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.

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Reactive Arthritis

International Journal of STD & AIDS ◽

10.1177/095646249500600302 ◽

1995 ◽

Vol 6 (3) ◽

pp. 156-160 ◽

Cited By ~ 2

Author(s):

B Svenungsson

Keyword(s):

Reactive Arthritis ◽

Intestinal Tract ◽

Average Duration ◽

The Body ◽

Chlamydia Infection ◽

Hla B27 ◽

Short Term ◽

Physical Treatment ◽

Steroid Injections ◽

Inflammatory Drugs

Reactive arthritis (ReA) develops after an infection elsewhere in the body, generally in the genitourinary or intestinal tract. Chlamydia trachomatis, Yersinia enterocolitica, salmonella, shigella, and campylobacter are frequent triggering agents. Between 60% and 90% of patients are positive for HLA-B27. The arthritis occurs within 4 weeks of the primary infection and is oligoarticular and asymmetric. Extra-articular manifestations include mucocutaneous symptoms, ocular inflammation, and urethritis. The average duration of arthritis is 4 to 5 months but two-thirds of patients have symptoms for more than a year. Bacterial antigens have been found in synovial specimens from patients with ReA, but cultures are sterile. The treatment of ReA comprises non-steroidal anti-inflammatory drugs, intra-articular steroid injections, and physical treatment. Short-term antibiotic treatment has no effect in manifest ReA, whereas a tendency to improvement has been seen with treatment over months, at least after chlamydia infection.

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Reactive Arthritis The Reiter-Fiessinger-Leroy Syndrome

Revista de Chimie ◽

10.37358/rc.20.2.7941 ◽

2020 ◽

Vol 71 (2) ◽

pp. 386-391

Author(s):

Doina Carina Voinescu ◽

Adrian Beznea ◽

Ciprian Dinu ◽

Camelia Ana Grigore ◽

Silvia Fotea ◽

...

Keyword(s):

Immune Response ◽

Genetic Predisposition ◽

Reactive Arthritis ◽

Structural Similarity ◽

The Body ◽

Hla B27 ◽

Urogenital Infections ◽

Classic Triad ◽

Joint Pathology ◽

Reiter Syndrome

The role of creating the expression of reactive arthritis rests with AHO in 1973, which defines reactive arthritis as an acute, unsupportive, sterile inflammatory arthropathy, arising from infections located at a distance in people with a certain genetic predisposition; the disease is systemic and, despite its name, is not limited to the joints. Reactive arthritis (RA), included in Reiter syndrome (with the classic triad of urethritis, conjunctivitis and arthritis), is a non-suppurative inflammatory joint pathology, with a minimal autoimmune component, which it is installed following intestinal or urogenital infections, mainly in people with genetic predisposition. Reactive arthritis is a form of arthritis that affects the joints, urethra, eyes and membranes and sometimes the skin and mucous membranes. This condition is also called Reiter`s syndrome, although this name only indicates a subtype. Reactive arthritis is a seronegative spondyloarthropathy, which brings together a group of disorders that cause inflammation in the body, especially in the spine - such as ankylosing spondylitis, and in the legs. The study covers a number of 20 patients (11 men, 9 women) admitted to the Rheumatology Service of the Clinical Recovery Hospital, between 2010 and 2011, aged over 20, who were diagnosed with reactive arthritis. The existence of a structural similarity between the etiological agent and the HLA-B27 molecule determines either the recognition of the disease-causing germ as a self, so that no immune response will be initiated against it and the antigen will be able to trigger the disease, or the recognition of the germ as nonself, with the triggering of an immune response aimed at both itself and against the HLA-B27 molecule carrying cells of similar structure. Reactive arthritis (RA), included in the Reiter syndrome (with the classic triad of urethritis, conjunctivitis and arthritis), is a non-suppurative inflammatory joint pathology, with a minimal autoimmune component, which is installed as a result of intestinal or urogenital infections, mainly in people with genetic predisposition.

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Defensive activity of Hesperidin against Ciprofloxacin induced hepatic injury in rabbits.

International Journal of Pharmaceutical Quality Assurance ◽

10.25258/ijpqa.10.3.29 ◽

2019 ◽

Vol 10 (03) ◽

Author(s):

Hawraa M. Murad ◽

Tamadhur Hani Hussein ◽

Audai Sulaiman Khudhair ◽

Manal Muhi Murad ◽

Jawad Kadhim Faris

Keyword(s):

Body Weight ◽

Bacterial Infections ◽

Hepatoprotective Activity ◽

The Body ◽

Local Breed ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Defensive Activity ◽

Antioxidant Effects

This study was conducted to find out hepatoprotective activity of hesperidin (HES) 100mg/kg body weight (b.w.) against ciprofloxacin (CPX) 100 mg/kg induced hepatotoxicity in local breed rabbits .CPX is a broad spectrum antibiotic used for treatment of many bacterial infections. Twenty four male rabbits were divided into four groups ,group1: control, (1 ml/kg Saline orally) group 2: CPX (100 mg/kg orally) for (14) consecutive days , group 3: HES (100 mg//kg) orally for (14) consecutive days group 4: CPX (100 mg/kg orally) plus HES (100 mg//kg orally ) for (14) consecutive days. All the rabbits were killed on the (15) day of the experiment, and then the blood, and livers samples were taken. CPX induced hepatotoxicity was proved by a significant (p less than 0.01) reduction in the body weight ,and a significant (p less than 0.01) increased serum aspartate transaminase (AST), alanine transaminase (ALT) , Malonaldehyde enzyme (MAD) and histopathological changes. Protective hepatic toxicity effect and oxidative damage caused by CPX significantly (p less than 0.01) increasing in body weight and significantly (p less than 0.01) decreasing AST , ALT, MAD and improving tissue morphology in HES (100 mg//kg) . These results assure that HES (100 mg//kg) antioxidant effects can protect CPX-induced hepatotoxicity in rabbits.

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Molecular Targets of Phytochemicals for Skin Inflammation

Current Pharmaceutical Design ◽

10.2174/1381612824666180426113247 ◽

2018 ◽

Vol 24 (14) ◽

pp. 1533-1550 ◽

Cited By ~ 3

Author(s):

Jong-Eun Kim ◽

Ki Won Lee

Keyword(s):

Skin Diseases ◽

Molecular Targets ◽

Skin Inflammation ◽

Mechanisms Of Action ◽

The Body ◽

Cellular Damage ◽

Aesthetic Appearance ◽

Immune Mediated ◽

Skin Conditions ◽

Effects Of Aging

Skin is a protective organ and the largest of the human body. Due to its pivotal role in aesthetic appearance, skin health has a significant impact on quality of life. Chronic inflammation of the skin often marks the beginning of various skin diseases. Immune-mediated responses serve to protect the body from external insults and require succinct control, and can lead to ongoing cellular damage and various skin conditions if left unchecked. Studies have shown that phytochemicals can alter processes involved in skin inflammation and alleviate the effects of aging, cancer, atopic dermatitis, psoriasis, and vitiligo. Direct molecular targets of some phytochemicals have been identified and their precise mechanisms of action investigated. In this review, we summarize recent findings on the effects of phytochemicals on skin inflammation and the mechanisms of action involved.

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FRI0445 HLA-B27 IN POSTSTREPTOCOCCAL REACTIVE ARTHRITIS WITH ENTHESITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2546 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 820.1-820

Author(s):

I. Naishtetik ◽

L. Khimion ◽

O. Yashchenko ◽

P. Dolinskiy

Keyword(s):

Rheumatic Fever ◽

Reactive Arthritis ◽

Streptococcal Infection ◽

Joint Involvement ◽

Hla B27 ◽

Aseptic Inflammation ◽

Beta Hemolytic Streptococcus ◽

Common Diagnosis ◽

Poststreptococcal Reactive Arthritis ◽

Rheumatology Practice

Background:Poststreptococcal reactive arthritis (PSRA) is a very common diagnosis in rheumatology practice, which develops after recent pharyngeal streptococcal infection and characterized by aseptic inflammation in one or more joints and periarticular involvement. Now no diagnostic criteria have been agreed [2,4]; association of the expression of HLA-B27 and PSRA is not clear [1,3].Objectives:In our study we analyzed the features of PSRA in presence of HLA-B27.Methods:88 patients (48 female and 40 male) aged between 18-55 years with complains of pain, tender and swollen joints developed after recent pharyngeal streptococcal infection underwent standard physical and laboratory rheumatological examinations. Acute rheumatic fever and other inflammatory arthritis were excluded.Results:60 patients (68,2%) had oligo-polyarthralgia, 10 patients (11,4%) - monoarthritis, 24 patients (27,3%) had asymmetrical olygoarthritis, 4 patients (4,5%) had polyarthritis, enthesitis was found in 4 (4,5%) patients, tenosynovitis of the palmar flexor tendons in 10 cases (11,4%) and the peroneal tendons of the ankles in 5 patients (5,7%), one-sided sacroiliitis (confirmed by MRI) in 5 patients (5,7%).The mean level of ASL-O was 542 U/ml, CRP -15 mg/L, ESR - 34 mm/H; HLA-B27 was present in 24 (30,7%) patients. HLA-B27 positivity was connected to enthesitis, sacroiliitis, more joint involvement with higher levels of ESR and CRP.Conclusion:30% of patients with poststreptococcal reactive arthritis are HLA-B27 positive, the presence of HLA-B27 leads to more frequent development of enthesitis, polyarthritis and sacroiliitis with higher level of inflammatory activity which dictate the need for longer supervision of such patients for possible triggering of ankylosing spondylitis development.References:[1]Ahmed S, Ayoub EM, ScorniK JC, Wang C-Y, She J-X. Poststreptococcal reactive arthritis. Clinical characteristics and association with YLA-DR alleles. Arthritis Rheum 1998; 41:1096-102.9[[2]Gibofsky A, Khanna A, Suh E, et al. The genetics of rheumatic fever: Relationship to streptococcal infection and autoimmune disease. J Rheumatol Suppl. 1991;30:1–5. [PubMed] [Google Scholar][3]Leitch DN, Holland CD/ Reactive arthritis, beta-hemolytic Streptococcus and Staphylococcus aureus. Br J Rheumatol 1996;35:912.[4]Mackie SL, Keat A. Poststreptococcal reactive arthritis: what is it and how do we know? Rheumatology (Oxford) 2004;43:949–54. 10.1093/rheumatology/keh225 [PubMed].Disclosure of Interests:None declared

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Effects of Triphala on Lipid and Glucose Profiles and Anthropometric Parameters: A Systematic Review

Journal of Evidence-Based Integrative Medicine ◽

10.1177/2515690x211011038 ◽

2021 ◽

Vol 26 ◽

pp. 2515690X2110110

Author(s):

Wiraphol Phimarn ◽

Bunleu Sungthong ◽

Hiroyuki Itabe

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Blood Glucose ◽

Waist Circumference ◽

Lipid Profile ◽

Body Mass ◽

The Body ◽

Current Evidence ◽

Diabetic Patients ◽

Anthropometric Parameters

Aim. The efficacy of triphala on lipid profile, blood glucose and anthropometric parameters and its safety were assessed. Methods. Databases such as PubMed, ScienceDirect, Web of Science, and Thai Library Integrated System (ThaiLIS) were systematically searched to review current evidence of randomized controlled trials (RCT) on triphala. RCTs investigating the safety and efficacy of triphala on lipid profile, blood glucose and anthropometric parameters were included. Study selection, data extraction, and quality assessment were performed independently by 2 authors. Results. Twelve studies on a total of 749 patients were included. The triphala-treated groups showed significantly reduced low-density lipoprotein-cholesterol, total cholesterol and triglyceride in 6 studies. Five RCTs demonstrated triphala-treated groups led to statistically significant decrease in body weight, body mass index and waist circumference of obese patients. Moreover, triphala significantly decreased fasting blood glucose level in diabetic patients but not in people without diabetes. No serious adverse event associated with triphala was reported during treatment. Conclusions. This review summarized a current evidence to show triphala might improve the lipid profile, blood glucose, the body weight, body mass index and waist circumference under certain conditions. However, large well-designed RCTs are required to confirm this conclusion.

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Perceived Oral Health Literacy, Behaviors, and Oral Health Care among Caregivers to the Homebound Population

Home Health Care Management & Practice ◽

10.1177/10848223211008435 ◽

2021 ◽

pp. 108482232110084

Author(s):

Agata Wilk ◽

Lisa LaSpina ◽

Linda D. Boyd ◽

Jared Vineyard

Keyword(s):

Health Care ◽

Oral Health ◽

Health Literacy ◽

Oral Care ◽

Oral Health Care ◽

The Body ◽

Current Evidence ◽

Oral Health Literacy ◽

Cross Sectional Survey ◽

Cross Sectional

This study aimed to explore the level of perceived oral health literacy (OHL) among caregivers of the homebound population in the Chicago metropolitan area and how caregivers’ OHL impacts their oral care to the homebound population. The relationships between demographic characteristics, perceived OHL levels, personal oral health behaviors, and oral health care to clients were also assessed. This cross-sectional survey research examined 69 caregivers of the homebound population employed by home health agencies. The OHL was determined by the validated Health Literacy in Dentistry Scale (HeLD-14). Independent t-tests, chi-square tests set at p < .05 significance level, and logistic regressions were used for analysis. The mean age of participants was 43. The HeLD-14 scores indicated a high perceived OHL among this group. Caregivers came from diverse groups, and the majority spoke a second language at home. About 93% performed oral self-care the recommended amount of time or more, while only 57% did it for their clients. Those who cleaned clients’ mouth twice a day had a higher OHL score ( M = 23 compared to M = 19). About 43% did not check for sores in the client’s mouth, and those who checked had a higher OHL score ( M = 25 compared to M = 19). Controlling for OHL, age was a good predictor of oral care frequency to clients. These findings provide current evidence and add to the body of knowledge on OHL among homebound individuals. The results provide insights for designing a preventive approach in oral health care to the homebound population.

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Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA

Rheumatology International ◽

10.1007/s00296-021-04879-3 ◽

2021 ◽

Author(s):

Yoshinori Taniguchi ◽

Hirofumi Nishikawa ◽

Takeshi Yoshida ◽

Yoshio Terada ◽

Kurisu Tada ◽

...

Keyword(s):

Reactive Arthritis ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Intravesical Instillation ◽

Group Classification ◽

Pathogenic Mechanism ◽

Hla B27 ◽

Bacillus Calmette Guerin ◽

Poncet’S Disease ◽

Streptococcal Tonsillitis

AbstractReactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

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Arthritis and Foodborne Bacteria

Journal of Food Protection ◽

10.4315/0362-028x-57.10.935 ◽

1994 ◽

Vol 57 (10) ◽

pp. 935-941 ◽

Cited By ~ 11

Author(s):

JAMES L. SMITH

Keyword(s):

T Cells ◽

Ankylosing Spondylitis ◽

Reactive Arthritis ◽

Molecular Mimicry ◽

Food Poisoning ◽

Cell Subset ◽

Bacterial Cells ◽

Hla B27 ◽

Reiter's Syndrome ◽

Reiter’S Syndrome

Diarrheic episodes caused by the foodborne pathogens Campylobacter, Salmonella, Shigella or Yersinia may lead to a sterile arthritis such as reactive arthritis, Reiter's syndrome or ankylosing spondylitis. Reiter's syndrome and reactive arthritis have been shown to be sequelae in a few well-studied bacterial food poisoning outbreaks. Reactive arthritis, Reiter's syndrome and ankylosing spondylitis show strong familial association related to the gene for HLA-B27 (HLA = human leucocyte antigen) antigen. Why HLA-B27-positive individuals are more susceptible to arthritis is not known, but molecular mimicry between the HLA-B27 antigen and antigens of triggering bacteria has been demonstrated and this mimicry has been proposed as a mechanism involved in etiology of the arthritides. Antigens from bacteria that triggered the arthritis are present in arthritic joints but bacterial cells are not found. Antibodies and T-cells specific for the triggering bacteria have been demonstrated in arthritic patients. T-cells present in synovial joints respond specifically to the particular arthritic triggering pathogen. The cells that respond to bacterial antigens belong to the T-cell subset TH1 that secrete a limited number of cytokines but it is not known if cytokines are involved in arthritis. A few studies have demonstrated that T-cells from the joints of arthritic patients respond to both bacterial and human heat shock proteins indicating that autoimmunity may be involved in causation of arthritis. While only about 2% of a population exposed to a triggering infection will acquire arthritis, these individuals undergo pain and suffering as well as economic hardships as a result of their disease.

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