Reaktive Arthritis – eine vergessene Erkrankung?

Was ist neu?

Epidemiologie und Pathogenese Campylobacter jejuni/enteritidis ist in Westeuropa zu einem der häufigsten Erreger der ReA geworden. Auch nach mit Reisediarrhö assoziierten Escherischia-coli-Infektionen (DEC-Infektionen) können Arthralgien und milde ReA auftreten. HLA-B27 spielt eine Rolle bei der Erregerinvasion und -persistenz in Zellen der Mukosa und als antigenpräsentierendes Molekül. Neu sind Erkenntnisse, dass durch Auslösung einer Unfolded Protein Response (UPR) als Folge einer Fehlfaltung des HLA-B27-Moleküls eine proinflammatorische Stressantwort ausgelöst werden kann und dass enterobakterielle Infektionen diese Reaktion des angeborenen Immunsystems auslösen oder verstärken.

Diagnostik Die Diagnostik beruht nicht auf einzelnen Parametern, sondern auf einer Kombination von klinischen, anamnestischen und serologischen bzw. PCR-basierten Faktoren.

Therapie Antibiotika werden nur zur Therapie einer noch bestehenden Chlamydophilia-trachomatis-Infektion an der Eintrittspforte (urogenital) eingesetzt, nicht aber zur Therapie der posturethritischen oder postenteritischen ReA. Bei therapierefraktären chronischen Verläufen können Biologika (TNF-Inhibitoren) entsprechend ihrer Zulassung bei Spondyloarthritiden eingesetzt werden.

Abstract

Reactive arthritis (ReA) is an aseptic, immune mediated arthritis with typical manifestations following urogenital, gastrointestinal or respiratory tract infections. The interval between the antecedent infection and arthritis is ranging from several days to 4–6 weeks. ReA is classified as member of the group of spondyloarthritides. The triggering microorganisms are not culturable by routine methods from the affected joints. In the pathogenesis of ReA, bacterial and immunological as well as genetic factors (HLA-B27) play an important role. Post-streptococcal arthritis, Lyme arthritis (Borreliosis) and viral arthritis are not classified as ReA within the spondyloarthritis group. In the treatment of ReA, antibiotics are not used. Acute ReA is treated by nonsteroidal anti-inflammatory drugs, and refractory (chronic) arthritis by steroids, sulfasalazine and TNF inhibitors. Notably, only a few original papers on ReA have been published within the last years.

Schlüsselwörter

reaktive Arthritis - Yersinia - Camplyobacter - Chlamydophilia - Salmonella - HLA-B27

Key words

reactive arthritis - Yersinia - Camplyobacter - Chlamydophilia - Salmonella - HLA-B27

Publication History

Article published online:
30 November 2020

• Literatur

• 1 Sieper J, Rudwaleit M, Braun J. et al. Diagnosing reactive arthritis: role of clinical setting in the value of serologic and microbiologic assays. Arthritis Rheum 2002; 46: 319-327
• 2 Hülsemann JL, Zeidler H. Undifferentiated arthritis in an early synovitis out‐patient clinic. Clin Exp Rheumatol 1995; 13: 37-43
• 3 Leirisalo-Repo M, Sieper J. Reactive arthritis: epidemiology, clinical features, and treatment. In: Weisman MH, van der Heijde D, Reveille JD. eds. Ankylosing spondylitis and the spondyloarthropathies. 53. Philadelphia: Mosby Elsevier; 2006
• 4 Ajene AN, Fischer Walker CL, Black RE. Enteric pathogens and reactive arthritis: a systematic review of Campylobacter, salmonella and Shigella-associated reactive arthritis. J Health Popul Nutr 2013; 31: 299-307
• 5 Vasala M, Hallanvuo S, Ruuska P. et al. High frequency of reactive arthritis in adults after Yersinia pseudotuberculosis O:1 outbreak caused by contaminated grated carrots. Ann Rheum Dis 2014; 73: 1793-1796
• 6 Tuompo R, Lääveri T, Hannu T. et al. Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC). Ann Rheum Dis 2020; 79: 605-611
• 7 Hayes KM, Hayes RJP, Turk MA. et al. Evolving patterns of reactive arthritis. Clin Rheumatol 2019; 38: 2083-2088
• 8 Zeidler H, Hudson AP. Chlamydia-Induced Reactive Arthritis: Disappearing Entity or Lack of Research?. Curr Rheumatol Rep 2019; 21: 63
• 9 Nikkari S, Rantakokko K, Ekman P. 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. Arthritis Rheum 1999; 42: 84-89
• 10 Gérard HC, Carter JD, Hudson AP. Chlamydia trachomatis is present and metabolically active during the remitting phase in synovial tissues from patients with chronic Chlamydia-induced reactive arthritis. Am J Med Sci 2013; 346: 22-25
• 11 Granfors K, Jalkanen S, von Essen R. et al. Yersinia antigens in synovial-fluid cells from patients with reactive arthritis. N Engl J Med 1989; 320: 216-221
• 12 Gaston JS, Life PF, Granfors K. et al. Synovial T lymphocyte recognition of organisms that trigger reactive arthritis. Clin Exp Immunol 1989; 76: 348-353
• 13 Hermann E, Fleischer B, Mayet WJ. et al. Response of synovial fluid T cell clones to Yersinia enterocolitica antigens in patients with reactive Yersinia arthritis. Clin Exp Immunol 1989; 75: 365-370
• 14 Saarinen M, Ekman P, Ikeda M. et al. Invasion of Salmonella into human intestinal epithelial cells is modulated by HLA-B27. Rheumatology 2002; 41: 651-657
• 15 Hermann E, Yu DT, Meyer zum Büschenfelde KH. et al. HLA-B27-restricted CD8 T cells derived from synovial fluids of patients with reactive arthritis and ankylosing spondylitis. Lancet 1993; 342: 646-650
• 16 Antoniou AN, Lenart I, Kriston-Vizi J. et al. Salmonella exploits HLA-B27 and host unfolded protein responses to promote intracellular replication. Ann Rheum Dis 2019; 78: 74-82
• 17 Clegg DO, Reda DJ, Weisman MH. et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter’s syndrome). A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 1996; 39: 2021-2027
• 18 Zeng H, Luo B, Zhang Y. et al. Treatment of reactive arthritis with biological agents: a review. Biosci Rep 2020; 40: BSR20191927