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Reactive Arthritis

Mechanisms and Drug Therapy

  • Practical Therapeutics
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Summary

Reactive arthritis is a joint inflammation developing soon after or during an infection elsewhere in the body. A strong association between the development of reactive arthritis and tissue antigen HLA-B27 has been known for a long time. However, it is still unclear by what mechanism(s) this antigen determines the appearance of joint complications. There is considerable evidence that causative micro-organisms or their structures are not efficiently eliminated but persist for long periods of time in patients with reactive arthritis. This suggests that the interaction between micro-organism and host is somehow disturbed in HLA-B27-positive persons developing this complication. The possibility that living micro-organisms persist somewhere in unknown locations in the bodies of patients with reactive arthritis has provided a rationale for antibiotic therapies. In addition, it seems to be clear now that development of reactive arthritis depends on the dissemination of microbial antigens into joints. There they stimulate a local response that could damage joint tissue.

Adequate therapy of reactive arthritis depends on the individual clinical course. In many patients the disease is only of short duration and with a self-limiting character. Symptomatic anti-inflammatory therapy with nonsteroidal anti-inflammatory drugs is often the appropriate treatment. In patients with chronic arthritis, glucocorticoids or even immunosuppressive agents may be administered. Long term therapy with antibiotics seems to be of benefit in patients with uroarthritides caused by, for example, Chlamydia trachomatis. The potential therapeutic impact on enteroarthritides has been up to now less predictable.

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References

  1. Granfors K. Do bacterial antigens cause reactive arthritis? Rheum Dis Clin North Am 1992; 18: 37–48

    PubMed  CAS  Google Scholar 

  2. Granfors K, Jalkanen S, von Essen R, et al. Yersinia antigens in synovial fluid cells from patients with reactive arthritis. N Engl J Med 1989; 320: 216–21

    Article  PubMed  CAS  Google Scholar 

  3. Granfors K, Jalkanen S, Lindberg AA, et al. Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis. Lancet 1990; 335: 985–8

    Article  Google Scholar 

  4. Granfors K, Jalkanen S, Toivanen P, et al. Bacterial lipopolysaccharide in synovial fluid-cells in Shigella-triggered reactive arthritis. J Rheumatol 1992; 19: 500

    PubMed  CAS  Google Scholar 

  5. Mäki-Ikola O, Granfors K. Salmonella-triggered reactive arthritis. Lancet 1992; 339: 1096–8

    Article  PubMed  Google Scholar 

  6. Wuorela M, Jalkanen S, Toivanen P, et al. Yersinia lipopolysaccharide is modified by human monocytes. Infect Immun 1993; 36: 1633–5

    Google Scholar 

  7. Aho K, Ahvonen P, Lassus A, et al. HL-A antigen 27 and reactive arthritis. Lancet 1973; ii: 157

    Article  Google Scholar 

  8. Kellner H, Yu D. The pathogenetic aspects of spondylarthropathies from the point of view of HLA-B27. Rheumatol Int 1992; 12: 121–7

    Article  PubMed  CAS  Google Scholar 

  9. Repo H, Ristola M, Leirisalo-Repo M. Enhanced inflammatory reactivity in the pathogenesis of spondylarthropathies. Autoimmunity 1990; 7: 245–54

    Article  PubMed  CAS  Google Scholar 

  10. Salmi M, Granfors K, Leirisalo-Repo M, et al. Selective endothelial binding of interleukin-2 dependent human T cell lines originated from different tissues. Proc Natl Acad Sci USA 1992; 89: 11436–40

    Article  PubMed  CAS  Google Scholar 

  11. Salmi M, Granfors K, MacDermott R, et al. Aberrant lymphocyte binding to endothelium in inflammatory bowel diseases. Gastroenterology 1994; 21: 115–22

    Google Scholar 

  12. Leino R, Vuento R, Koskimies S, et al. Depressed lymphocyte transformation by Yersinia and Escherichia coli in Yersinia arthritis. Ann Rheum Dis 1983; 42: 176–81

    Article  PubMed  CAS  Google Scholar 

  13. Inman RD, Chiu B, Johnston MEA, et al. HLA class I-related impairment in IL-2 production and lymphocyte response to microbial antigens in reactive arthritis. J Immunol 1989; 142: 4256–60

    PubMed  CAS  Google Scholar 

  14. Mäki-Ikola O, Yli-Kerttula U, Saario R, et al. Salmonella-specific antibodies in serum and synovial fluid in reactive arthritis. Br J Rheumatol 1992; 31: 25–9

    Article  PubMed  Google Scholar 

  15. Ford DK, Da Roza DM, Shulzer M. Lymphocytes from the site of disease but not blood lymphocytes indicate the cause of arthritis. Ann Rheum Dis 1985; 444: 701–10

    Article  Google Scholar 

  16. Gaston JSH, Life PH, Granfors K, et al. Synovial T lymphocyte recognition of organisms that trigger reactive arthritis. Clin Exp Immunol 1989; 76: 348–53

    PubMed  CAS  Google Scholar 

  17. Lahesmaa R, Yssel H, Batsford S, et al. Yersinia enterocolitica activates a T helper type 1-like cell subset in reactive arthritis. J Immunol 1992; 148: 3079–85

    PubMed  CAS  Google Scholar 

  18. Schlaak J, Hermann E, Ringhoffer M, et al. Predominance of Th1-type T cells in synovial fluid of patients with Yersinia-induced reactive arthritis. Eur J Immunol 1992; 22: 2771–6

    Article  PubMed  CAS  Google Scholar 

  19. Hermann E, Yu DTY, Meyer zum Büschenfelde K-H, et al. HLA-B27-restricted CD8 T cells derived from synovial fluids of patients with reactive arthritis and ankylosing spondylitis. Lancet 1993; 342: 646–50

    Article  PubMed  CAS  Google Scholar 

  20. Life PF, Bassey EOE, Gaston JSH. T-cell recognition of bacterial heat-shock proteins in inflammatory arthritis. Immunol Rev 1991; 121: 113–35

    Article  PubMed  CAS  Google Scholar 

  21. Probst P, Hermann E, Meyer zum Büschenfelde K-H, et al. Identification of the Yersinia enterocolitica urease β subunit as a target antigen for human synovial T lymphocytes in reactive arthritis. Infect Immun 1993; 61: 4507–9

    PubMed  CAS  Google Scholar 

  22. Hermann E, Lohse AW, van der Zee R, et al. Synovial fluid-derived Yersinia-reactive T cells responding to human 65-kDa heat-shock protein and heat stressed antigen-presenting cells. Eur J Immunol 1991; 21: 2139–43

    Article  PubMed  CAS  Google Scholar 

  23. Keat A. Reiter’s syndrome and reactive arthritis in perspective. N Engl J Med 1983; 309: 1606–15

    Article  PubMed  CAS  Google Scholar 

  24. Leirisalo M, Skylv G, Kousa M, et al. Follow-up study on patients with Reiter’s disease and reactive arthritis with special reference to HLA-B27. Arthritis Rheum 1982; 25: 249–59

    Article  PubMed  CAS  Google Scholar 

  25. Arnett FC. Seronegative spondyloarthropathies. Bull Rheum Dis 1987; 37: 1

    PubMed  CAS  Google Scholar 

  26. Treating Reiter’s syndrome [editorial]. Lancet 1987; 2: 1125–6

  27. Fan PT, Yu DTY. Reiter’s syndrome. In: Kelley WN, Harris ED, Ruddy S, et al., editors. Textbook of rheumatology. Philadelphia: WB Saunders, 1993

    Google Scholar 

  28. Yoshida S, Motal Y, Hattori H, et al. A case of HLA-B27 negative ankylosing spondylitis treated with methylprednisolone pulse therapy. J Rheumatol 1993; 20: 1805–6

    PubMed  CAS  Google Scholar 

  29. Keat A, Thomas B, Disey J, et al. Chlamydia trachomatis and reactive arthritis: the missing link. Lancet 1987; i: 72–4

    Article  Google Scholar 

  30. Fryden A, Bengtsson A, Foberg U, et al. Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological studies. BMJ 1990; 301: 1299–302

    Article  PubMed  CAS  Google Scholar 

  31. Panayi GS, Clark B. Minocycline in the treatment of patients with reactive syndrome. Clin Exp Rheumatol 1989; 7: 100–1

    PubMed  CAS  Google Scholar 

  32. Pott HG, Wittenborh A, Junge-Hülsing G. Long-term antibiotic treatment in reactive arthritis. Lancet 1988; i: 245–8

    Article  Google Scholar 

  33. Leirisalo-Repo M, Skylv G, Kousa M. Follow-up of Reiter’s disease and reactive arthritis. Factors influencing the natural course and the prognosis. Clin Rheumatol 1987; 6 Suppl. 2: 73–82

    Article  PubMed  Google Scholar 

  34. Popert AJ, Gill AJ, Laird SM. A prospective study of Reiter’s syndrome: an interim report of the first 82 cases. Br J Vener Dis 1964; 40: 160–5

    PubMed  CAS  Google Scholar 

  35. Lauhio A, Leirisalo-Repo M, Lähdevirta J, et al. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum 1991; 34: 6–14

    Article  PubMed  CAS  Google Scholar 

  36. Bradin T, Enel C, Cornells F, et al. Antibiotic treatment of venereal disease and Reiter’s syndrome in Greenland population. Arthritis Rheum 1992; 35: 190–4

    Article  Google Scholar 

  37. Lauhio A, Sorsa T, Lindy O, et al. The anticollagenolytic potential of lymecycline in the long-term treatment of reactive arthritis. Arthritis Rheum 1992; 35: 195–8

    Article  PubMed  CAS  Google Scholar 

  38. Buxbaum J. Therapy for seronegative spondylarthropathies. Curr Opin Rheumatol 1992; 4: 500–6

    PubMed  CAS  Google Scholar 

  39. Dougados M, Maetzel A, Mijiyawa M, et al. Evaluation of sulphasalazine in the treatment of spondyloarthropathies. Ann Rheum Dis 1992; 51: 955–8

    Article  PubMed  CAS  Google Scholar 

  40. Owen ET, Cohen ML. Methotrexate in Reiter’s disease. Ann Rheum Dis 1979; 38: 48–50

    Article  PubMed  CAS  Google Scholar 

  41. Lally EV, Ho G. A review of methotrexate therapy in Reiter’s syndrome. Semin Arthritis Rheum 1985; 15: 139–45

    Article  PubMed  CAS  Google Scholar 

  42. Calin A. A placebo controlled, cross-over study of azathioprine in Reiter’s syndrome. Ann Rheum Dis 1986; 45: 653–5

    Article  PubMed  CAS  Google Scholar 

  43. Kellner H, Füessl S, Herzer P. Seronegative spondyloarthropathies in HIV-infected patients: further evidence of uncommon clinical features. Rheumatol Int 1994; 13: 211–3

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Medizinische Poliklinik Klinikum Innenstadt, Rheumaeinheit der Universität München, München, Germany

    Herbert Kellner

  2. National Public Health Institute, Turku, Finland

    Kaisa Granfors

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  1. Herbert Kellner
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  2. Kaisa Granfors
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Kellner, H., Granfors, K. Reactive Arthritis. Clin Immunother 4, 338–345 (1995). https://doi.org/10.1007/BF03259297

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