Yersinia Arthritis Research Articles

Characterization of the cell envelope of Yersinia enterocolitica and the immune response to its components

The cell envelope was isolated from a recent patient isolate of Y. enterocolitica type 3 grown under different conditions, and a plasmid-less derivative of it. The typical enterobacterial outer membrane proteins, porin and OmpA, were identified by SDS-PAGE; they were invariant in both strains irrespective of culture conditions. By contrast, growth at 37° under Ca** limitation caused the appearance of a major new protein in the envelope of the plasmid-bearing but not the plasmid-less strain. This protein has an apparent molecular weight of 47 000; in the isolated envelope it is present in a multimeric form with an apparent molecular weight of appr. 200.000, but it is dissociated into its subunits by boiling in urea-containing buffer. The lipopolysaccharide (LPS) of both strains contained a large fraction of rough-type LPS in addition to the O-specific side chain which varies according to growth conditions. Antibodies to these separate components could be identified by immunoblotting techniques; in addition, an enzyme immunoassay to the isolated LPS was used. Sera of patients with reactive yersinia arthritis showed high titre abtibodies to the rough LPS, and often reacted also with rough LPS from other enteric bacteria. The anti-LPS antibody response often contained a strong IgA component.

Chemotaxis in yersinia arthritis. In vitro stimulation of neutrophil migration by HLA--B27 positive and negative sera.

Chemotactic and chemokinetic migration of polymorphonuclear leukocytes in sera from patients with previous yersinia arthritis and from healthy subjects with or without HLA--B27 were studied by the leading front method. Irrespective of yersinia arthritis, zymosan-activated sera from subjects who were HLA--B27 positive were significantly more chemokinetic than were HLA--B27 negative zymosan-activated sera from healthy control subjects. The chemotactic activities of zymosan-activated sera that were HLA--B27 positive or negative, as determined by chemotactic increments, were much the same. The results suggest that zymosan-activated serum that is HLA--B27 positive stimulates random migration of polymorphonuclear leukocytes, but not their directional migration, more than does HLA--B27 negative serum that has been zymosan activated. This may contribute to accumulation of polymorphonuclear leukocytes at the site of inflammation in vivo and thereby to inflammatory symptoms in yersinia arthritis patients with HLA--B27.

Followup study on patients with Reiter's disease and reactive arthritis, with special reference to HLA-B27.

An analysis of 160 patients with Reiter's disease, 144 with yersinia arthritis, and 9 with salmonella arthritis was performed, Complete or incomplete Reiter's syndrome was observed in one-third of the patients with yersinia arthritis and in most of those with salmonella arthritis. During the followup period, chronic back pain and joint symptoms were frequent in all the patient groups. Patients who were HLA-B27 positive had a more severe acute disease (more frequent back pain, urologic symptoms, mucocutaneous manifestations, and a longer duration of the disease) and more frequent chronic back pain and sacroiliitis.

Immundiagnostik bei entzündlichen rheumatischen Erkrankungen

Identification of the rheumatoid factor in rheumatoid arthritis is conclusive at very high titre levels only. If necessary, identification is effected in the synovial fluid together with ragocytes.Differential diagnosis against visceral lupus erythematodes: The decisive criterion is the identification of antibodies against unmodified double-strand DNS with a particularly high DNS bonding pattern over 30 U/ml.The decisive criterion for rheumatic fever (nowadays an extremely rare disease) is that rheumatoid factor findings are negative. Antibodies against various antigens of Astreptococci predominate; at the same time, there are cross-reacting heart antibodies with sarcolemma fluorescence.In Yersinia arthritis there is a predominant antibody titre against Yersinia O antigen together with a frequent finding of HLA-B27.In ankylosing spondylitis (Bechterews disease, rheumatoid spondylitis) the identification of HLA-B27 dominates, too, with the exclusion of rheumatoid factors and Yersinia antibodies. Streptococci antibodies are found only if the heart is involved and in 25% only of low-titre cases.In Sjögren's syndrome we have a predominantly lupoid pattern and a special fluorescence pattern in the human parotid gland.In other collagenoses, e.g. in panarteriitis nodosa, the dominating criterion is the identification or exclusion of influence exercised by the hepatitis B virus, whereas in mixed collagenoses the identifikation of antibodies against extractable nuclear antigens predominates, these antigens being characterised as sensitive to ribonuclease. Dermatomyositis and progressive sclerodermia are often impossible to diagnose via serology alone.This survey shows that representative diagnosis is possible only if there is close collaboration between clinic, the immunological department, and the department of pathology (if necessary), and that it can be of vital importance in some cases. This is evident from the fact that indication for appropriate therapy involves considerable and widely different consequences. For these reasons it may be imperative, especially with the so called collagen diseases, to clarify and narrow down clinical diagnosis during in-patient observation whenever there is any suspicion arising from preliminary immunological diagnostic findings.

Synovial fluid lactate determinations as a diagnostic aid in cases of monoarticular arthritis.

The concentration of synovial fluid lactate was determined by an enzymatic kit method in 16 patients with various types of monoarticular arthritis and in 2 patients with non-inflammatory lesions and no joint effusion. Lactate concentrations in control cases were 1.2 mmol/l, in septic arthritis above 10 mmol/l, in pseudogout and yersinia arthritis around 7 mmol/l, and in other cases of inflammatory, nonseptic arthritis around 3.0 mmol/l.

Yersinia enterocolitica arthritis in southern Sweden: a four-year follow-up study.

Thirty-eight cases of suspected yersinia arthritis occurring in southern Sweden in 1975-6 were reviewed four to five years later. In 31 cases the diagnosis was confirmed. At follow-up three of the patients had definite ankylosing spondylitis, three radiologically confirmed sacroiliitis, three extensor tenosynovitis, five isolated articular joint disease, and 10 localised arthralgias; one patient had developed seropositive rheumatoid arthritis. Only six of the 31 patients were free of joint symptoms. These results suggest that although the acute symptoms of yersinia arthritis disappear within 12 months, the long-term prognosis may be less favourable than previously thought.

Common serological features in rheumatoid arthritis and yersinia arthritis. Demonstration of rheumatoid factors and antibodies against ssDNA and Yersinia enterocolitica Lipopolysaccharide by ELISA.

Sera from 31 patients with rheumatoid arthritis (RA) and from 49 patients with Yersinia enterocolitica 0:3 infection were examined for the presence of rheumatoid factors (RF) and antibodies against denatured (ss) DNA and Y. enterocolitica 0:3 lipopolysaccharide (LPS), by using enzyme-linked immunosorbent assays. Anti-ssDNA antibodies of IgG class were found equally often in the RA as in yersinia patients. The IgM-anti-ssDNA antibody levels were also elevated in the yersinia patients, whereas the RA patients had elevated levels of IgA-anti-ssDNA antibodies. High levels of RF were seen in the RA patients and an increase in IgA-RF activity was observed during the acute stage in the yersinia arthritis patients. An overlap in the serological profiles of RA and yersinia arthritis was further seen in th results of the anti-Y. enterocolitica LPS determinations, a anti-LPS antibodies of IgG class were present not only in yersiniosis but also in 16% of the RA patients.

Chemotaxis in yersinia arthritis. HLA-B27 positive neutrophils show high stimulated motility in vitro.

Chemotaxis, chemokinesis, and spontaneous locomotion of polymorphonuclear leukocytes (PMNs) of yersinia arthritis (YA) patients and healthy subjects with or without HLA-B27 were studied by agarose assay and membrane filter technique. HLA-B27 positive healthy control subjects and yersinia patients showed significantly higher response to chemotactic stimulus than HLA-B27 negative controls. Consequently, the high response was associated with HLA-B27 irrespective of YA. The high responder PMNs may contribute to the more severe inflammatory symptoms in YA patients with HLA-B27.

Persistence of IgM, IgG, and IgA antibodies to Yersinia in yersinia arthritis.

IgA antibodies to Yersinia enterocolitica were demonstrated in the sera of 13 patients with severe versinia arthritis who were studied six to eight months after an acute infection with Yersinia. Four of the patients were monitored for two to three years, and they continued to demonstrate these antibodies. Only one of 12 control patients (individuals with yersinia infection without arthritis) had IgA antibodies specific to Yersinia six to eight months after the acute infection. The persistence of IgG antibodies was also in direct correlation to the occurrence of arthritis, but not as clearly as was the persistence of IgA antibodies. Antibodies of the IgM class persisted in most cases for only one to three months and always disappeared during the first six months after the onset of the infection. Thus, the demonstration of IgA antibodies to Yersinia is important in the diagnosis of yersinia arthritis, and the occurrence of IgM antibodies indicates a recently acquired infection with Yersinia.

Relation between HLA-B27 and clinical features in patients with yersinia arthritis.

A study of 74 yersinia arthritis patients implied that the clinical picture of the disease may be modified by genetic background associated with the histocompatibility antigen B27 (HLA-B27). Sixty-six percent of patients were B27 positive. Joint symptoms were somewhat more severe in B27+ patients. Iritis, conjunctivitis, carditis, signs of urologic inflammation, and complete Reiter's triad occurred only in the B27 + group, whereas erythema nodosum was more common in B27 - group. Several B27 + patients also had "B27 + rheumatic diseases," such as ankylosing spondylitis or Reiter's disease, in their history.

The Histocompatibility Complex and Rheumatic Diseases

Histocompatibility typing has assumed an increasingly important role as a clinical and research tool in rheumatic diseases. The HLA antigens which are serologically defined (A and B series) are being used most extensively for clinical work, but the role of other immunologic determinants in the HLA complex is being evaluated. These include D-locus (MLC) determinants, several complement components, and immune response genes which have been well characterized in the mouse, but not in man. The products of the major histocompatibility complex are inherited in a simple Mendelian fashion as a series of co-dominant alleles. Large population studies have characterized the frequencies of various alleles, and family studies have allowed tentative mapping of the various loci within the complex on the sixth chromosome in man. A number of diseases which are considered to be autoimmune in nature are now known to be associated with specific HLA antigens. Of these disease associations, the strongest and best studied are the seronegative spondyloarthropathies which are highly associated with the B27 antigen. Included in this group are ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy, colitic arthropathy, Yersinia arthritis and a small group of juvenile rheumatoid arthritis patients with features of ankylosing spondylitis. The clinical application of tissue typing or B27 testing is most helpful in regard to difficult diagnostic problems in patients with early or atypical seronegative spondyloarthropathy. Its value as an indicator of prognosis, and its value in counselling family members is not well established. There are many interesting hypotheses regarding pathogenetic mechanisms of these rheumatic diseases based on susceptibility factors related to the major histocompatibility complex. An abnormal immune response gene within the complex is probably a key feature of the mechanism, but the exact details are little more than speculative at this point.

HL‐A 27 in reactive arthritis. A study of yersinia arthritis and Reiter's disease

AbstractThe histocompatibility antigen HL‐A 27 was identified in 43 of 49 patients with yersinia arthritis and in 36 of 40 patients with Reiter's disease, compared with 3 of 20 patients with yersinia infection without arthritis and 14% of the normal Finnish population. HL‐A 2 occurred in patients with reactive arthritis in the same high frequency as did HL‐A 27, but this antigen is present in 55% of Finns. HL‐A 27 negative patients usually had a mild or somewhat atypical disease.

Acute Rheumatic Fever and Yersinia Arthritis

Acute Rheumatic Fever and Yersinia Arthritis