Skip to main content
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1992 Nov;51(11):1208–1214. doi: 10.1136/ard.51.11.1208

Aetiological role of bacteria associated with reactive arthritis in pauciarticular juvenile chronic arthritis.

J Sieper 1, J Braun 1, E Döring 1, P Wu 1, J Heesemann 1, J Treharne 1, G Kingsley 1
PMCID: PMC1012457  PMID: 1466598

Abstract

BACKGROUND: The cause of juvenile chronic arthritis (JCA) is unknown. Pauciarticular JCA is the most common subtype and can be subdivided into early (type I) and late onset (type II) forms, the latter clinically resembling reactive arthritis. METHODS: The cellular immune responses to bacteria associated with reactive arthritis in blood and synovial fluid from 39 children with pauciarticular JCA, three children with classical reactive arthritis, and two children with psoriatic arthritis were examined. Specific titres of antibodies to bacteria in serum samples were measured in all patients. RESULTS: A bacteria specific synovial cellular immune response was found in two of three (67%) patients with reactive arthritis and 14 of 28 (50%) patients with pauciarticular JCA type II but only in one of 11 (9%) patients with pauciarticular JCA type I and none in patients with psoriatic arthritis. Six patients responded specifically to Chlamydia trachomatis and 11 to Yersinia enterocolitica. Antigen specific lymphocyte proliferation correlated poorly with the specific antibody response. CONCLUSIONS: These findings suggest that bacteria with associated reactive arthritis may have a causative role in pauciarticular JCA type II but not in JCA type I.

Full text

PDF
1208

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnett F. C. The Lyme spirochete: another cause of Reiter's syndrome? Arthritis Rheum. 1989 Sep;32(9):1182–1184. doi: 10.1002/anr.1780320921. [DOI] [PubMed] [Google Scholar]
  2. Burgos-Vargas R., Howard A., Ansell B. M. Antibodies to peptidoglycan in juvenile onset ankylosing spondylitis and pauciarticular onset juvenile arthritis associated with chronic iridocyclitis. J Rheumatol. 1986 Aug;13(4):760–762. [PubMed] [Google Scholar]
  3. Cassidy J. T., Levinson J. E., Bass J. C., Baum J., Brewer E. J., Jr, Fink C. W., Hanson V., Jacobs J. C., Masi A. T., Schaller J. G. A study of classification criteria for a diagnosis of juvenile rheumatoid arthritis. Arthritis Rheum. 1986 Feb;29(2):274–281. doi: 10.1002/art.1780290216. [DOI] [PubMed] [Google Scholar]
  4. Chantler J. K., Tingle A. J., Petty R. E. Persistent rubella virus infection associated with chronic arthritis in children. N Engl J Med. 1985 Oct 31;313(18):1117–1123. doi: 10.1056/NEJM198510313131803. [DOI] [PubMed] [Google Scholar]
  5. Craft J. E., Grodzicki R. L., Steere A. C. Antibody response in Lyme disease: evaluation of diagnostic tests. J Infect Dis. 1984 May;149(5):789–795. doi: 10.1093/infdis/149.5.789. [DOI] [PubMed] [Google Scholar]
  6. Dattwyler R. J., Volkman D. J., Luft B. J., Halperin J. J., Thomas J., Golightly M. G. Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte responses to Borrelia burgdorferi. N Engl J Med. 1988 Dec 1;319(22):1441–1446. doi: 10.1056/NEJM198812013192203. [DOI] [PubMed] [Google Scholar]
  7. De Graeff-Meeder E. R., van der Zee R., Rijkers G. T., Schuurman H. J., Kuis W., Bijlsma J. W., Zegers B. J., van Eden W. Recognition of human 60 kD heat shock protein by mononuclear cells from patients with juvenile chronic arthritis. Lancet. 1991 Jun 8;337(8754):1368–1372. doi: 10.1016/0140-6736(91)93057-g. [DOI] [PubMed] [Google Scholar]
  8. De Maria A. F., Malnati M. S., Poggi A., Pende D., Cottafava F., Moretta L. Clonal analysis of joint fluid T lymphocytes in patients with juvenile rheumatoid arthritis. J Rheumatol. 1990 Aug;17(8):1073–1078. [PubMed] [Google Scholar]
  9. Denman A. M. A viral aetiology for juvenile chronic arthritis? Br J Rheumatol. 1988 Jun;27(3):169–170. doi: 10.1093/rheumatology/27.3.169. [DOI] [PubMed] [Google Scholar]
  10. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  11. Ford D. K., da Roza D. M., Shah P., Wenman W. M. Cell-mediated immune responses of synovial mononuclear cells in Reiter's syndrome against ureaplasmal and chlamydial antigens. J Rheumatol. 1980 Sep-Oct;7(5):751–755. [PubMed] [Google Scholar]
  12. Ford D. K., da Roza D. M., Ward R. H. Arthritis confined to knee joints. Synovial lymphocyte responses to microbial antigens correlate with distribution of HLA. Arthritis Rheum. 1984 Oct;27(10):1157–1164. doi: 10.1002/art.1780271012. [DOI] [PubMed] [Google Scholar]
  13. Gaston J. S., Life P. F., Granfors K., Merilahti-Palo R., Bailey L., Consalvey S., Toivanen A., Bacon P. A. Synovial T lymphocyte recognition of organisms that trigger reactive arthritis. Clin Exp Immunol. 1989 Jun;76(3):348–353. [PMC free article] [PubMed] [Google Scholar]
  14. Granfors K., Jalkanen S., von Essen R., Lahesmaa-Rantala R., Isomäki O., Pekkola-Heino K., Merilahti-Palo R., Saario R., Isomäki H., Toivanen A. Yersinia antigens in synovial-fluid cells from patients with reactive arthritis. N Engl J Med. 1989 Jan 26;320(4):216–221. doi: 10.1056/NEJM198901263200404. [DOI] [PubMed] [Google Scholar]
  15. Grayston J. T., Campbell L. A., Kuo C. C., Mordhorst C. H., Saikku P., Thom D. H., Wang S. P. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis. 1990 Apr;161(4):618–625. doi: 10.1093/infdis/161.4.618. [DOI] [PubMed] [Google Scholar]
  16. Heesemann J., Eggers C., Schröder J. Serological diagnosis of yersiniosis by immunoblot technique using virulence-associated antigen of enteropathogenic Yersiniae. Contrib Microbiol Immunol. 1987;9:285–289. [PubMed] [Google Scholar]
  17. Hussein A., Abdul-Khaliq H., von der Hardt H. Atypical spondyloarthritis in children: proposed diagnostic criteria. Eur J Pediatr. 1989 Apr;148(6):513–517. doi: 10.1007/BF00441545. [DOI] [PubMed] [Google Scholar]
  18. Ingram D. L., Runyan D. K., Collins A. D., White S. T., Durfee M. F., Pearson A. W., Occhiuti A. R. Vaginal Chlamydia trachomatis infection in children with sexual contact. Pediatr Infect Dis. 1984 Mar-Apr;3(2):97–99. doi: 10.1097/00006454-198403000-00002. [DOI] [PubMed] [Google Scholar]
  19. Keat A. C., Knight S. C. Do synovial fluid cells indicate the cause of reactive arthritis? J Rheumatol. 1990 Oct;17(10):1257–1259. [PubMed] [Google Scholar]
  20. Keat A. Reiter's syndrome and reactive arthritis in perspective. N Engl J Med. 1983 Dec 29;309(26):1606–1615. doi: 10.1056/NEJM198312293092604. [DOI] [PubMed] [Google Scholar]
  21. Kingsley G., Panayi G. Antigenic responses in reactive arthritis. Rheum Dis Clin North Am. 1992 Feb;18(1):49–66. [PubMed] [Google Scholar]
  22. Kunnamo I., Kallio P., Pelkonen P., Hovi T. Clinical signs and laboratory tests in the differential diagnosis of arthritis in children. Am J Dis Child. 1987 Jan;141(1):34–40. doi: 10.1001/archpedi.1987.04460010034018. [DOI] [PubMed] [Google Scholar]
  23. Lang B. A., Shore A. A review of current concepts on the pathogenesis of juvenile rheumatoid arthritis. J Rheumatol Suppl. 1990 Mar;21:1–15. [PubMed] [Google Scholar]
  24. Lauhio A., Leirisalo-Repo M., Lähdevirta J., Saikku P., Repo H. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum. 1991 Jan;34(1):6–14. doi: 10.1002/art.1780340103. [DOI] [PubMed] [Google Scholar]
  25. Leak A. M. Autoantibody profile in juvenile chronic arthritis. Ann Rheum Dis. 1988 Mar;47(3):178–182. doi: 10.1136/ard.47.3.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Michels H., Häfner R., Morhart R., Schuchmann L., Truckenbrodt H. Five year follow-up of a prospective cohort of juvenile chronic arthritis with recent onset. Clin Rheumatol. 1987 Sep;6 (Suppl 2):87–92. doi: 10.1007/BF02203390. [DOI] [PubMed] [Google Scholar]
  27. Mielants H., Veys E. M., Joos R., Cuvelier C., De Vos M., Proot F. Late onset pauciarticular juvenile chronic arthritis: relation to gut inflammation. J Rheumatol. 1987 Jun;14(3):459–465. [PubMed] [Google Scholar]
  28. Nepom B. S., Malhotra U., Schwarz D. A., Nettles J. W., Schaller J. G., Concannon P. HLA and T cell receptor polymorphisms in pauciarticular-onset juvenile rheumatoid arthritis. Arthritis Rheum. 1991 Oct;34(10):1260–1267. doi: 10.1002/art.1780341009. [DOI] [PubMed] [Google Scholar]
  29. Odum N., Morling N., Platz P., Hofmann B., Ryder L. P., Heilmann C., Pedersen F. K., Nielsen L. P., Friis J., Svejgaard A. Increased prevalence of late stage T cell activation antigen (VLA-1) in active juvenile chronic arthritis. Ann Rheum Dis. 1987 Nov;46(11):846–852. doi: 10.1136/ard.46.11.846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Pitzalis C., Kingsley G., Haskard D., Panayi G. The preferential accumulation of helper-inducer T lymphocytes in inflammatory lesions: evidence for regulation by selective endothelial and homotypic adhesion. Eur J Immunol. 1988 Sep;18(9):1397–1404. doi: 10.1002/eji.1830180915. [DOI] [PubMed] [Google Scholar]
  31. Pritchard M. H., Matthews N., Munro J. Antibodies to influenza A in a cluster of children with juvenile chronic arthritis. Br J Rheumatol. 1988 Jun;27(3):176–180. doi: 10.1093/rheumatology/27.3.176. [DOI] [PubMed] [Google Scholar]
  32. Rosenberg A. M. Analysis of a pediatric rheumatology clinic population. J Rheumatol. 1990 Jun;17(6):827–830. [PubMed] [Google Scholar]
  33. Rosenberg A. M., Petty R. E. Reiter's disease in children. Am J Dis Child. 1979 Apr;133(4):394–398. doi: 10.1001/archpedi.1979.02130040048011. [DOI] [PubMed] [Google Scholar]
  34. Salari S. H., Ward M. E. Polypeptide composition of Chlamydia trachomatis. J Gen Microbiol. 1981 Apr;123(2):197–207. doi: 10.1099/00221287-123-2-197. [DOI] [PubMed] [Google Scholar]
  35. Schaller J. G. Chronic arthritis in children. Juvenile rheumatoid arthritis. Clin Orthop Relat Res. 1984 Jan-Feb;(182):79–89. [PubMed] [Google Scholar]
  36. Schönberg A., Camey C., Kahl O., Wilske B., Preac-Mursic V., Hovind-Hougen K. First isolation of Borrelia burgdorferi, the agent of Lyme borreliosis, from Ixodes ricinus (Acari: Ixodidae) in Berlin (West). Zentralbl Bakteriol Mikrobiol Hyg A. 1988 Jun;268(4):487–494. doi: 10.1016/s0176-6724(88)80128-7. [DOI] [PubMed] [Google Scholar]
  37. Shafer M. A., Prager V., Shalwitz J., Vaughan E., Moscicki B., Brown R., Wibbelsman C., Schachter J. Prevalence of urethral Chlamydia trachomatis and Neisseria gonorrhoeae among asymptomatic, sexually active adolescent boys. J Infect Dis. 1987 Jul;156(1):223–224. doi: 10.1093/infdis/156.1.223. [DOI] [PubMed] [Google Scholar]
  38. Sieper J., Kingsley G., Palacios-Boix A., Pitzalis C., Treharne J., Hughes R., Keat A., Panayi G. S. Synovial T lymphocyte-specific immune response to Chlamydia trachomatis in Reiter's disease. Arthritis Rheum. 1991 May;34(5):588–598. doi: 10.1002/art.1780340511. [DOI] [PubMed] [Google Scholar]
  39. Terasaki P. I., Bernoco D., Park M. S., Ozturk G., Iwaki Y. Microdroplet testing for HLA-A, -B, -C, and -D antigens. The Phillip Levine Award Lecture. Am J Clin Pathol. 1978 Feb;69(2):103–120. doi: 10.1093/ajcp/69.2.103. [DOI] [PubMed] [Google Scholar]
  40. Treharne J. D., Darougar S., Jones B. R. Modification of the microimmunofluorescence test to provide a routine serodiagnostic test for chlamydial infection. J Clin Pathol. 1977 Jun;30(6):510–517. doi: 10.1136/jcp.30.6.510. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES