Causality of Chlamydiae in Arthritis and Spondyloarthritis: a Plea for Increased Translational Research

Abstract

Current molecular genetic understanding of the metabolically active persistent infection state of Chlamydia trachomatis and Chlamydia pneumoniae in the synovium in patients with arthritis and spondyloarthritis favors a causal relationship. Here, we examine how adequately the accepted criteria for that etiologic relationship are fulfilled, emphasizing the situation in which these microorganisms cannot be cultivated by standard or other means. We suggest that this unusual situation of causality by chlamydiae in rheumatic disease requires establishment of a consensus regarding microorganism-specific terminology as well as the development of new diagnostic and classification criteria. Recent studies demonstrate the value of molecular testing for diagnosis of reactive arthritis, undifferentiated spondyloarthritis, and undifferentiated arthritis caused by C. trachomatis and C. pneumoniae in clinical practice. Data regarding combination antibiotic therapy is consistent with the causative role of chlamydiae for these diseases. Observations of multiple intra-articular coinfections require more research to understand the implications and to respond to them.

Chlamydia trachomatis -induced reactive arthritis in India: frequency and clinical presentation

“…Intra-articular C. trachomatis major outer membrane protein (MOMP)/plasmid was evident in synovial fluid (SF) of patients with ReA/uSpA (n=45; 24.4%) by seminested (sn)/nested (n) PCR as reported earlier (p<0.05),1 while cytological diagnosis in SF by direct fluorescence assay (DFA) showed the presence of C. trachomatis elementary bodies (31.1%) 2. Anti- C. trachomatis IgA antibodies were also significantly higher in SF and serum (31.1% and 15.5%, respectively) of these patients.…”

Osteoarthritis and intervertebral disc degeneration: Quite different, quite similar

“…Several systemic inflammatory factors have been described to tip this balance toward degeneration in both diseases, such as diabetes, obesity, smoking, and low-grade systemic infection. [78][79][80][81][82][83][84][85][86][87][88][89] Mechanical overloading is another established factor that induces local inflammation in NP and AC, 90,91 especially in the AC of knee and ankle, 86,92 since the lesions are often localized to weight-bearing cartilage or to sites of trauma. 93,94 Catabolic cell behavior is characterized by an increase in the expression of cytokines and matrix-degrading enzymes, and a downregulation of their inhibitors.…”

Chronic Inflammatory Diseases at Secondary Sites Ensuing Urogenital or Pulmonary Chlamydia Infections

“…At present, compelling evidences have incriminated C. trachomatis (serovars D to K) as the culprit which provokes post-venereal ReA [13,14]. Infection by C. pneumoniae has also been associated with ReA although doubts remain concerning its role in the onset of disease [64,65], as it was detected at lower prevalence than C. trachomatis among ReA patients [66][67][68][69][70]. A long list of pathogens have been implicated in ReA including enteric pathogens Salmonella, Shigella, or Campylobacter, etc.…”