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Reactive and undifferentiated arthritis in North Africa: use of PCR for detection of Chlamydia trachomatis

Clinical Rheumatology volume 28, pages 11–16 (2009)Cite this article

Abstract

Little is known about the possible role of Chlamydia in patients with reactive or unclassified arthritis in North Africa. This study used polymerase chain reaction (PCR) to survey this population. In addition, we compared the results in three different laboratories for PCR analyses for Chlamydia trachomatis (Ct) in synovial fluid (SF) and tissue (ST) from these North African patients with reactive arthritis (ReA), undifferentiated arthritis (UA), and in rheumatoid arthritis (RA) and osteoarthritis (OA). Eight ReA (six posturethritic, two postenteritic), 23 UA, 13 OA, and 12 RA patients were studied in Algeria, Morocco, and Tunisia. Serum, SF, and ST were obtained from each patient. Ct-PCR was performed in the three different laboratories and compared to Ct-serology [microimmunofluorescence (MIF) and anti-hsp60 enzyme-linked immunosorbent assay (ELISA)] performed in one laboratory. The rate of Ct-PCR positivity in SF/ST was low: none out of the eight ReA and three out of 23 UA patients. In the controls, Ct DNA was detected in two OA SF and in one RA SF. There was no concordance for Ct-PCR positivity between the three laboratories. MIF suggested previous Ct infection (IgG-positive) in two out of five posturethritic ReA, none out of one postenteritic ReA, one out of 17 UA, and nine out of 21 RA/OA patients tested. No MIF-positive patient was PCR-positive from SF or ST. However, anti-hsp60 IgG was detected in all four out of four patients positive by PCR and in 11 out of 44 PCR-negative patients (p = 0.002). In this multinational comparative study, the rate of Ct-PCR-positive synovial specimens in North African ReA/UA patients was low. Concordance among the three PCR testing laboratories was poor indicating the need for test standardization. All Ct-PCR-positive patients were found positive by anti-hsp60 IgG serology.

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References

  1. Schachter J (1985) Overview of Chlamydia trachomatis infection and the requirements for a vaccine. Rev Infect Dis 7:713–716

    PubMed  CAS  Google Scholar 

  2. Pearlman MD, McNely SG (1992) A review of the microbiology, immunology, and clinical implications of Chlamydia trachomatis infections. Obstet Gyn Surv 47:448–461

    CAS  Article  Google Scholar 

  3. Keat A, Dixey J, Sonnex C, Thomas B, Osborn M, Taylor-Robinson D (1987) Chlamydia trachomatis and reactive arthritis: the missing link. Lancet 1:72–74

    PubMed  Article  CAS  Google Scholar 

  4. Kvien TK, Glennas A, Melby K, Granfors K, Andrup O, Karstensen B, Thoen JE (1994) Reactive arthritis: incidence, triggering agents and clinical presentation. J Rheumatol 21:115–122

    PubMed  CAS  Google Scholar 

  5. Keat A, Thomas B, Hughes R (1989) Chlamydia trachomatis in reactive arthritis. Rheumatol Int 9:197–200

    PubMed  CAS  Google Scholar 

  6. Rahman MU, Hudson AP, Schumacher HR (1992) Chlamydia and Reiter’s syndrome (reactive arthritis). Rheum Dis Clin North Am 18:67–79

    PubMed  CAS  Google Scholar 

  7. Rahman MU, Cantwell R, Johnson CC, Hodinka RL, Schumacher HR, Hudson AP (1992) Inapparent genital infection with Chlamydia trachomatis and its potential role in the genesis of Reiter’s syndrome. DNA Cell Biol 11:215–219

    PubMed  CAS  Google Scholar 

  8. Schumacher HR, Magge S, Cherian V et al (1988) Light and electron microscopic studies on the synovial membrane in Reiter’s syndrome: immunocytochemical identification of Chlamydial antigen in patients with early disease. Arthritis Rheum 31:937–946

    PubMed  Article  Google Scholar 

  9. Taylor-Robinson D, Gilroy CB, Thomas BJ, Keat ACS (1992) Detection of Chlamydia trachomatis DNA in joints of reactive arthritis patients by polymerase chain reaction. Lancet 340:81–82

    PubMed  Article  CAS  Google Scholar 

  10. Bas S, Griffais R, Kvien TK, Glennas A, Melby K, Visher TL (1995) Amplification of plasmid and chromosome Chlamydia DNA in synovial fluid of patients with reactive arthritis and undifferentiated seronegative oligoarthropathies. Arthritis Rheum 38:1005–1013

    PubMed  Article  CAS  Google Scholar 

  11. Pavlica L, Nikolic D, Magic Z et al (2005) Successful treatment of postvenereal reactive arthritis with synovectomy and 3 months’ azithromycin. J Clin Rheumatol 11:257–263

    PubMed  Article  Google Scholar 

  12. Bas S, Muzzin P, Ninet B, Bornand JE, Scieux C, Vischer TL (2001) Chlamydial serology: comparative diagnostic value of immunoblotting, microimmunofluorescence test, and immunoassays using different recombinant proteins as antigens. J Clin Microbiol 39:1368–1377

    PubMed  Article  CAS  Google Scholar 

  13. Bas S, Genevay S, Schenkel M-C, Vischer TL (2002) Importance of species-specific antigens in the serodiagnosis of Chlamydia trachomatis reactive arthritis. Rheumatology 41:1017–1020

    PubMed  Article  CAS  Google Scholar 

  14. Wollenhaupt J, Kolbus F, Weißbrodt H, Schneider C, Krech T, Zeidler H (1995) Manifestations of Chlamydia induced arthritis in patients with silent versus symptomatic urogenital chlamydial infection. Clin Exp Rheumatol 13:453–458

    PubMed  CAS  Google Scholar 

  15. Schnarr S, Putschky N, Jendro MC, Zeidler H, Hammer M, Kuipers JG, Wollenhaupt J (2001) Chlamydia- and Borrelia-DNA in synovial fluid of patients with undifferentiated oligoarthritis: results of a prospective study. Arthritis Rheum 44:2679–2685

    PubMed  Article  CAS  Google Scholar 

  16. Sieper J, Rudwaleit M, Braun J, van der Heijde D (2002) Diagnosing reactive arthritis Role of clinical setting in the value of serologic and microbiologic assays. Arthritis Rheum 46:319–327

    PubMed  Article  Google Scholar 

  17. Apfalter P, Assadian O, Blasi F, Bomann J, Gaydos CA, Kundi M et al (2002) Reliability of nested PCR for detection of Chlamydia pneumoniae DNA in atheromas: results from a multicenter study applying standardized protocols. J Clin Microbiol 40:4428–4434

    PubMed  Article  CAS  Google Scholar 

  18. Boman J, Hoglind J, Alakarppa H et al (2003) Chlamydia pneumoniae PCR methods developed in-house: a survey of intra- and inter-laboratory variation of sensitivity and specificity among 12 laboratories. In: Chlamydial infections. Proc 10th International Symposium on Human Infections. Antalya, Turkey 389–392

  19. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227

    PubMed  Article  CAS  Google Scholar 

  20. Amor B (1986) Reactive arthritis. Nosological situation, incidence and diagnostic criteria. Rev Med Interne 7:491–498

    PubMed  CAS  Article  Google Scholar 

  21. Jaulhac B, Chary-Valckenaere I, Sibilia J, Javier RM, Piémont Y, Kuntz JL et al (1996) Detection of Borrelia burgdorferi by DNA amplification in synovial tissue samples from patients with Lyme arthritis. Arthr Rheum 39:736–745

    Article  CAS  Google Scholar 

  22. Gerard HC, Branigan PJ, Schumacher HR, Hudson AP (1998) Synovial Chlamydia trachomatis in patients with reactive arthritis/Reiters syndrome are viable but show aberrant gene expression. J Rheumatol 25:734–742

    PubMed  CAS  Google Scholar 

  23. Olmez N, Wang GF, Li Y, Zhang H, Schumacher HR (2001) Chlamydial nucleic acids in synovium in osteoarthritis: what are the implications? J Rheumatol 28:1874–1880

    PubMed  CAS  Google Scholar 

  24. Cox CJ, Kempsell KE, Gaston JSH (2003) Investigation of infectious agents associated with arthritis by reverse transcription PCR of bacterial rRNA. Arthritis Res Ther 5:R1–8

    PubMed  Article  CAS  Google Scholar 

  25. Stephens RS, Mullenbach G, Sanches-Pescador R, Agabian N (1986) Sequence analysis of the major outer membrane protein gene from Chlamydia trachomatis serovar L2. J Bacteriol 168:1277–1282

    PubMed  CAS  Google Scholar 

  26. Kuipers JG, Nietfeld L, Dreses-Werringloer U, Köhler L, Wollenhaupt J, Zeidler H, Hammer M (1999) Optimised sample preparation of synovial fluid for detection of Chlamydia trachomatis DNA by polymerase chain reaction. Ann Rheum Dis 59:103–108

    Google Scholar 

  27. Freise J, Gerard HC, Bunke T, Whittum-Hudson JA, Zeidler H, Köhler L, Hudson AP, Kuipers JG (2001) Optimized sample DNA preparation for detection of Chlamydia trachomatis in synovial tissue by PCR and LCR. Ann Rheum Dis 60:140–145

    PubMed  Article  CAS  Google Scholar 

  28. Rahman MU, Cheema MA, Schumacher HR, Hudson AP (1992) Molecular evidence for the presence of Chlamydia in the synovium of patients with Reiter’s syndrome. Arthritis Rheum 35:521–529

    PubMed  Article  CAS  Google Scholar 

  29. Poole S, Highton J, Wilkins RJ, Lamott IL (1992) A search for Chlamydia trachomatis in synovial fluids from patients with reactive arthritis using the polymerase chain reaction and antigen detection methods. Br J Rheumatol 31:31–34

    PubMed  Article  CAS  Google Scholar 

  30. Branigan PJ, Gérard HC, Schumacher HR, Hudson AP (1996) Comparison of synovial tissue and fluid as sources for nucleic acids for detection of C. trachomatis by polymerase chain reaction. Arthritis Rheum 39:1740–1746

    PubMed  Article  CAS  Google Scholar 

  31. Kuipers JG, Andresen J, Köhler L, Schnarr S, Putschky N, Zeidler H et al (2002) Evaluation of Amplicor Chlamydia PCR and LCX Chlamydia LCR to detect Chlamydia trachomatis in synovial fluid. Clin Exp Rheumatol 20:185–192

    PubMed  CAS  Google Scholar 

  32. Freise J, Priem S, Mey I, Meier S, Zeidler H, Krause A et al (2003) Optimization and standardization of highly-sensitive detection methods for Chlamydia trachomatis (CT) in synovial fluid (SF). Arthritis Rheum 48(Suppl):S520

    Google Scholar 

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Acknowledgment

This study wa supported by the International League of Associations for Rheumatology (ILAR).

Disclosures

None

Author information

Affiliations

  1. Department of Rheumatology, Rotes Kreuz Krankenhaus, St. Pauli Deich 24, 28199, Bremen, Germany

    J. G. Kuipers

  2. Department of Rheumatology, University of Strasbourg, Strasbourg, France

    J. Sibilia

  3. Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland

    S. Bas & T. L. Vischer

  4. Division of Rheumatology, University of Cambridge, Cambridge, UK

    H. Gaston

  5. National Public Health Institute, Turku, Finland

    K. Granfors

  6. Department of Rheumatology, El Ayachi University Hospital of Rabat-Sale, Rabat, Morocco

    N. Hajjaj-Hassouni

  7. Rheumatology Department, Ben Aknoun Hospital, Algiers, Algeria

    A. Ladjouze-Rezig

  8. Rheumatology Department, La Rabta Hospital, Tunis, Tunisia

    S. Sellami

  9. Division of Rheumatology, Eilbeck Hospital, Hamburg, Germany

    J. Wollenhaupt

  10. Rheumatologikum Hannover, Hannover, Germany

    H. Zeidler

  11. Rheumatology Division, University of Pennsylvania and VA Medical Center, Philadelphia, PA, USA

    H. R. Schumacher

  12. Department of Rheumatology B, Hopital Cochin, Paris, France

    M. Dougados

Authors
  1. J. G. Kuipers
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  2. J. Sibilia
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  3. S. Bas
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  4. H. Gaston
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  5. K. Granfors
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  6. T. L. Vischer
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  7. N. Hajjaj-Hassouni
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  8. A. Ladjouze-Rezig
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  9. S. Sellami
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  10. J. Wollenhaupt
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  11. H. Zeidler
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  12. H. R. Schumacher
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  13. M. Dougados
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Corresponding author

Correspondence to J. G. Kuipers.

Additional information

J. G. Kuipers and J. Sibilia contributed equally to this study. H. R. Schumacher and M. Dougados are equal senior authors of this study.

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Kuipers, J.G., Sibilia, J., Bas, S. et al. Reactive and undifferentiated arthritis in North Africa: use of PCR for detection of Chlamydia trachomatis . Clin Rheumatol 28, 11–16 (2009). https://doi.org/10.1007/s10067-008-0968-z

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  • DOI: https://doi.org/10.1007/s10067-008-0968-z

Keywords

  • C. trachomatis
  • PCR
  • Reactive arthritis