Zeidler Henning, Hudson Alan P
Division of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, MI, USA.
Curr Rheumatol Rep. 2016 Feb;18(2):9. doi: 10.1007/s11926-015-0559-3.
Current molecular genetic understanding of the metabolically active persistent infection state of Chlamydia trachomatis and Chlamydia pneumoniae in the synovium in patients with arthritis and spondyloarthritis favors a causal relationship. Here, we examine how adequately the accepted criteria for that etiologic relationship are fulfilled, emphasizing the situation in which these microorganisms cannot be cultivated by standard or other means. We suggest that this unusual situation of causality by chlamydiae in rheumatic disease requires establishment of a consensus regarding microorganism-specific terminology as well as the development of new diagnostic and classification criteria. Recent studies demonstrate the value of molecular testing for diagnosis of reactive arthritis, undifferentiated spondyloarthritis, and undifferentiated arthritis caused by C. trachomatis and C. pneumoniae in clinical practice. Data regarding combination antibiotic therapy is consistent with the causative role of chlamydiae for these diseases. Observations of multiple intra-articular coinfections require more research to understand the implications and to respond to them.
目前对于关节炎和脊柱关节炎患者滑膜中沙眼衣原体和肺炎衣原体代谢活跃的持续感染状态的分子遗传学理解支持一种因果关系。在此，我们考察该病因关系的公认标准在多大程度上得到满足，重点关注这些微生物无法通过标准或其他方法培养的情况。我们认为，衣原体在风湿性疾病中这种不同寻常的因果关系情形需要就微生物特异性术语达成共识，并制定新的诊断和分类标准。近期研究证明了分子检测在临床实践中诊断由沙眼衣原体和肺炎衣原体引起的反应性关节炎、未分化脊柱关节炎和未分化关节炎方面的价值。关于联合抗生素治疗的数据与衣原体在这些疾病中的致病作用相符。对多种关节内合并感染的观察需要更多研究来了解其影响并做出应对。
