title: Causality of Chlamydiae in Arthritis and Spondyloarthritis: a Plea for Increased Translational Research.
abstract: Current molecular genetic understanding of the metabolically active persistent infection state of Chlamydia trachomatis and Chlamydia pneumoniae in the synovium in patients with arthritis and spondyloarthritis favors a causal relationship. Here, we examine how adequately the accepted criteria for that etiologic relationship are fulfilled, emphasizing the situation in which these microorganisms cannot be cultivated by standard or other means. We suggest that this unusual situation of causality by chlamydiae in rheumatic disease requires establishment of a consensus regarding microorganism-specific terminology as well as the development of new diagnostic and classification criteria. Recent studies demonstrate the value of molecular testing for diagnosis of reactive arthritis, undifferentiated spondyloarthritis, and undifferentiated arthritis caused by C. trachomatis and C. pneumoniae in clinical practice. Data regarding combination antibiotic therapy is consistent with the causative role of chlamydiae for these diseases. Observations of multiple intra-articular coinfections require more research to understand the implications and to respond to them.
authors.affiliation: Division of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany. zeidler.henning@mh-hannover.de.
authors.forename: Henning
authors.initials: H
authors.lastname: Zeidler
authors.affiliation: Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Hudson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016918:Arthritis, Reactive / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy; D002692:Chlamydia trachomatis; D016993:Chlamydophila pneumoniae; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009626:Terminology as Topic; D057170:Translational Research, Biomedical / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic combination therapy; Chlamydia arthritis; Chlamydia pneumoniae; Chlamydia spondyloarthritis; Chlamydia trachomatis; Coinfection; Reactive arthritis; Slow bacterial infection; Spondyloarthritis