title: Exacerbation of rheumatoid arthritis following Helicobacter pylori eradication: disruption of established oral tolerance against heat shock protein?
abstract: A 62-year-old Japanese woman with RA received an eradication therapy against Helicobacter pylori in November 1999. Eight weeks later, successful eradication was confirmed by negative results for rapid urease test, pathologic findings, and a fall in anti-H. pylori IgG antibody titer. During the course, parameters for RA activity were exacerbated: C-reactive protein 1.1-4.2 mg/dL, rheumatoid arthritis precipitation antigen 2560-5120 dils., erythrocyte sedimentation rate 52-123 mm/h, and complements CH50 50 to over 60 U/mL. Lansbury index increased from 70% to 105%. Two more weeks later, the patient noticed right shoulder pain. She also complained of bilateral gonalgia two months later, and physical examination revealed increased fluid in the knee joints. Prednisolone was required to control the disease activity. The results of this case suggested that RA patients might experience a deleterious effect on the disease activity following H. pylori eradication possibly through disruption of the established oral tolerance against stress protein such as mycobacterial heat shock protein 65.
authors.affiliation: Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, Oyaguchi-kamimachi, Itabashi, Tokyo 173-8610, Japan. m-2000@mbk.ocn.ne.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsukawa
authors.forename: Yasukiyo
authors.initials: Y
authors.lastname: Asai
authors.forename: Noboru
authors.initials: N
authors.lastname: Kitamura
authors.forename: Shigemasa
authors.initials: S
authors.lastname: Sawada
authors.forename: Hanzo
authors.initials: H
authors.lastname: Kurosaka
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016918:Arthritis, Reactive / Q000209:etiology / Q000276:immunology / Q000382:microbiology; D001172:Arthritis, Rheumatoid / Q000209:etiology* / Q000276:immunology* / Q000382:microbiology; D001426:Bacterial Proteins / Q000276:immunology*; D018834:Chaperonin 60; D018833:Chaperonins / Q000276:immunology*; D004361:Drug Tolerance; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D016480:Helicobacter pylori; D006801:Humans; D008875:Middle Aged; D018448:Models, Immunological; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D018834:Chaperonin 60; C074119:heat-shock protein 65, Mycobacterium; D018833:Chaperonins