Wilkinson N Z, Kingsley G H, Sieper J, Braun J, Ward M E
University of Southampton, UK.
Arthritis Rheum. 1998 May;41(5):845-54. doi: 10.1002/1529-0131(199805)41:5<845::AID-ART11>3.0.CO;2-P.
To resolve how frequently Chlamydia trachomatis and Chlamydia pneumoniae DNA are present in the joints of unselected patients with reactive arthritis (ReA) and undifferentiated oligoarthritis, and to determine if there is an accompanying serologic or cellular antichlamydial immune response.
Two polymerase chain reaction (PCR) protocols to detect the plasmid of C. trachomatis and the outer membrane protein 1 gene of C. pneumoniae were developed for specific use with synovial fluid (SF). Subsequently, the assays were used to detect DNA from the 2 organisms in SF from 54 adult patients with rheumatic diseases, including 4 with sexually acquired ReA and 31 with undifferentiated oligoarthritis. The presence of chlamydial antibodies and SF lymphocyte proliferation responses were determined in parallel.
The PCR protocols were species-specific and highly sensitive. SF samples from 15 patients (8 with undifferentiated oligoarthritis, 3 with ReA, 1 with rheumatoid arthritis, and 1 with psoriatic arthritis) were positive for C. trachomatis. There was no significant correlation between the presence of C. trachomatis DNA in the joint and a Chlamydia-specific synovial T cell response or a serologic response. C. pneumoniae was not detected in any of the 54 patients, although it was identified in the SF from a rheumatoid arthritis patient outside this study, demonstrating that the assay was capable of detecting the organism in the joint.
C. trachomatis DNA was present in ReA patients and in nearly one-third of unselected patients with undifferentiated oligoarthritis, which further supports the hypothesis that it plays an important role in disease pathogenesis. However, its presence did not correlate with evidence of an antichlamydial immune response. Despite previous anecdotal reports, C. pneumoniae does not appear to be a major cause of undifferentiated oligoarthritis or ReA.
明确在未经挑选的反应性关节炎（ReA）和未分化寡关节炎患者的关节中沙眼衣原体和肺炎衣原体DNA的出现频率，并确定是否存在伴随的血清学或细胞抗衣原体免疫反应。
开发了两种聚合酶链反应（PCR）方法，分别用于检测沙眼衣原体的质粒和肺炎衣原体的外膜蛋白1基因，专门用于滑膜液（SF）检测。随后，使用这些检测方法对54例成年风湿性疾病患者的SF中的这两种病原体的DNA进行检测，其中包括4例性传播获得性ReA患者和31例未分化寡关节炎患者。同时测定衣原体抗体的存在情况和SF淋巴细胞增殖反应。
PCR方法具有种属特异性且高度灵敏。15例患者（8例未分化寡关节炎患者、3例ReA患者、1例类风湿关节炎患者和1例银屑病关节炎患者）的SF样本沙眼衣原体检测呈阳性。关节中沙眼衣原体DNA的存在与衣原体特异性滑膜T细胞反应或血清学反应之间无显著相关性。54例患者中均未检测到肺炎衣原体，尽管在本研究之外的1例类风湿关节炎患者的SF中检测到了该病原体，这表明该检测方法能够在关节中检测到该病原体。
ReA患者以及近三分之一未经挑选的未分化寡关节炎患者的关节中存在沙眼衣原体DNA，这进一步支持了其在疾病发病机制中起重要作用的假说。然而，其存在与抗衣原体免疫反应的证据无关。尽管有既往传闻报道，但肺炎衣原体似乎并非未分化寡关节炎或ReA的主要病因。
