of ReA are best known for enteric ReA, whereas studies dealing with the long-term outcome of ReA attributable to Chlamydia trachomatis are lacking.

Prevalence of spondyloarthritis and its subtypes in southern Sweden

ObjectiveTo estimate the prevalence of spondyloarthritis and its subtypes.MethodsThe Swedish healthcare organisation comprises a system where all inpatient and outpatient care is registered by a personal identifier. For the calendar...

Prolonged Remission of Chronic Reactive Arthritis Treated With Three Infusions of Infliximab

Reactive arthritis is generally self-remitting but can be chronic. Predictors of chronicity include HLA B27 positivity and triggering infections with Yersinia, Salmonella, Shigella, or Chlamydia. Nonsteroidal antiinflammatory drugs and local steroids are the mainstays, with some evidence for disease modifying antirheumatic drugs. Limited evidence suggests effectiveness of tumor necrosis factor antagonists. We report the case of reactive arthritis following a Chlamydia urinary tract infection progressing to a chronic course, treated with a short course of high dose tumor necrosis factor antagonist, followed up for over 2 years with prolonged remission, allowing discontinuation of disease modifying antirheumatic drug therapy.

Emerging Bacterial Pathogens in Meat and Poultry: An Overview

Many foodborne diseases are associated with consumption of meat and poultry. Some pathogens were not previously known (new pathogens), others have newly arisen as foodborne (emerging pathogens), and others have become more potent or associated with other products (evolving pathogens). Many of these pathogens may cause severe illness, besides gastroenteritis. Campylobacter jejuni is a leading cause of food-associated bacterial illness; Campylobacter jejuni O:19 and other serotypes are common etiological agents of Guillain–Barre syndrome, a neuropathy due to autoimmune response. Salmonella Typhimurium DT104 and other serotypes have been found to be multi-drug resistant; salmonellosis may lead to chronic reactive arthritis. Many outbreaks of enterohemorrhagic Escherichia coli have been associated with consumption of undercooked contaminated ground beef; complication may occur (e.g., hemolytic uremic syndrome and thrombotic thrombocytopenic purpura). Listeria monocytogenes is ubiquitous; listeriosis is of major public health concern because of the severity and non-enteric nature of the disease (meningitis or meningoencephalitis, septicemia, and abortion) and its ability to multiply at refrigeration temperature. Arcobacter butzleri is a potential foodborne pathogen, and has been isolated from raw poultry, meat, and meat products; but its role in causing human illness is not fully understood. Mycobacterium avium subsp. paratuberculosis can be transmitted by ingestion of raw and processed meats; the organism may contribute to Crohn’s disease, a chronic intestinal enteritis. Beef, pork, lamb, and/or poultry have been reported as sources of infection for the abovementioned organisms but have not been generally associated with disease outbreaks of some of the pathogens.

Campylobacter Reactive Arthritis: A Systematic Review

To review the literature on the epidemiology of Campylobacter-associated reactive arthritis (ReA). A Medline (PubMed) search identified studies from 1966 to 2006 that investigated the epidemiology of Campylobacter-associated ReA. Search terms included: "reactive arthritis," "spondyloarthropathy," "Reiter's syndrome," "gastroenteritis," "diarrhea," "epidemiology," "incidence," "prevalence," and "Campylobacter." The literature available to date suggests that the incidence of Campylobacter ReA may occur in 1 to 5% of those infected. The annual incidence of ReA after Campylobacter or Shigella may be 4.3 and 1.3, respectively, per 100,000. The duration of acute ReA varies considerably among reports, and the incidence and impact of chronic ReA from Campylobacter infection is virtually unknown. Campylobacter-associated ReA incidence and prevalence varies widely among reviews due to case ascertainment differences, exposure differences, lack of diagnostic criteria for ReA, and perhaps genetics and ages of exposed individuals. At the population level it may not be associated with HLA-B27, and inflammatory back involvement is uncommon. Follow-up for long-term sequelae is largely unknown. Five percent of Campylobacter ReA may be chronic or relapsing (with respect to musculoskeletal symptoms).

Antibiotics in the Treatment of Reactive Arthritis

Reactive arthritis is triggered by an infection. Much of evidence has been accumulated to prove that the causative microbes or their components may persist in the organism for extended periods, maintaining an active immune response. Therefore, the question about the value of antibiotics has been entertained by several research groups. A number of studies have demonstrated that antibiotics may be useful only if applied very early, before the pathogenetic process has started. In established reactive arthritis short-term treatment is apparently not effective. Also a three-month course of ciprofloxacin has been demonstrated to be without clinical effect as observed during a one-year follow-up. The same findings were made in a large multicenter EULAR study regarding azithromycin. However, when patients were re-examined four to seven years after an initial 3-month course of the antibiotics in the Finnish ciprofloxacin study, it turned out that patients in the placebo group had significantly more often developed chronic joint symptoms and objective findings of rheumatic disease than those treated with the antibiotic. In addition, a recent study suggests that intensive treatment with a combination of doxycycline and rifampin may have a beneficial effect even in chronic reactive arthritis. The question must be raised whether antibiotics, after all, should be considered especially in HLA-B27 positive patients. Keywords: Reactive arthritis, spondylarthrtopathies, enteroarthritis, uroarthritis, HLA-B27, ciprofloxacin