How can a causal role for small bacteria in chronic inflammatory arthritides be established or refuted?

Taylor‐Robinson, David; Keat, Andrew

doi:10.1136/ard.60.3.177

Cited by 14 publications

(4 citation statements)

References 88 publications

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“…It is clear that Koch's postulates are insufficient for this purpose and new suggestions as to how causality could be ascribed to an infectious agent have been proposed more recently. 20 The notion that reactive arthritis is caused or triggered by particular infections is based on several strands of evidence. Most persuasive of these is epidemiological data from outbreaks of bacterial diarrhoea.…”

Section: Epidemiologymentioning

confidence: 99%

When is arthritis reactive?

Hamdulay

Glynne²,

Keat³

2006

Postgraduate Medical Journal

115

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Reactive arthritis is an important cause of lower limb oligoarthritis, mainly in young adults. It is one of the spondyloarthropathy family; it is distinguishable from other forms of inflammatory arthritis by virtue of the distribution of affected sites and the high prevalence of characteristic extra-articular lesions. Many terms have been used to refer to this and related forms of arthritis leading to some confusion. Reactive arthritis is precipitated by an infection at a distant site and genetic susceptibility is marked by possession of the HLA-B27 gene, although the mechanism remains uncertain. Diagnosis is a two stage process and requires demonstration of a temporal link with a recognised "trigger" infection. The identification and management of "sexually acquired" and "enteric" forms of reactive arthritis are considered. Putative links with HIV infection are also discussed. The clinical features, approach to investigation, diagnosis, and management of reactive arthritis are reviewed.

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Section: Epidemiologymentioning

confidence: 99%

When is arthritis reactive?

Hamdulay

Glynne²,

Keat³

2006

Postgraduate Medical Journal

115

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“…We have previously drawn attention to the problems of attributing causality in inflammatory arthritis and suggested some measures which would support a causal role for a specific micro-organism. 47 Clearly, so far as C. trachomatis and SARA are concerned, some of these criteria are met and it must be the front-runner. However, evidence of culturable micro-organisms in very early disease has yet to be presented, and in only one of many studies has substantial benefit of antimicrobial treatment been reported and that in patients with chronic disease.…”

Section: Discussionmentioning

confidence: 99%

Observations on Chlamydia trachomatis and other microbes in reactive arthritis

Taylor‐Robinson

Keat

2014

Int J STD AIDS

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There are problems in attributing causality in inflammatory arthritis. So far as C. trachomatis and sexually acquired reactive arthritis are concerned, there is much in favour of a causal relationship, although there are important caveats which need to be explored before it is possible to say unreservedly that C. trachomatis plays a causative role in reactive arthritis. For example, micro-organisms have never been cultured from synovial effusions in early disease, and only once has substantial benefit of antimicrobial treatment been reported. The claim that ocular strains of C. trachomatis are of over-riding importance in pathogenesis needs confirmation before it can be accepted. No conclusion can be made about the possibility of other small intracellular bacteria in joints having a role in causing disease. However, if it can be shown that eradication of the micro-organism, which may be difficult to prove, coincides with clinical recovery, it would go some way to recognising causality. In spite of the recognised difficulties, antibiotic studies have an important role in identifying aetiology. They need to focus on very early disease and on eradication of intra-articular bacteria. Treatment of established disease is likely to be less informative. Although a combination of antibiotics might have a future in treating established disease, diagnosing and treating non-gonococcal urethritis as soon as possible should be the aim in order to prevent the development of reactive arthritis.

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“…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.…”

Section: Trachomatis and Reactive Arthritismentioning

confidence: 99%

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

et al. 2020

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Chlamydia trachomatis and C. pneumoniae are members of the Chlamydiaceae family of obligate intracellular bacteria. The former causes diseases predominantly at the mucosal epithelial layer of the urogenital or eye, leading to pelvic inflammatory diseases or blindness; while the latter is a major causative agent for pulmonary infection. On top of these well-described diseases at the respective primary infection sites, Chlamydia are notoriously known to migrate and cause pathologies at remote sites of a host. One such example is the sexually acquired reactive arthritis that often occurs at few weeks after genital C. trachomatis infection. C. pneumoniae, on the other hand, has been implicated in an extensive list of chronic inflammatory diseases which include atherosclerosis, multiple sclerosis, Alzheimer’s disease, asthma, and primary biliary cirrhosis. This review summarizes the Chlamydia infection associated diseases at the secondary sites of infection, and describes the potential mechanisms involved in the disease migration and pathogenesis.

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How can a causal role for small bacteria in chronic inflammatory arthritides be established or refuted?

Cited by 14 publications

References 88 publications

When is arthritis reactive?

When is arthritis reactive?

Observations on Chlamydia trachomatis and other microbes in reactive arthritis

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

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