RESUMO
To investigate the role of Yersinia persistence in chronic undifferentiated arthritis, two patients who had chronic undifferentiated polyarthritis and circulating IgA and IgG antibodies to Yersinia outer proteins were studied. Immunofluorescence using antibodies directed against Yersinia adhesin A was performed on colonic and synovial tissue. Synovial tissue T cells were cloned aspecifically and screened for their proliferative responses to Yersinia enterocolitica. Furthermore, a Yersinia-specific polymerase chain reaction (PCR) was performed on synovial tissue. Both patients were found to have Yersinia antigens in colonic and synovial tissue. Y. enterocolitica-positive T-cell clones were grown from the synovial tissue: 4 CD4+ clones of 37 clones from patient 1 and 6 CD4+ clones of 53 clones from patient 2. Yersinia-specific PCR products were not detected in the synovial tissue specimens. The results support the hypothesis that an immune-mediated response to Yersinia antigens may play an important role in the pathogenesis of chronic undifferentiated arthritis.
Assuntos
Antígenos de Bactérias/análise , Artrite/imunologia , Artrite/microbiologia , Yersiniose/complicações , Yersinia enterocolitica/imunologia , Adesinas Bacterianas/imunologia , Adulto , Linfócitos T CD4-Positivos/imunologia , Doença Crônica , Colo/microbiologia , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Ativação Linfocitária , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Líquido Sinovial/microbiologia , Yersiniose/imunologiaRESUMO
We studied the cellular and humoral immune response to Chlamydia trachomatis, Yersinia enterocolitica and Borrelia burgdorferi in paired samples of peripheral blood and synovial fluid (SF) in undifferentiated oligoarthritis, reactive arthritis (ReA) and rheumatoid arthritis. Antigen specific lymphocyte proliferation was found in SF of 43% of patients with ReA and 34% of patients with undifferentiated oligoarthritis. C. trachomatis was the most frequent single agent. HLA-B27 was positive in 83% of patients with ReA and in 62% of patients with undifferentiated oligoarthritis with antigen specific lymphocyte proliferation. Antigen specific lymphocyte proliferation correlated poorly with the specific antibody response. Only chlamydial antigen was detected in SF cells using monoclonal antibodies. We conclude that some patients with undifferentiated oligoarthritis may have a forme fruste of ReA. This finding is important in view of recent evidence supporting the efficacy of antibiotic therapy in ReA.
Assuntos
Artrite/microbiologia , Grupo Borrelia Burgdorferi/fisiologia , Chlamydia trachomatis/fisiologia , Yersinia enterocolitica/fisiologia , Adulto , Anticorpos Antibacterianos/análise , Anticorpos Antibacterianos/imunologia , Anticorpos Monoclonais/análise , Anticorpos Monoclonais/imunologia , Formação de Anticorpos , Antígenos de Bactérias/análise , Antígenos de Bactérias/imunologia , Artrite/imunologia , Artrite Reativa/imunologia , Artrite Reativa/microbiologia , Artrite Reumatoide/imunologia , Artrite Reumatoide/microbiologia , Infecções por Borrelia/imunologia , Grupo Borrelia Burgdorferi/imunologia , Infecções por Chlamydia/imunologia , Chlamydia trachomatis/imunologia , Feminino , Imunofluorescência , Antígeno HLA-B27/análise , Humanos , Linfócitos/imunologia , Linfócitos/fisiologia , Masculino , Pessoa de Meia-Idade , Proibitinas , Líquido Sinovial/citologia , Líquido Sinovial/imunologia , Yersiniose/imunologia , Yersinia enterocolitica/imunologiaRESUMO
The IgA and IgG antibody response to plasmid-encoded outer membrane proteins was studied in 59 patients with yersinia-associated spondylarthropathy during 15 months of follow-up. Initially, all patients had specific IgA and IgG antibodies to the 36 and 46 kDa and 30% also to the 26 and 58 kDa released proteins, which correlated with the finding of virulent Yersinia bacilli in intestinal biopsies. IgA disappeared in 69% of untreated patients after nine months and persisted in 31% after one year. IgA disappeared within three to six months in 81% of the patients treated with antibiotics for four to six weeks and persisted in 6% after one year (p less than 0.002). IgG antibodies to the 36 and 46 kDa outer membrane proteins persisted in 80% of all patients. Disappearance of IgA was coupled with disappearance of yersinia from intestinal biopsies.