title: Nested polymerase chain reaction strategy simultaneously targeting DNA sequences of multiple bacterial species in inflammatory joint diseases. II. Examination of sacroiliac and knee joint biopsies of patients with spondyloarthropathies and other arthritides.
abstract: OBJECTIVE
  Bacteria play a crucial pathogenetic role in reactive arthritis (ReA) and other forms of spondyloarthropathy (SpA) and in Lyme arthritis. Although there is evidence of local persistence of bacterial antigens no definitive method revealing microbes in peripheral joints has been established. We detected DNA of individual bacteria in synovial material by PCR. Applying molecular technology we screened simultaneously for 8 bacterial genomes in arthritis and sacroiliitis.
  
  
  METHODS
  Sacroiliac (SI) biopsy specimens taken from the SI joint of 8 patients with ankylosing spondylitis (AS, n = 5) and undifferentiated SpA (uSpA, n = 3) by computed tomography guided biopsy were investigated for presence of bacterial DNA. Similarly, synovial membrane samples obtained by office arthroscopy from 15 patients with ReA (n = 5), uSpA (n = 3), undifferentiated oligoarthritis (uOligo, n = 3), and rheumatoid arthritis (RA, n = 4) were screened. Nested PCR was performed for DNA of the following bacteria: Chlamydia trachomatis, C. pneumoniae, Yersinia enterocolitica, Salmonella enteritidis, Campylobacter jejuni, Shigella flexneri, Klebsiella pneumoniae, and Borrelia burgdorferi.
  
  
  RESULTS
  No bacterial DNA was found in the SI biopsies of patients with uSpA and AS. DNA of B. burgdorferi (n = 2) and C. trachomatis (n = 1) was detected in 3 patients with uOligo, but not in patients with ReA or RA. DNA of other microbes including K. pneumoniae was not found. Patients' mean disease duration was 5.3 years (2 mo-8.4 yrs).
  
  
  CONCLUSIONS
  We found bacterial DNA in peripheral joints of patients with uOligo, while in patients with ReA, AS, and uSpA no bacterial DNA was detected in peripheral or SI joints. The failure to detect bacterial DNA in patients with SpA suggests autoimmune mechanisms operate in later stages of disease.
authors.affiliation: Department of Nephrology and Rheumatology, Klinikum Benjamin Franklin Freie Universität, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Braun
authors.forename: M
authors.initials: M
authors.lastname: Tuszewski
authors.forename: S
authors.initials: S
authors.lastname: Ehlers
authors.forename: J
authors.initials: J
authors.lastname: Häberle
authors.forename: M
authors.initials: M
authors.lastname: Bollow
authors.forename: U
authors.initials: U
authors.lastname: Eggens
authors.forename: A
authors.initials: A
authors.lastname: Distler
authors.forename: J
authors.initials: J
authors.lastname: Sieper
mesh_terms: D000328:Adult; D000368:Aged; D016918:Arthritis, Reactive / Q000382:microbiology*; D002692:Chlamydia trachomatis / Q000235:genetics; D004269:DNA, Bacterial / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D000091402:Prohibitins; D012446:Sacroiliac Joint / Q000382:microbiology*; D015008:Yersinia enterocolitica / Q000235:genetics
chemical_list: D004269:DNA, Bacterial; C000717331:PHB2 protein, human; D000091402:Prohibitins