[HLA-antigens and some pathogenetic aspects of reactive arthritis]. / HLA-antigeny i nekotorye patogeneticheskie aspekty reaktivnykh artritov.

AIM: Investigation of associations of reactive arthritis (ReA) with histocompatibility antigens class I and II and determination of new approaches to assessment of association ReA with antigen HLA B27. MATERIALS AND METHODS: 118 ReA patients with associated intestinal and 82 ReA patients with associated urogenital infection were studied. The infection was identified bacteriologically, with agglutination reaction, enzyme immunoassay, direct and indirect immunofluorescence, culturing. HLA-antigens were studied in lymphocytotoxic test: locus A, B and C in all the patients, DR in 65 patients. RESULTS: ReA triggers were intracellularly parasite bacteria: facultative parasites in the enterocolitic variant (Yersinia, as a rule), obligate parasite in the urogenital (Chlamidia, as a rule). HLA B27 antigen was discovered in 77.5% of patients (RR 45.8), HLA DR1--in 48.4% of patients (RR 3.3). In urogenital variant HLA B27 antigen occurred more frequently than in enterocolitic: 87.8% (RR 95.6) versus 70.3% (RR 31.5); p < 0.01). In HLA-B27-positive patients compared to HLA-B27-negative ones there were higher ESR (p < 0.001), leukocyte count (p < 0.05), concentrations of CRP and alpha-2-globulins (p < 0.001). CONCLUSION: In HLA-B27-subjects optimal conditions exist for generalization of obligate parasites and favorable for production of facultative ones. The degree of association of ReA with HLA B27 antigens is dependent on adaptive features of microorganisms appearing in the process of evolution--obligaty and facultativeness of their internal parasitivity.

[Reactive arthritis: terminology, etiology and pathogenesis]. / Reaktivnye artrity: terminologiia, etiologiia, patogenez.

Different serovars of Y. enterocolitica, Y. pseudotuberculosis, Acinetobacter calcoaceticus, and Pseudomonas pauimobilis were isolated from the synovial fluid of 23 out of 34 patients with Yersinia-triggered arthritis by a new bacteriological method based on the selection of the optimal conditions for microorganism culturing; in some cases the strains were isolated repeatedly. The authors discuss the necessity of correcting the previous notions on the aseptic nature of reactive arthritis.

[Approach to evaluation of the indicators of Yersinia infections in reactive and rheumatoid arthritis]. / Podkhody k otsenke pokazatelei iersinioznoi infektsii pri reaktivnom i revmatoidnom artrite.

A total of 140 patients with reactive arthritis due to Yersinia infection were under observation for 2-10 years. A group of 104 patients with erosive rheumatoid arthritis served as control for analysis of the results of bacteriological and serological studies. The bacteriological analysis of the feces, urine, smears of the feces and blood were made repeatedly. As established the articular syndrome in reactive arthrosis has its specific features depending on the nature of the pathological process: primary, recurrent and chronic. Patients with primary reactive arthritis exhibited recovery without residual phenomena and relapses in 35.8% of the cases; in 86% the disease relapsed; in 36% it was chronic, persisting for a number of years as a non-erosive seronegative arthritis; in 25.3% arthralgia persisted; in 6.2% the clinical picture of secondary osteoarthrosis developed; in 17.3% the disease changed into spondyloarthritis and in 1.2% of the cases it changed into RA. Since in reactive arthritis Yersinia infection was confirmed in 48.5% of the cases and in RA in 14-21%, laboratory diagnosis cannot serve as an absolute criterion for reactive arthritis. It is necessary to take into consideration the anamnesis and the peculiarities of the clinical picture and the course of the articular syndrome.

[The state of the gastrointestinal tract in reactive arthritis]. / Sostoianie zheludochno-kishechnogo trakta pri reaktivnom artrite.

The gastrointestinal tract status (GIT) was evaluated in 23 reactive arthritis (RA) patients: in 17 after intestinal infection, in 2 after urogenital infection, and in 4 after mixed infection. All the examined were found to have signs of diffuse variously pronounced chronic inflammation of the small and large intestine, impaired barrier function of the stomach, liver disorders, and moderate-severe intestinal dysbacteriosis with developing transitory bacteraemia in most severe cases. The GIT changes were correlated with the severity of the RA course. In 20 control-group patients not afflicted with joint disease and operated on for cicatricial stricture of the oesophagus, no signs of chronic inflammation of the mucosa were revealed in the biopsy samples of the large and small intestine. The obtained results may be indicative of the role played by the GIT in the development of pathogenic processes in RA.

[Various aspects of the chronic course of Reiter's disease]. / Nekotorye aspekty khronicheskogo techeniia bolezni Reitera.

A comparative clinicolaboratory study of followed-up patients with a chronic (38 patients), acute and lingering (137 patients) course of Reiter's disease was conducted. The role of a persisting focus of infection in the genitourinary organs and genetic predisposition (HLA-B27 was detected in 100% of the cases) in the formation of a chronic variant of disease was shown. Sacroileitis, amyotrophy, bursitis and enthesitis developed more frequently in a chronic than in an acute variant; erosion in the joints was detected in over 40% of the patients. Morphological investigation of the synovial bioptates revealed a picture of chronic synovitis with superficial localization of an inflammatory process.