Clinical InvestigationChlamydia trachomatis Is Present and Metabolically Active During the Remitting Phase in Synovial Tissues From Patients With Chronic Chlamydia-induced Reactive Arthritis
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Patient Samples
Not surprisingly, it is difficult to obtain samples from patients in the remitting/quiescent phase of chronic Chlamydia-induced ReA. However, one of the authors (J.D.C.) was able to obtain synovial biopsies from 4 consenting patients, under an approved protocol; these were patients 1, 2, 3 and 7 in a continuing study. With one exception, all were single samples from individuals with quiescent disease; the exception was 2 samples from one patient, the first (sample 7A) was obtained during
Bacterial Load and Levels of Selected Chlamydial Transcripts During Quiescent ReA
We first assessed whether chlamydiae were present in synovial tissue in patients with remitting disease, and if so, what the bacterial load was in the samples compared with values for load averaged from congruent freezer library samples from 10 patients with well-characterized, active Chlamydia-induced arthritis (Table 3). Standard PCR analyses indeed showed that the organism was present in each remitting sample (data not shown), and as shown in Figure 1A, the relative level of C trachomatis
DISCUSSION
Chlamydia trachomatis, the causative agent in Chlamydia-induced arthritis, exists in synovial tissues in the persistent infection form rather than the form characteristic of active infection2., 3., 4., 7. for review. In this state, chlamydiae display an unusual transcript profile compared with that seen during normal active infection,4., 11., 14., 15. and we hypothesized that if the organism is indeed present in synovial tissue during the remitting disease phase, then the significantly lower
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2019, Best Practice and Research: Clinical RheumatologyCitation Excerpt :By definition, no viable bacteria can be cultivated from the inflamed joint, and the triggering enterobacteria have generally been eliminated from the gut at the time of disease outburst [6]. However, in the case of Chlamydia-induced ReA, there is evidence for the persistence of bacteria within monocytic cells in the synovium [8]. This observation is consistent with the efficacy of a prolonged course of a combination of antibiotics targeting intracellular bacteria, on Chlamydia-associated ReA [9].
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The authors declare no conflicts of interest.