title: Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis.
abstract: Reactive arthritis (ReA) is an inflammatory disease that can follow gastrointestinal or genitourinary infections. The primary etiologic agent for post-venereal ReA is the bacterium Chlamydia trachomatis; its relative, C pneumoniae, has also been implicated in disease induction although to a lesser degree. Studies have indicated that the arthritis is elicited by chlamydiae infecting synovial tissue in an unusual biologic state designated persistence. We review clinical aspects, host-pathogen interactions, and treatments for the disease. Areas covered: We briefly discuss both the historic and,more extensively, the current medical literature describing ReA, and we provide a discussion of the biology of the chlamydiae as it relates to elicitation of the disease. A summary of clinical aspects of Chlamydia-induced ReA is included to give context for approaches to treatment of the arthritis. Expert commentary: Basic research into the biology and host-pathogen interactions characteristic of C trachomatis has provided a wealth of information that underlies our current understanding of the pathogenic processes occurring in the ReA synovium. Importantly, a promising approach to cure of the disease is at hand. However, both basic and clinical research into Chlamydia-induced ReA has lagged over the last 5 years, including required studies relating to cure of the disease.
authors.affiliation: a Department of Internal Medicine, Division of Rheumatology , University of South Florida School of Medicine , Tampa , FL , USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Carter
authors.affiliation: b 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: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000628:therapy; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000628:therapy; D002692:Chlamydia trachomatis / Q000276:immunology*; D016993:Chlamydophila pneumoniae / Q000276:immunology*; D004359:Drug Therapy, Combination; D054884:Host-Pathogen Interactions; D006801:Humans; D000091402:Prohibitins; D013583:Synovial Membrane / Q000276:immunology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; C000717331:PHB2 protein, human; D000091402:Prohibitins
keywords: Chlamydia pneumoniae; Chlamydia trachomatis; Chlamydia-induced arthritis; combination antibiotic therapy; persistent bacterial infection; reactive arthritis; spondyloarthritis