Causality of Chlamydiae in Arthritis and Spondyloarthritis: a Plea for Increased Translational Research

Current Rheumatology Reports
H Zeidler, Alan P Hudson

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.

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Citations

Sep 15, 2016·Expert Review of Clinical Immunology·John D Carter, Alan P Hudson
Aug 2, 2017·Cranio : the Journal of Craniomandibular Practice·Larry M Wolford
Sep 7, 2016·Zeitschrift für Rheumatologie·M Rihl
Aug 3, 2016·Clinical Rheumatology·Hayley J DenisonRebecca Grainger
Aug 30, 2019·JOR Spine·Christine M E RustenburgTheodoor H Smit
Nov 20, 2019·Current Rheumatology Reports·Henning Zeidler, Alan P Hudson
Jul 2, 2016·Zeitschrift für Rheumatologie·H Zeidler

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