Espinoza Luis R, García-Valladares Ignacio
Departamento de Medicina Interna, Sección de Reumatología, Louisiana State University Health Sciences Center, Nueva Orleans, Estados Unidos.
Reumatol Clin. 2013 Jul-Aug;9(4):229-38. doi: 10.1016/j.reuma.2012.06.008. Epub 2012 Sep 1.
The association between microbes and joints has existed since antiquity, and remains complex. Diagnosis is often times difficult to determine despite highly suspicious clinical characteristics for the presence of an underlying infection. Over the several past decades, considerable advances have occurred in diagnostic methodologies and therapy. However, the morbidity and mortality of septic arthritis remains high. Great advances have occurred in the diagnosis, pathogenesis, and therapeutic management of reactive arthritis, and there is evidence that when the responsible microorganism is Chlamydia trachomathis, complete remission and cure is possible. Emergent infections, especially viral, has been recognized, i.e. HIV, hepatitis C, and most recently Chikengunya virus, and in the case of HIV associated articular manifestations, the introduction of HAART has resulted in a decrease in the incidence and development of newer complications such as the immune reconstitution syndrome. The infectious etiology of rheumatoid arthritis is being strongly considered once again, and the exciting association with periodontal disease is at the forefront of intense research. The gut microbiota is also being investigated and new and most interesting data is being gathered of the potential role of commensal gut organisms and the pathogenesis of rheumatoid arthritis.
微生物与关节之间的关联自古就有，且依然复杂。尽管存在高度可疑的潜在感染临床特征，但诊断往往难以确定。在过去几十年里，诊断方法和治疗方面取得了相当大的进展。然而，化脓性关节炎的发病率和死亡率仍然很高。反应性关节炎在诊断、发病机制和治疗管理方面取得了巨大进展，并且有证据表明，当致病微生物为沙眼衣原体时，完全缓解和治愈是可能的。已认识到一些新发感染，尤其是病毒感染，如艾滋病毒、丙型肝炎病毒，以及最近的基孔肯雅病毒，就艾滋病毒相关关节表现而言，高效抗逆转录病毒治疗的引入已导致免疫重建综合征等新并发症的发病率和发生率有所下降。类风湿关节炎的感染病因再次受到强烈关注，与牙周病令人兴奋的关联处于深入研究的前沿。肠道微生物群也在接受研究，关于共生肠道微生物的潜在作用以及类风湿关节炎发病机制的新的且非常有趣的数据正在收集之中。
