The effect of Helicobacter pylori seropositivity and activity on disease outcome in patients with rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis

Abstract

The association between infection with Gram-negative bacteria and autoimmune diseases has been investigated with controversies about the role of the organisms especially, Helicobacter pylori (H. pylori). To evaluate the impact of the presence and activity of H. pylori on the disease activity in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS). This study was carried out on one hundred adult patients and 50 controls. Patients included 40 RA, 40 SLE, and 20 AS. Participants were subjected to clinical examination and laboratory investigations; ESR (spectrophotometric assay), CRP (turbidimetric method), serum H.pylori IgG antibody test (enzyme immunoassay), and H. pylori antigen test (lateral flow immunoassay, rapid one-step test) in stool. Positive test in stool indicated active current H. pylori infection. Mean age of patients was 36.95±10.34; 51.2±6.91, 35.5±3.71, and 48.82±5.81 in SLE, RA, AS, and control groups respectively. Serum H. pylori IgG antibodies was 0.803±0.497 U/mL in SLE group, 1.48±0.637 U/mL in RA group and 0.75±0.68 U/mL in AS group while it was 0.2±0.61U/mL in the control group with a significant difference (P=0.000). The H. pylori antigen in stool was found positive in 30%, 70% and 20% of patients of the three groups respectively while it was positive in 10% of the control group with P>0.001. Patients with active SLE (SLEDAI >3) and RA (DAS-28 >3.2) demonstrated higher frequency of positive test for H. pylori antigen in stool than patients at remission (66.7% P= 0.02 and 83.3% P= 0.01 respectively). In contrast, 22.2% of patients with active AS (BASDAI > 4) were positive for H. pylori in stool. In conclusion, H. pylori infection is associated with increased disease activity in patients with SLE and RA but not AS.

Influence of Helicobacter pylori infection on risk of rheumatoid arthritis: a nationwide population-based study

“…Hamed et al investigated the effects of H. pylori ’s existence and activity on RA disease activity. According to their results, patients with active RA (DAS-28 > 3.2) showed a higher positive rate of H. pylori stool antigen than patients in remission 29 . Ebrahimia et al showed that RA patients who were H. pylori CagA-positive tended to have severe clinical manifestations with higher DAS-28 scores and higher mean VAS scores than CagA-negative patients.…”

Study of the Effect of Treatment of Helicobacter pylori Infection in Rheumatoid Arthritis Patients

“…The sample size was calculated using the WHO sample size calculator by using the population prevalence of H-pylori infection in patients of RA as 30%. 7 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

“…All participating patients were diagnosed as RA patients based on the 2010 revised criteria of the American College of Rheumatology for the classification of RA. 7 For classification purposes, a patient has to satisfy at least four of the seven criteria to be considered to have RA. Six weeks is the minimum duration for symptoms of criteria.…”

Impact of Helicobacter pylori and metabolic syndrome-related mast cell activation on cardiovascular diseases

“…Many autoimmune disorders such as systemic lupus erythematosus, polymyositis, dermatomyositis, and rheumatoid arthritis have been connected with chronic urticaria (23). In this regard, H. pylori infection and/or MetS are linked to such disorders as systemic lupus erythematosus and rheumatoid arthritis (24)(25)(26)(27). MCs also contribute to the pathophysiology of these autoimmune disorders (26,28).…”