HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

SUMMARY Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, nonculturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease.

[1]  M. Leirisalo-Repo,et al.  Long term prognosis of reactive salmonella arthritis , 1997, Annals of the rheumatic diseases.

[2]  T. Salo,et al.  In vivo inhibition of human neutrophil collagenase (MMP‐8) activity during long‐term combination therapy of doxycycline and non‐steroidal anti‐inflammatory drugs (NSAID) in acute reactive arthritis , 1994, Clinical and experimental immunology.

[3]  M. De Vos,et al.  HLA-B27 related arthritis and bowel inflammation. Part 2. Ileocolonoscopy and bowel histology in patients with HLA-B27 related arthritis. , 1985, The Journal of rheumatology.

[4]  A. Calin,et al.  Reiter's syndrome following epidemic shigellosis. , 1981, The Journal of rheumatology.

[5]  G. Covell Chemotherapy of Malaria , 1964 .

[6]  A. McMichael,et al.  Multiple T cell expansions are found in the blood and synovial fluid of patients with reactive arthritis. , 1997, The Journal of rheumatology.

[7]  Andreas Radbruch,et al.  Low secretion of tumor necrosis factor alpha, but no other Th1 or Th2 cytokines, by peripheral blood mononuclear cells correlates with chronicity in reactive arthritis. , 1999, Arthritis and rheumatism.

[8]  G. Alarcón,et al.  Reactive arthritis in patients attending an urban sexually transmitted diseases clinic. , 1996, Arthritis and rheumatism.

[9]  J. Taurog Arthritis in HLA-B27 transgenic animals. , 1998, The American journal of the medical sciences.

[10]  H. Isomäki,et al.  Incidence of inflammatory rheumatic diseases in Finland. , 1978, Scandinavian journal of rheumatology.

[11]  J. Braun,et al.  Pathogenesis of spondylarthropathies. Persistent bacterial antigen, autoimmunity, or both? , 1995, Arthritis and rheumatism.

[12]  R. Inman,et al.  Postdysenteric reactive arthritis , 1988 .

[13]  L. V. D. van de Putte,et al.  Second-line treatment in seronegative spondylarthropathies. , 1994, Seminars in arthritis and rheumatism.

[14]  T. Möttönen,et al.  Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis , 2003 .

[15]  B. Krausse-Opatz,et al.  Infection of Human Monocyte-Derived Macrophages with Chlamydia trachomatis Induces Apoptosis of T Cells: a Potential Mechanism for Persistent Infection , 2000, Infection and Immunity.

[16]  J. Kuipers,et al.  Role of bacteria and HLA-B27 in the pathogenesis of reactive arthritis. , 2003, Rheumatic diseases clinics of North America.

[17]  G. Panayi,et al.  Minocycline in the treatment of patients with Reiter's syndrome. , 1989, Clinical and experimental rheumatology.

[18]  E. Lally,et al.  A review of methotrexate therapy in Reiter syndrome. , 1985, Seminars in arthritis and rheumatism.

[19]  S. Ehlers,et al.  Nested polymerase chain reaction strategy simultaneously targeting DNA sequences of multiple bacterial species in inflammatory joint diseases. I. Screening of synovial fluid samples of patients with spondyloarthropathies and other arthritides. , 1997, The Journal of rheumatology.

[20]  H. Locht,et al.  Antineutrophil cytoplasmic antibodies in reactive arthritis. , 1995, The Journal of rheumatology.

[21]  E. Hay Reiter's syndrome and reactive arthritis. , 1991, British journal of rheumatology.

[22]  K. Krogfelt,et al.  Comparison of rheumatological and gastrointestinal symptoms after infection with Campylobacter jejuni/coli and enterotoxigenic Escherichia coli , 2002, Annals of the rheumatic diseases.

[23]  H. Gérard,et al.  Synovial Chlamydia trachomatis in patients with reactive arthritis/Reiter's syndrome are viable but show aberrant gene expression. , 1998, The Journal of rheumatology.

[24]  J. Braun,et al.  Rheumatologic manifestations of gastrointestinal disorders. , 1999, Current opinion in rheumatology.

[25]  T. Elliott,et al.  Lymphoblastoid cells express HLA‐B27 homodimers both intracellularly and at the cell surface following endosomal recycling , 2003, European journal of immunology.

[26]  H. Doerr,et al.  Testing for Chlamydia trachomatis in urine , 1997, The Lancet.

[27]  M. Leirisalo-Repo,et al.  Chlamydia pneumoniae as a triggering infection in reactive arthritis. , 1999, Rheumatology.

[28]  T. Kvien,et al.  Reactive arthritis: incidence, triggering agents and clinical presentation. , 1994, The Journal of rheumatology.

[29]  P. Toivanen From reactive arthritis to rheumatoid arthritis. , 2001, Journal of autoimmunity.

[30]  T. Vischer,et al.  The value of isotype determination of serum antibodies against Chlamydia for the diagnosis of Chlamydia reactive arthritis. , 1996, British journal of rheumatology.

[31]  H. Schumacher How micro-organisms are handled to localize to joints and within joints. , 1995, Scandinavian journal of rheumatology. Supplement.

[32]  Hanschell,et al.  MEDICAL SOCIETY FOR THE STUDY OF VENEREAL DISEASES. , 1922 .

[33]  T. Kvien,et al.  Prediction of diagnosis in acute and subacute oligoarthritis of unknown origin. , 1996, British journal of rheumatology.

[34]  S. Jalkanen,et al.  Bacterial lipopolysaccharide in synovial fluid cells in Shigella triggered reactive arthritis. , 1992, The Journal of rheumatology.

[35]  G. Lathrop,et al.  Antibiotic treatment of venereal disease and Reiter's syndrome in a Greenland population. , 1992, Arthritis and rheumatism.

[36]  R. Terkeltaub,et al.  Cartilage and joint inflammation. Regulation of IL-8 expression by human articular chondrocytes. , 1992, Journal of immunology.

[37]  S. Jalkanen,et al.  Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis , 1990, The Lancet.

[38]  D. Reda,et al.  Comparison of sulfasalazine and placebo for the treatment of axial and peripheral articular manifestations of the seronegative spondylarthropathies: a Department of Veterans Affairs cooperative study. , 1999, Arthritis and rheumatism.

[39]  C. Eastmond,et al.  An outbreak of Campylobacter enteritis--a rheumatological followup survey. , 1983, The Journal of rheumatology.

[40]  A. Hudson,et al.  Alteration of Chlamydia trachomatis biologic behavior in synovial membranes. Suppression of surface antigen production in reactive arthritis and Reiter's syndrome. , 1995, Arthritis and rheumatism.

[41]  A. Poole The histopathology of ankylosing spondylitis: are there unifying hypotheses? , 1998, The American journal of the medical sciences.

[42]  John E. Bennett,et al.  Principles and practice of infectious diseases. Vols 1 and 2. , 1979 .

[43]  J. Vácha,et al.  Sulphasalazine in the treatment of reactive arthritis. , 1987, Scandinavian journal of rheumatology. Supplement.

[44]  A. Siitonen,et al.  Reactive arthritis following an outbreak of Salmonella Bovismorbificans infection. , 1998, The Journal of infection.

[45]  M. Leirisalo-Repo Therapeutic aspects of spondyloarthropathies -- a review. , 1998, Scandinavian Journal of Rheumatology.

[46]  K. Granfors,et al.  Salmonella-triggered reactive arthritis , 1992, The Lancet.

[47]  Andrej Tarkowski,et al.  Intra-articularly localized bacterial DNA containing CpG motifs induces arthritis , 1999, Nature Medicine.

[48]  T. Vischer,et al.  Different humoral immune response to Chlamydia trachomatis major outer membrane protein variable domains I and IV in Chlamydia-infected patients with or without reactive arthritis. , 1999, Arthritis and rheumatism.

[49]  B. Thomas,et al.  Detection of Chlamydia trachomatis DNA in joints of reactive arthritis patients by polymerase chain reaction , 1992, The Lancet.

[50]  E. Hulse,et al.  COLUMBUS: WAS IT REITER'S DISEASE? , 1981, The Lancet.

[51]  P. Bowness HLA B27 in health and disease: a double-edged sword? , 2002, Rheumatology.

[52]  H. Zeidler,et al.  Chlamydial rRNA in the joints of patients with Chlamydia-induced arthritis and undifferentiated arthritis. , 1992, Clinical and experimental rheumatology.

[53]  J. Pearce,et al.  Identification and characterization of a DR4‐restricted T cell epitope within chlamydia heat shock protein 60 , 1997, Clinical and experimental immunology.

[54]  R. Lahesmaa,et al.  Persistence of Yersinia antigens in peripheral blood cells from patients with Yersinia enterocolitica O:3 infection with or without reactive arthritis. , 1998, Arthritis and rheumatism.

[55]  W. Beatty,et al.  Reactivation of persistent Chlamydia trachomatis infection in cell culture , 1995, Infection and immunity.

[56]  T. Möttönen,et al.  Effect of a three month course of ciprofloxacin on the outcome of reactive arthritis , 2000, Annals of the rheumatic diseases.

[57]  D K FORD,et al.  Reiter's syndrome , 1981 .

[58]  J. Heesemann,et al.  Infection of Synovial Fibroblasts in Culture by Yersinia enterocolitica and Salmonella enterica Serovar Enteritidis: Ultrastructural Investigation with Respect to the Pathogenesis of Reactive Arthritis , 2001, Infection and Immunity.

[59]  S. Jalkanen,et al.  Dual binding capacity of mucosal immunoblasts to mucosal and synovial endothelium in humans: dissection of the molecular mechanisms , 1995, The Journal of experimental medicine.

[60]  M. Leirisalo-Repo Prognosis, course of disease, and treatment of the spondyloarthropathies. , 1998, Rheumatic diseases clinics of North America.

[61]  P. Saikku,et al.  Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. , 1991, Arthritis and rheumatism.

[62]  J. Woodward,et al.  Yersinia enterocolitica produces superantigenic activity. , 1992, Journal of immunology.

[63]  P. Emery,et al.  Classification of inflammatory arthritis by enthesitis , 1998, The Lancet.

[64]  H. Gérard,et al.  Comparison of synovial tissue and synovial fluid as the source of nucleic acids for detection of Chlamydia trachomatis by polymerase chain reaction. , 1996, Arthritis and rheumatism.

[65]  T. Vischer,et al.  Chlamydia trachomatis antibody detection and diagnosis of reactive arthritis. , 1998, British journal of rheumatology.

[66]  J. Braun,et al.  Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. , 1998, Arthritis and rheumatism.

[67]  M. Skurnik,et al.  The Evolutionarily Conserved Ribosomal Protein L23 and the Cationic Urease β-Subunit of Yersinia enterocolitica O:3 Belong to the Immunodominant Antigens in Yersinia-Triggered Reactive Arthritis: Implications for Autoimmunity , 1994, Molecular medicine.

[68]  Del valle Gutiérrez Fj,et al.  [Reiter's syndrome]. , 1977 .

[69]  K. Granfors,et al.  Infectious agents as triggers of reactive arthritis. , 1998, The American journal of the medical sciences.

[70]  M. Leirisalo-Repo,et al.  Modulation of peripheral blood mononuclear cell activation status during Salmonella-triggered reactive arthritis. , 1999, Arthritis and rheumatism.

[71]  I. Bjarnason,et al.  Inflammatory bowel disease and spondylarthropathy. , 2001, Arthritis and rheumatism.

[72]  L. Pelliniemi,et al.  HLA‐B27 modulates intracellular survival of Salmonella enteritidis in human monocytic cells , 1997, European journal of immunology.

[73]  S. Jalkanen,et al.  Human Leukocyte Subpopulations from Inflamed Gut Bind to Joint Vasculature Using Distinct Sets of Adhesion Molecules1 , 2001, The Journal of Immunology.

[74]  K. Cann Principles and practice of infectious disease , 1990 .

[75]  J. Vartiainen,et al.  ARTHRITIS DUE TO SALMONELLA TYPHIMURIUM. REPORT OF 12 CASES OF MIGRATORY ARTHRITIS IN ASSOCIATION WITH SALMONELLA TYPHIMURIUM INFECTION. , 2009, Acta medica Scandinavica.

[76]  P. Lipsky,et al.  Association between reactive arthritis and antecedent infection with Shigella flexneri carrying a 2-Md plasmid and encoding an HLA-B27 mimetic epitope. , 1993, Arthritis and rheumatism.

[77]  M. Skurnik,et al.  Bacterial PCR in the diagnosis of joint infection , 2001, Annals of the rheumatic diseases.

[78]  P. Pratsidou-Gertsi,et al.  Persistent or severe course of reactive arthritis following Salmonella enteritidis infection. A prospective study of 9 cases. , 1998, Scandinavian journal of rheumatology.

[79]  Michael J. Wilson,et al.  Cutting Edge: Leukocyte Receptor Complex-Encoded Immunomodulatory Receptors Show Differing Specificity for Alternative HLA-B27 Structures1 , 2001, The Journal of Immunology.

[80]  D. Nance,et al.  Inhibition of Apoptosis in Chlamydia-infected Cells: Blockade of Mitochondrial Cytochrome c Release and Caspase Activation , 1998, The Journal of experimental medicine.

[81]  D. Levitt,et al.  The immunobiology of Chlamydia. , 1987, Immunology today.

[82]  J. Reveille,et al.  HLA-B27 and the seronegative spondyloarthropathies. , 1998, The American journal of the medical sciences.

[83]  S. Jalkanen,et al.  Yersinia enterocolitica serotype O:3 alters the expression of serologic HLA-B27 epitopes on human monocytes , 1997, Infection and immunity.

[84]  F. Emmrich,et al.  Characterization of the binding region for the Yersinia enterocolitica adhesin YadA on types I and II collagen. , 1995, Arthritis and rheumatism.

[85]  A. Bubert,et al.  Dendritic cell function is perturbed by Yersinia enterocolitica infection in vitro , 2000, Clinical and experimental immunology.

[86]  J. Heesemann,et al.  Persistence of Yersinia enterocolitica in man , 1988, Infection.

[87]  H. Schumacher,et al.  Light and electron microscopic studies on the synovial membrane in Reiter's syndrome. Immunocytochemical identification of chlamydial antigen in patients with early disease. , 1988, Arthritis and rheumatism.

[88]  K. Granfors Do bacterial antigens cause reactive arthritis? , 1992, Rheumatic diseases clinics of North America.

[89]  J. Weitzman Dendritic cell function , 2001, Genome Biology.

[90]  P. Wu,et al.  Crucial role of interleukin-10/interleukin-12 balance in the regulation of the type 2 T helper cytokine response in reactive arthritis. , 1997, Arthritis and rheumatism.

[91]  R. Vuento,et al.  In vitro lymphoproliferative response to Yersinia: depressed response in arthritic patients years after Yersinia infection. , 1983, Clinical and experimental rheumatology.

[92]  L. Espinoza,et al.  Chlamydia-induced reactive arthritis. , 1993, Rheumatic diseases clinics of North America.

[93]  H. Kautiainen,et al.  Annual incidence of inflammatory joint diseases in a population based study in southern Sweden , 2002, Annals of the rheumatic diseases.

[94]  J. Braun,et al.  Treatment of reactive arthritis with antibiotics. , 1998, British journal of rheumatology.

[95]  L. Latulippe,et al.  [Reactive arthritis]. , 1980, L'union medicale du Canada.

[96]  D. M. van der Heijde,et al.  Limited effect of sulphasalazine treatment in reactive arthritis. A randomised double blind placebo controlled trial , 1997, Annals of the rheumatic diseases.

[97]  J. Harley,et al.  A hypothesis for the HLA-B27 immune dysregulation in spondyloarthropathy: contributions from enteric organisms, B27 structure, peptides bound by B27, and convergent evolution. , 1993, Proceedings of the National Academy of Sciences of the United States of America.

[98]  T. Feltkamp Factors involved in the pathogenesis of HLA-B27 associated arthritis. , 1995, Scandinavian journal of rheumatology. Supplement.

[99]  J. Braun,et al.  Pathogenesis of spondylarthropathies , 1995 .

[100]  First,et al.  Identification of the Yersinia enterocolitica urease beta subunit as a target antigen for human synovial T lymphocytes in reactive arthritis , 1993, Infection and immunity.

[101]  H. Rammensee,et al.  Misfolding of HLA-B27 as a result of its B pocket suggests a novel mechanism for its role in susceptibility to spondyloarthropathies. , 1999, Journal of immunology.

[102]  D. Karras,et al.  Change in the epidemiology of Reiter's syndrome (reactive arthritis) in the post-AIDS era? An analysis of cases appearing in the Greek Army. , 1995, The Journal of rheumatology.

[103]  I. Paronen Reiter's Disease. A Study of 344 Cases Observed, in Finland. , 1948 .

[104]  Ulrich Dobrindt,et al.  Prokaryotic Chromosomes and Disease , 2003, Science.

[105]  A. Keat Reiter's syndrome and reactive arthritis in perspective. , 1983, The New England journal of medicine.

[106]  F. Wollheim Enteropathic arthritis: how do the joints talk with the gut? , 2001, Current opinion in rheumatology.

[107]  C. Goldsmith,et al.  Randomised, blinded, placebo controlled trial of doxycycline for chronic seronegative arthritis , 2001, Annals of the rheumatic diseases.

[108]  J. Braun,et al.  Frequency of triggering bacteria in patients with reactive arthritis and undifferentiated oligoarthritis and the relative importance of the tests used for diagnosis , 2001, Annals of the rheumatic diseases.

[109]  K. Aho,et al.  Incidence of chronic inflammatory joint diseases in Finland in 1995. , 2000, The Journal of rheumatology.

[110]  L. Laasonen,et al.  Antibiotic treatment and long term prognosis of reactive arthritis , 2003, Annals of the rheumatic diseases.

[111]  G. Kingsley,et al.  Report on the Fourth International Workshop on Reactive Arthritis. , 2000, Arthritis and rheumatism.

[112]  R. Inman Classification criteria for reactive arthritis. , 1999, The Journal of rheumatology.

[113]  G. Cornelis,et al.  Differential secretion of interleukin-8 by human epithelial cell lines upon entry of virulent or nonvirulent Yersinia enterocolitica , 1996, Infection and immunity.

[114]  M. De Vos,et al.  Course of gut inflammation in spondylarthropathies and therapeutic consequences. , 1996, Bailliere's clinical rheumatology.

[115]  Y. Hirata,et al.  Nitric oxide production and inducible nitric oxide synthase expression in inflammatory arthritides. , 1995, The Journal of clinical investigation.

[116]  T. Möttönen,et al.  Salmonella-triggered reactive arthritis: use of polymerase chain reaction, immunocytochemical staining, and gas chromatography-mass spectrometry in the detection of bacterial components from synovial fluid. , 1999, Arthritis and rheumatism.

[117]  H. Reiter Ueber eine bisher unerkannte Spirochäteninfektion (Spirochaetosis arthritica) , 1916 .

[118]  M. Ikeda,et al.  The pathogenesis of HLA-B27 arthritis: role of HLA-B27 in bacterial defense. , 1998, The American journal of the medical sciences.

[119]  Muhammad Asim Khan,et al.  Update on Spondyloarthropathies , 2002, Annals of Internal Medicine.

[120]  A. McMichael,et al.  Cutting edge: HLA-B27 can form a novel beta 2-microglobulin-free heavy chain homodimer structure. , 1999, Journal of immunology.

[121]  E. Braunstein,et al.  Radiologic features of Reiter disease. , 1979, Radiology.

[122]  S. Prahalad,et al.  Predisposing factors in the Spondyloarthropathies: New insights into the role of HLA-B27 , 2001, Current rheumatology reports.

[123]  W. V. Van Voorhis,et al.  Analysis of lymphocyte phenotype and cytokine activity in the inflammatory infiltrates of the upper genital tract of female macaques infected with Chlamydia trachomatis. , 1996, The Journal of infectious diseases.

[124]  W. Tsai,et al.  Expression of arthritis-causing HLA-B27 on Hela cells promotes induction of c-fos in response to in vitro invasion by Salmonella typhimurium. , 1998, The Journal of clinical investigation.

[125]  R. Lawrence,et al.  A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us? , 1997, Archives of internal medicine.

[126]  M. Dougados,et al.  Predictive factors for the longterm outcome of spondyloarthropathies. , 1994, The Journal of rheumatology.

[127]  A. Toivanen Managing reactive arthritis. , 2000, Rheumatology.

[128]  J. Peterson,et al.  Yersinia enterocolitica envelope proteins that are crossreactive with the thyrotropin receptor (TSHR) also have B-cell mitogenic activity. , 1996, Journal of autoimmunity.

[129]  M. Dougados,et al.  The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. , 1991, Arthritis and rheumatism.

[130]  H. Zeidler,et al.  Reactive or infectious arthritis , 1999, Annals of the rheumatic diseases.

[131]  L. Voipio‐Pulkki,et al.  Followup study on patients with Reiter's disease and reactive arthritis, with special reference to HLA-B27. , 1982, Arthritis and rheumatism.

[132]  D. Wakefield,et al.  Ciprofloxacin treatment does not influence course or relapse rate of reactive arthritis and anterior uveitis. , 1999, Arthritis and rheumatism.

[133]  G. Ehrlich Kelley's Textbook of Rheumatology, 6th ed, CD-ROM , 2002 .

[134]  M. De Vos,et al.  Gut inflammation in psoriatic arthritis: a prospective ileocolonoscopic study. , 1995, The Journal of rheumatology.

[135]  R. Terkeltaub,et al.  Monocyte chemoattractant protein-1 (MCP-1) expression in human articular cartilage. Induction by peptide regulatory factors and differential effects of dexamethasone and retinoic acid. , 1992, The Journal of clinical investigation.

[136]  P. Toivanen,et al.  Salmonella specific antibodies in serum and synovial fluid in patients with reactive arthritis. , 1992, British journal of rheumatology.

[137]  S. Jalkanen,et al.  Combination therapy in rheumatoid arthritis. , 1992 .

[138]  A. Toivanen,et al.  Does Yersinia induce autoimmunity? , 1994, International archives of allergy and immunology.

[139]  J. Strominger,et al.  Free Heavy Chains of HLA-B2705 on the Cell Surface , 2002 .

[140]  J. Sibilia,et al.  Reactive arthritis or chronic infectious arthritis? , 2002, La Revue de medecine interne.

[141]  H. Zeidler,et al.  Detection of Chlamydia trachomatis in peripheral blood leukocytes of reactive arthritis patients by polymerase chain reaction. , 1998, Arthritis and rheumatism.

[142]  D. Heijde,et al.  Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis. , 2000 .

[143]  G. Kingsley,et al.  Lack of correlation between the detection of Chlamydia trachomatis DNA in synovial fluid from patients with a range of rheumatic diseases and the presence of an antichlamydial immune response. , 1998, Arthritis and rheumatism.

[144]  S. Jalkanen,et al.  Increased synovial endothelium binding and transendothelial migration of mononuclear cells during Salmonella infection. , 1998, Arthritis and rheumatism.

[145]  B. Amor Reiter's syndrome. Diagnosis and clinical features. , 1998, Rheumatic diseases clinics of North America.

[146]  N. Tsuchiya,et al.  Induction of alternative splicing of HLA-B27 by bacterial invasion. , 1997, Arthritis and rheumatism.

[147]  P. Greminger,et al.  Systemic vasculitis associated with seronegative spondylarthropathy (Reiter's syndrome) , 1997, Clinical Rheumatology.

[148]  H. Zeidler,et al.  Undifferentiated arthritis and reactive arthritis. , 1998, Current opinion in rheumatology.

[149]  S. Wahl,et al.  Modulation of monocyte chemotactic function in inflammatory lesions. Role of inflammatory mediators. , 1991, Journal of immunology.

[150]  E. Unanue,et al.  The basis for the immunoregulatory role of macrophages and other accessory cells. , 1987, Science.

[151]  M. Sieck,et al.  Light and electron microscopic studies on the synovial membrane in reiter's syndrome. , 1988 .

[152]  R. Hammer,et al.  Defective dendritic cell (DC) function in a HLA-B27 transgenic rat model of spondyloarthropathy (SpA). , 1995, Advances in experimental medicine and biology.

[153]  H. Gérard,et al.  Chlamydia trachomatis nucleic acids can be found in the synovium of some asymptomatic subjects. , 1999, Arthritis and rheumatism.

[154]  J. Braun,et al.  The 19 kDa protein of Yersinia enterocolitica O:3 is recognized on the cellular and humoral level by patients with Yersinia induced reactive arthritis. , 1999, The Journal of rheumatology.

[155]  D. Resnick Diagnosis of Bone and Joint Disorders , 1987 .

[156]  R. Inman,et al.  ME1 epitope of HLA-B27 confers class I-mediated modulation of gram-negative bacterial invasion. , 1994, Journal of immunology.

[157]  Y. Konttinen,et al.  The anticollagenolytic potential of lymecycline in the long-term treatment of reactive arthritis. , 1992, Arthritis and rheumatism.

[158]  R. Hughes,et al.  Antigen-presenting cells but not lymphocytes in the joint may indicate the cause of reactive arthritis. , 1996, British journal of rheumatology.

[159]  E. Märker-Hermann,et al.  The cutting edge of spondylarthropathy research in the millennium. , 2002, Arthritis and rheumatism.

[160]  R. Inman,et al.  Postdysenteric reactive arthritis. A clinical and immunogenetic study following an outbreak of salmonellosis. , 1988, Arthritis and rheumatism.

[161]  P. Galle,et al.  IL10.G microsatellites mark promoter haplotypes associated with protection against the development of reactive arthritis in Finnish patients. , 2001, Arthritis and rheumatism.

[162]  A. Toivanen,et al.  Two forms of reactive arthritis? , 1999, Annals of the rheumatic diseases.

[163]  T. Yli-Kerttula,et al.  Effect of antimicrobial treatment on chronic reactive arthritis. , 1993, Clinical and experimental rheumatology.

[164]  I. Olivieri,et al.  Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging. , 1998, The Journal of rheumatology.

[165]  A. Toivanen,et al.  Epidemiologic, clinical, and therapeutic aspects of reactive arthritis and ankylosing spondylitis. , 1995, Current opinion in rheumatology.

[166]  P. Emery,et al.  Distinct vascular patterns of early synovitis in psoriatic, reactive, and rheumatoid arthritis. , 1999, Arthritis and rheumatism.

[167]  M. Fiorillo,et al.  CD8(+) T-cell autoreactivity to an HLA-B27-restricted self-epitope correlates with ankylosing spondylitis. , 2000, The Journal of clinical investigation.

[168]  L. Espinoza,et al.  Detection of bacterial DNA in Latin American patients with reactive arthritis by polymerase chain reaction and sequencing analysis. , 2002, The Journal of rheumatology.

[169]  A. Kantele,et al.  Salmonella-specific antibodies in reactive arthritis. , 1991, The Journal of infectious diseases.

[170]  E. Veys,et al.  HLA-B27 related arthritis and bowel inflammation. Part 1. Sulfasalazine (salazopyrin) in HLA-B27 related reactive arthritis. , 1985, The Journal of rheumatology.

[171]  S. Jalkanen,et al.  Yersinia antigens in synovial-fluid cells from patients with reactive arthritis. , 1989, The New England journal of medicine.

[172]  H. Locht,et al.  Reactive arthritis after Salmonella among medical doctors--study of an outbreak. , 1993, The Journal of rheumatology.

[173]  L. Espinoza,et al.  Reactive arthritis: newer developments. , 2003, Rheumatic diseases clinics of North America.

[174]  J. Whittum-Hudson,et al.  Chlamydia and associated arthritis , 2000, Current opinion in rheumatology.

[175]  K. Mølbak,et al.  High frequency of reactive joint symptoms after an outbreak of Salmonella enteritidis. , 2002, The Journal of rheumatology.

[176]  J. Heesemann,et al.  Yersinia enterocolitica in the synovial membrane of patients with Yersinia-induced arthritis. , 1990, Arthritis and rheumatism.

[177]  R. Hammer,et al.  The germfree state prevents development of gut and joint inflammatory disease in HLA-B27 transgenic rats , 1994, The Journal of experimental medicine.

[178]  A. Toivanen,et al.  IgA class antibodies against Yersinia enterocolitica O:3 in patients with thyroid disease. , 1988, Acta endocrinologica.

[179]  R. Inman,et al.  HLA-B27 expression modulates gram-negative bacterial invasion into transfected L cells. , 1992, Journal of immunology.

[180]  U. DeBellis Reiter's disease. , 1952, British medical journal.

[181]  P. Toivanen,et al.  What determines arthritogenicity of bacterial cell wall? A study on Eubacterium cell wall-induced arthritis. , 2000, Rheumatology.

[182]  M. Weisman,et al.  The physician Hans Reiter as prisoner of war in Nuremberg: a contextual review of his interrogations (1945-1947). , 2003, Seminars in arthritis and rheumatism.

[183]  L. Boyle,et al.  Breaking the rules: the unconventional recognition of HLA-B27 by CD4+ T lymphocytes as an insight into the pathogenesis of the spondyloarthropathies. , 2003, Rheumatology.

[184]  F. Hiepe,et al.  No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study. , 1999, Arthritis and rheumatism.

[185]  D. Reda,et al.  Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study. , 1996, Arthritis and rheumatism.

[186]  L. Hoenig The arthritis of Christopher Columbus. , 1992, Archives of internal medicine.

[187]  T. Vischer,et al.  Chlamydial Serology: Comparative Diagnostic Value of Immunoblotting, Microimmunofluorescence Test, and Immunoassays Using Different Recombinant Proteins as Antigens , 2001, Journal of Clinical Microbiology.

[188]  M. Neurath,et al.  T cell specificity and cross reactivity towards enterobacteria,Bacteroides,Bifidobacterium, and antigens from resident intestinal flora in humans , 1999, Gut.

[189]  J. Heesemann,et al.  Yersinia enterocolitica Impairs Activation of Transcription Factor NF-κB: Involvement in the Induction of Programmed Cell Death and in the Suppression of the Macrophage Tumor Necrosis Factor α Production , 1998, The Journal of experimental medicine.

[190]  T. Vischer,et al.  Amplification of plasmid and chromosome Chlamydia DNA in synovial fluid of patients with reactive arthritis and undifferentiated seronegative oligoarthropathies. , 1995, Arthritis and rheumatism.

[191]  H. Dienes,et al.  Enterobacteria-infected T cells as antigen-presenting cells for cytotoxic CD8 T cells: a contribution to the self-limitation of cellular immune reactions in reactive arthritis? , 1997, The Journal of infectious diseases.

[192]  G. Peltz,et al.  Pathogen antigen- and superantigen-reactive synovial fluid T cells in reactive arthritis. , 1995, The Journal of infectious diseases.

[193]  H. Jasin Bacterial lipopolysaccharides induce in vitro degradation of cartilage matrix through chondrocyte activation. , 1983, The Journal of clinical investigation.

[194]  R. Patterson,et al.  Coronary artery stenosis in Reiter's syndrome: a complication of aortitis. , 1994, The Journal of rheumatology.

[195]  L. Laasonen,et al.  Infectious background of patients with a history of acute anterior uveitis , 2002, Annals of the rheumatic diseases.

[196]  J. Braun,et al.  Diagnosing reactive arthritis: role of clinical setting in the value of serologic and microbiologic assays. , 2002, Arthritis and rheumatism.

[197]  C. Ritchlin,et al.  Recent advances in the treatment of the seronegative spondyloarthropathies , 2001, Current rheumatology reports.

[198]  G. Kingsley,et al.  On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999. , 2000, The Journal of rheumatology.

[199]  G. Kingsley,et al.  Third International Workshop on Reactive Arthritis. 23-26 September 1995, Berlin, Germany. Report and abstracts. , 1996, Annals of the rheumatic diseases.

[200]  D. Wallace,et al.  Should a war criminal be rewarded with eponymous distinction?: the double life of hans reiter (1881-1969). , 2000, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[201]  M. Helfand,et al.  Screening for chlamydial infection. , 2001, American journal of preventive medicine.

[202]  J. Heesemann,et al.  Invasion and persistence of Salmonella in human fibroblasts positive or negative for endogenous HLA B27 , 1997, Annals of the rheumatic diseases.

[203]  D. Allison CHRISTOPHER COLUMBUS: FIRST CASE OF REITER'S DISEASE IN THE OLD WORLD? , 1980, The Lancet.

[204]  R. Cuchacovich,et al.  Applications of polymerase chain reaction in rheumatology. , 2003, Rheumatic diseases clinics of North America.

[205]  R. Colbert,et al.  HLA-B27 misfolding: a solution to the spondyloarthropathy conundrum? , 2000, Molecular medicine today.

[206]  A. Bengtsson,et al.  Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study. , 1990, BMJ.

[207]  R. Lahesmaa,et al.  Molecular mimickry between HLA B27 and Yersinia, Salmonella, Shigella and Klebsiella within the same region of HLA α1‐helix , 1991, Clinical and experimental immunology.

[208]  A. Toivanen,et al.  Persistence of IgM, IgG, and IgA antibodies to Yersinia in yersinia arthritis. , 1980, The Journal of infectious diseases.

[209]  W. Barth,et al.  Reactive arthritis (Reiter's syndrome). , 1999, American family physician.

[210]  O. Oniankitan,et al.  Spondyloarthropathies in sub-Saharan Africa , 2000, Current Opinion in Rheumatology.

[211]  B. Thomas,et al.  CHLAMYDIA TRACHOMATIS AND REACTIVE ARTHRITIS: THE MISSING LINK , 1987, The Lancet.

[212]  B. Thomas,et al.  Laboratory techniques for the diagnosis of chlamydial infections. , 1991, Genitourinary medicine.

[213]  J. Gaston,et al.  Clinical and experimental evidence for persistent Yersinia infection in reactive arthritis. , 1999, Arthritis and rheumatism.

[214]  J. Angulo,et al.  The spectrum of skin, mucosa and other extra-articular manifestations. , 1998, Bailliere's clinical rheumatology.

[215]  M. Poca,et al.  Reactive arthritis with a severe lesion of the cervical spine. , 1997, British journal of rheumatology.

[216]  M. Tamulaitienė,et al.  A comparative quantitative morphometric study of cell apoptosis in synovial membranes in psoriatic, reactive and rheumatoid arthritis. , 1999, Rheumatology.

[217]  H. Luthra,et al.  Spontaneous inflammatory arthritis in HLA-B27 transgenic mice lacking beta 2-microglobulin: a model of human spondyloarthropathies , 1995, The Journal of experimental medicine.

[218]  P. Davis,et al.  The sacroiliitis of acute Reiter's syndrome. , 1977, The Journal of rheumatology.

[219]  J. Heesemann,et al.  Yersinia enterocolitica: a cause of chronic polyarthritis. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[220]  S Gary Firestein,et al.  Kelley's Textbook of Rheumatology , 2004 .

[221]  R. Hughes,et al.  Reiter's Syndrome and Reactive Arthritis: A , 1994 .

[222]  J. Reveille,et al.  HLA-B27 and genetic predisposing factors in spondyloarthropathies , 2001, Current opinion in rheumatology.

[223]  Hongwei H Zhang,et al.  Tumor Necrosis Factor Receptor p55-Deficient Mice Respond to Acute Yersinia enterocolitica Infection with Less Apoptosis and More Effective Host Resistance , 2000, Infection and Immunity.

[224]  J. Goronzy,et al.  Immune responses to Borrelia burgdorferi in patients with reactive arthritis. , 1989, Arthritis and rheumatism.

[225]  A. Calin,et al.  Reiter's syndrome: Evaluation of preliminary criteria for definite disease , 1982 .