Detection and frequency ofChlamydia trachomatisDNA in synovial samples from Tunisian patients with reactive arthritis and undifferentiated oligoarthritis

Abstract

We aimed to determine the frequency of Chlamydia trachomatis DNA in the synovial compartment of 34 arthritic patients. Chlamydia trachomatis DNA was detected using a nested PCR targeting the cryptic plasmid, the 16S rRNA gene and the outer membrane protein 1 gene. The presence of serum immunoglobulin (Ig)G and IgA antibodies against C. trachomatis was studied by a microimmunofluorescence assay and by an enzyme-linked immunosorbent assay, respectively. Synovial samples from 20 of 34 (59%) patients [nine with reactive arthritis (ReA), seven with undifferentiated oligoarthritis (UOA), two with rheumatoid arthritis and two with osteoarthritis] were positive for at least one C. trachomatis DNA sequence by nested PCR. The high sensitivity results most likely from the combination of a standardized automated MagNA Pure extraction method, PCR targeting three different C. trachomatis genes and the screening for C. trachomatis in synovial tissue and fluid samples. There was no correlation between the presence of C. trachomatis DNA in the joint and a Chlamydia-specific serologic response. Our data support that PCR is the method of choice to establish the diagnosis of Chlamydia-induced arthritis in patients with ReA. We suggest that this diagnosis might also be considered in C. trachomatis-positive patients previously classified as UOA.

Diagnosis of Chlamydia trachomatis in patients with reactive arthritis and undifferentiated spondyloarthropathy

“…One reason for this discrepancy could be that such patients might have undergone an earlier short episode of urogenital infection leading to arthritis. The lack of correlation between the detection of intraarticular C. trachomatis DNA in patients with ReA or uSpA by snPCR or nPCR and the serological results has been observed by others [13,36].…”

“…Further, published data indicate that 20%-40% of individuals with inflammatory arthritis but no documented prior genital infection with C. trachomatis who are given a diagnosis of uSpA, oligoor mono-arthritis are PCR positive in synovial tissue and/or fluid for C. trachomatis DNA [31,32]. A study published in 2009 reported that C. trachomatis DNA in ReA and uSpA patients is rather high (100% and 64%, respectively) [13], while other studies reported relatively low frequencies (25%) [11]. Thus, published data on the use of PCR for the detection of intraarticular C. trachomatis varies greatly in patients with ReA and uSpA [10,33].…”

“…As molecular tests serve as sensitive and specific tools for the diagnosis of C. trachomatis in joint samples, rRNA hybridization and, PCR have been used to detect several C. trachomatis components such as major outer membrane protein (MOMP), rRNA, and plasmid DNA in the affected joints of ReA patients. Published data on the use of PCR for the detection of intra-articular C. trachomatis varies between 0% and 100% positivity in patients with ReA and undifferentiated spondyloarthropathy (uSpA) [10][11][12][13]. Furthermore, serological tests can be helpful in establishing past or present chlamydial infections, although serology can never replace molecular methods of chlamydial infection detection.…”

Optimized testing for C. trachomatis DNA in synovial fluid samples in clinical practice

“…C. tr. can appear in the joints of patients who have other clinical diagnoses, including RA and OA, as well as in asymptomatic, clinically normal joints [1,11,13,16]. None of the samples from a very large number of patients with RA and OA were positive for C. tr.…”

“…These patients were screened for the presence of C. tr. DNA using a combination of the standardized automated MagNA Pure extraction method (Roche, Basel, Switzerland) and a nested PCR targeting the cryptic plasmid, the 16S rRNA gene, and the omp1 gene [16]. The high PCR sensitivity for C. tr.…”