Immune responses to Borrelia burgdorferi in patients with reactive arthritis.
In reactive arthritis (ReA), including Reiter's syndrome, a close relationship between chronic enteric and genitourinary infections and the clinical features of enthesitis has been described. In contrast, in Lyme arthritis, a distinct clinical entity, chronic infection with the tick-transmitted spirochete Borrelia burgdorferi has been associated with the disease. In a prospective study, 51 patients with ReA were tested for evidence of chlamydial and spirochetal infection. The presence of Chlamydia was determined by culture in 8 patients, and 7 additional patients had markedly elevated antibody titers. In 9 patients, antibodies specific to B burgdorferi were found. Purified peripheral blood T lymphocytes of all 9 patients proliferated specifically to stimulation with macrophages pre-pulsed with B burgdorferi antigens. Compared with other protein antigens, higher numbers of antigen-pulsed macrophages were necessary to activate B burgdorferi-specific T cells. Although antibody titers decreased in response to antibiotic treatment in 8 of 9 patients, second-line therapy with sulfasalazine or methotrexate was required to obtain clinical remission. These data suggest that chronic infection with B burgdorferi can cause ReA. In predisposed individuals, the arthritogenic immune response might be triggered by persisting infectious agents independent of their antigenic specificities.
Weyand
C M
CM
Department of Medicine, University of Heidelberg, Federal Republic of Germany.
Goronzy
J J
JJ
D000907:Antibodies, Bacterial / Q000032:analysis; D000937:Antigen-Antibody Reactions; D000938:Antigen-Presenting Cells / Q000276:immunology; D000942:Antigens, Bacterial / Q000032:analysis; D001170:Arthritis, Infectious / Q000276:immunology*; D001898:Borrelia / Q000276:immunology*; D002690:Chlamydia Infections / Q000276:immunology; D002692:Chlamydia trachomatis / Q000276:immunology; D000939:Epitopes / Q000032:analysis; D005260:Female; D005356:Fibromyalgia / Q000276:immunology; D005455:Fluorescent Antibody Technique; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008193:Lyme Disease / Q000276:immunology; D008297:Male; D000091402:Prohibitins; D011446:Prospective Studies
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D000939:Epitopes; D007074:Immunoglobulin G; C000717331:PHB2 protein, human; D000091402:Prohibitins