title: A review of serological tests to assist diagnosis of reactive arthritis: critical appraisal on methodologies.
abstract: On a population-based level, the incidence of reactive arthritis (ReA) is 0.6-27/100,000. The definition of ReA varies and its pathogenesis is not yet clear. Attempts in basic immunology to suggest hypotheses for proliferation of forbidden B cell clones, molecular mimicry, and involvement of cross-reactive antibodies are helpful but not sufficient. Importantly, for the clinical diagnosis of the preceding infection, serology is widely used. Unfortunately, the accuracy of associations between serologic findings and clinical conclusions is plagued by poor standardization of methods. So far, few attempts have been done to examine the pitfalls of different approaches. Here, we review several serologic techniques, their performance and limitations. We will focus on serology for Yersinia, Campylobacter, Salmonella, Shigella, and Chlamydia trachomatis because these bacteria have a longer history of being associated with ReA. We also address controversies regarding the role of serology for some other bacteria linked to autoimmune disorders.
authors.affiliation: Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki , Helsinki , Finland ; Eastern Finland Laboratory Centre Joint Authority Enterprise (ISLAB), Mikkeli District Laboratory , Mikkeli , Finland.
authors.forename: Tamara
authors.initials: T
authors.lastname: Tuuminen
authors.affiliation: Department of Infectious Diseases, Health Centre of Lahti , Lahti , Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Lounamo
authors.affiliation: Institute of Clinical Medicine, University of Helsinki , Helsinki , Finland ; Department of Medicine, Helsinki University Central Hospital , Helsinki , Finland.
authors.forename: Marjatta
authors.initials: M
authors.lastname: Leirisalo-Repo
keywords: Campylobacter; Chlamydia trachomatis; Salmonella; Yersinia; cross-reactivity; reactive arthritis; serology