Lymphocyte reactivity to Clostridium perfringens antigens and toxoid in patients with arthritis.
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Biomedical subjects
Publications and source records attributed to B Olhagen.
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During the last 50 years there has been an obvious change in the relationship between Reiter's syndrome and spondarthritis, probably due to the introduction of antibiotics. Postgonorrhoeic prostatovesiculitis was formerly common: Romanus' spondylitics in the 1940s had a history of gonorrhoea in 35% of cases and 50% of my patients with chronic uro-arthritis in the 1950s had had gonorrhoea. Urogenital syndromes nowadays rarely develop into ankylosing spondylitis; on the other hand, sacroiliitis is still a rather common late sequela, especially in females, however often asymptomatic. The HLA-B27 tissue type is much less frequent in the urogenital syndromes than in ankylosing spondylitis. Accordingly one may postulate that patients with HLA-B27 negative sacroiliitis run a small risk that the disease will progress to ankylosing spondylitis.
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Sixteen patients with aseptic arthritis developing after gonorrhoea and 14 patients with arthritis after nongonococcal urogenital infection have been analysed with respect to clinical course, roentgenological signs, and humoral as well as cellular immune responses to Neisseria gonorrhoeae antigen. Fifty-eight healthy blood donors were used as controls. The clinical pattern did not differ significantly between the 2 groups. Eye or skin lesions indicative of Reiter's syndrome were found in 5 patients of both groups. Signs of sacroiliac arthritis were found in 8 and 6 patients respectively. Gonococcal complement fixation was positive in 9 of 16 patients in the postgonorrhoeal arthritis group and in 0 of 14 patients in the arthritis group with nongonococcal urogenital infection. The lymphocyte stimulation induced by gonococcal antigen was significantly greater in patients with postgonorrhoeal arthritis than in healthy controls. When reference was made to the results of stimulation of the lymphocytes with PPD, there was also a significant difference in the lymphocyte reactivity to gonococcal antigen between the group of patients with postgonorrhoeal arthritis and that of patients with arthritis after non-gonococcal urogenital infection. No such difference was noted between the latter group and the healthy controls. The clinical and immunologic data argue in favour of the hypothesis that Neisseria gonorrhoeae may induce an aseptic arthritis which sometimes presents as a complete Reiter's syndrome.
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One hundred % of 66 patients with pelvospondylitis were found to have HL-A27, whereas the frequency of the antigen in 60 patients with sacroiliitis was 70 %. The difference in frequency of HL-A27 between the two patient groups is statistically highly significant. This implies that tissue typing could be of clinical importance for a prognostic evaluation of patients with sacroiliitis. Studies in families with several HL-A/MLC identical sibs indicated a relatively low penetrance of disease in those carrying the gene for increased susceptibility to development of AS. No association of AS to particular MLC alleles was found either in families or in several SD-2 identical AS patients.
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