Frequency of triggering bacteria in patients with reactive arthritis and undifferentiated oligoarthritis and the relative importance of the tests used for diagnosis
Frequency of triggering bacteria in patients with reactive arthritis and undifferentiated oligoarthritis and the relative importance of the tests used for diagnosis
复制标题
反应性关节炎和未分化少关节炎患者中触发细菌的频率以及用于诊断的测试的相对重要性
DOI：
10.1136/ard.60.4.337
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发表时间：
2001
影响因子：
27.4
通讯作者：
Berlin H Sörensen
中科院分区：
文献类型：
--
作者：
C. Fendler;S. Laitko;H. Sörensen;C. Gripenberg;A. Groh;J. Uksila;K. Granfors;J. Braun;J. Sieper;Rheumaklinik Buch;Berlin S Laitko;Berlin H Sörensen
目的沙眼衣原体或耶尔森氏菌、沙门氏菌、空肠弯曲菌、志贺氏菌等肠道细菌引起的反应性关节炎(ReA)是临床表现为未分化少发关节炎(UoA)的重要鉴别诊断。这项研究是为了评估最佳诊断方法。患者和方法52例以关节炎和既往有症状的肠道或生殖道感染为特征的REA患者，以及74例以无症状感染的少关节炎和排除其他诊断(UOA)后可能的REA患者为研究对象。用下列诊断试验鉴定触发细菌：对于耶尔森氏菌诱导的粪便培养，酶免疫分析(EIA)和肥达氏凝集试验检测耶尔森氏菌的抗体；对于沙门氏菌或弯曲杆菌诱导的粪便培养，EIA检测沙门氏菌和空肠弯曲杆菌的抗体；对于志贺氏菌粪便培养的感染；对于沙眼衣原体感染的泌尿生殖道培养，微量免疫荧光法和免疫过氧化物酶试验检测沙眼衣原体抗体。结果52例REA患者中有29例(56%)检出致病原菌。17例(52%)检出肠道细菌：沙门氏菌11例(33%)，耶尔森菌6例(18%)，沙眼衣原体为12/19例(63%)。在有UoA临床表现的患者中，35/74(47%)患者还发现了一种特定的触发细菌：耶尔森菌14/74(19%)，沙门氏菌9/74(12%)，沙眼衣原体12/74(16%)。结论沙眼衣原体、耶尔森氏菌和沙门氏菌在约50%的疑似或可能REA患者中可被鉴定为致病原菌。
OBJECTIVE Reactive arthritis (ReA) triggered by Chlamydia trachomatis or enteric bacteria such as yersinia, salmonella,Campylobacter jejuni, or shigella is an important differential diagnosis in patients presenting with the clinical picture of an undifferentiated oligoarthritis (UOA). This study was undertaken to evaluate the best diagnostic approach. PATIENTS AND METHODS 52 patients with ReA, defined by arthritis and a symptomatic preceding infection of the gut or the urogenital tract, and 74 patients with possible ReA, defined by oligoarthritis without a preceding symptomatic infection and after exclusion of other diagnoses (UOA), were studied. The following diagnostic tests were applied for the identification of the triggering bacterium: for yersinia induced ReA—stool culture, enzyme immunoassay (EIA), and Widal's agglutination test for detection of antibodies to yersinia; for salmonella or campylobacter induced ReA—stool culture, EIA for the detection of antibodies to salmonella andCampylobacter jejuni; for infections with shigella—stool culture; for infections withChlamydia trachomatis—culture of the urogenital tract, microimmunofluorescence and immunoperoxidase assay for the detection of antibodies to Chlamydia trachomatis. RESULTS A causative pathogen was identified in 29/52 (56%) of all patients with ReA. In 17 (52%) of the patients with enteric ReA one of the enteric bacteria was identified: salmonella in 11/33 (33%) and yersinia in 6/33 (18%).Chlamydia trachomatis was the causative pathogen in 12/19 (63%) of the patients with urogenic ReA. In patients with the clinical picture of UOA a specific triggering bacterium was also identified in 35/74 (47%) patients: yersinia in 14/74 (19%), salmonella in 9/74 (12%), and Chlamydia trachomatis in 12/74 (16%). CONCLUSIONS Chlamydia trachomatis, yersinia, and salmonella can be identified as the causative pathogen in about 50% of patients with probable or possible ReA if the appropriate tests are used.