ABSTRACT: To compare the efficacy of a 10-day and a 4-month doxycylcine course for the treatment of Chlamydia trachomatis-reactive arthritis (Ct-ReA).
Patients with active Ct-ReA were enrolled in a prospective, multicentre, double-blind, controlled clinical trial and randomised to receive doxycycline 100 mg twice daily for 10 days followed either by placebo or by continued doxycycline 100 mg twice daily over 4 months. Various clinical and laboratory parameters referring to disease activity were recorded in the beginning and at the end of treatment.
32 of 37 patients included (15 men and 17 women; mean (standard deviation) disease duration 17 (13) months completed the study; 17 were randomised to short-term doxycycline and placebo (placebo group) and 15 to prolonged treatment with doxycycline (doxycycline group) over the 4-month study period. After this time, only two patients from each group went into remission. There were no drop-outs owing to adverse events or treatment failures.
The results of this study suggest that prolonged treatment with a 4-month course of doxycycline is not superior to short-term treatment over 10 days in patients with Ct-ReA.
Annals of the Rheumatic Diseases 12/2006; 65(11):1521-4. · 8.73 Impact Factor
ABSTRACT: More than 50% of patients with synovitis involving 1-4 joints remain classified as having undifferentiated oligoarthritis (UOA) after 1 year of disease. The clinical presentation is often similar to that of reactive arthritis (ReA) and other spondylarthropathies or to Lyme arthritis. We therefore determined how often Chlamydia trachomatis (Ct) and Borrelia burgdorferi (Bb) can be identified in patients with UOA, by using an extensive laboratory approach.
We prospectively studied 52 patients with UOA who presented at an early synovitis clinic in a region highly endemic for Lyme disease. Patients were examined by standardized clinical and immunoserologic procedures. Synovial fluid was screened for the presence of Ct and Bb DNA by polymerase chain reaction (PCR). Urine was tested for Ct DNA by ligase chain reaction, and serum was tested for Ct antibodies by enzyme-linked immunosorbent assay and Bb antibodies by hemagglutination test and Western blotting. PCR results in the UOA patients were compared with the results in cohorts of patients with definite rheumatoid arthritis (RA), Lyme arthritis, and Chlamydia-induced arthritis (CIA).
In the synovial fluid of 9 of 52 patients with UOA (17%), we found Ct DNA, and in 6 of the 52 patients (12%), Bb DNA was found. The frequency of bacteria-specific DNA was 50% (7 of 14) in CIA patients and 69% (11 of 16) in patients with Lyme arthritis. No Bb or Ct DNA was found in the synovial fluid of the 31 RA patients.
With optimized PCR protocols, it is possible to detect considerable levels of Bb and Ct DNA in the synovial fluid of patients with UOA. Although the presence of bacterial DNA does not unequivocally prove its etiologic significance, we suggest that at least one-third of patients with UOA may have a form of ReA that involves asymptomatic primary infection.
Arthritis & Rheumatism 12/2001; 44(11):2679-85. · 7.87 Impact Factor
ABSTRACT: Chlamydia trachomatis and Borrelia burgdorferi infections are frequently the cause of unexplained oligoarthritis, as shown by identification of bacteria specific DNA in joint material from patients with reactive arthritis, Lyme arthritis, and undifferentiated oligoarthritis. The aim of this study was to determine whether the two organisms occur simultaneously in joint material from patients with arthritis.
Seventy six patients with unexplained arthritis were prospectively studied. Synovial fluid was obtained from all patients and examined for DNA from C trachomatis and B burgdorferi using specific polymerase chain reaction (PCR) protocols. Data concerning prior genitourinary infection or a history of tick bite were recorded and serum antibodies to C trachomatis and B burgdorferi were determined.
Six patients (8%) had DNA from both C trachomatis and B burgdorferi in the same synovial fluid specimen (mean leucocyte count 11.925/mm(3), 65% granulocytes). These patients (four men, two women; mean age 33.7 years) all had oligoarthritis of the knee, ankle, or both (mean disease duration 11.3 months). From the history and serological examination, four patients had some evidence of actual or previous infection with one or other of the bacteria, while the other two patients had a positive serological test for Chlamydia only.
DNA from two different microorganisms which are known to be triggering agents for arthritis may be present simultaneously in joint material from patients with unexplained oligoarthritis. This finding raises the question as to whether, in such cases, one or both bacteria contribute to the pathogenesis of the disease or whether they are only innocent bystanders.
Annals of the Rheumatic Diseases 07/2001; 60(6):632-4. · 8.73 Impact Factor
Der Orthopäde 12/1997; 26(11):1001-11. · 0.51 Impact Factor
ABSTRACT: Die Polymyalgia rheumatica (PMR) ist eine mit ausgeprägten symmetrischen Schultergürtel- und/oder Beckengürtelmyalgien einhergehende,
hochentzündliche Erkrankung des älteren Menschen unklarer Ätiologie und Pathomorphologie, die unter einer suffizienten Kortikosteroidtherapie
rasch zur Beschwerdefreiheit führt und meist innerhalb weniger Jahre ausheilt.
Häufig treten die Symptome einer PMR zusammen mit dem klinischen und histologischen Bild einer Riesenzellarteriitis (RZA)
auf, welche bei der Arteriitis temporalis bzw. capitis (AT/AC) typischerweise durch Sehstörungen, Kau- und Schläfenkopfschmerzen
gekennzeichnet ist. Im Prinzip stellt die RZA eine generalisierte Vaskulitis mittlerer und großer Arterien mit segmental verteiltem,
granulomatös-nekrotisierendem Befall der gesamten Gefäßwand dar und kann damit auch Koronarien, Aorta und Extremitätenarterien
betreffen oder bei okkulter Manifestation ausschließlich mit Zeichen einer konsumierenden Allgemeinerkrankung einhergehen.
Wahrscheinlich ist die PMR keine eigenständige Krankheitsentität, sondern nur eine der unterschiedlichen Manifestationen der
Der Orthopäde 10/1997; 26(11):1001-1011. · 0.51 Impact Factor
Der Internist 10/1997; 38(9):887-97, quiz 896. · 0.30 Impact Factor
ABSTRACT: PCR has been successfully used in research for the detection of C. trachomatis DNA in synovial samples. However, each research laboratory has developed its own PCR, making inter-laboratory comparisons difficult. To allow for standardization we evaluated two commercially available amplification systems originally designed for the examination of urogenital samples (Roche Amplicor Chlamydia PCR and Abbott LCX Chlamydia LCR), using them to analyse spiked and clinical synovial fluid (SF) samples from reactive arthritis (ReA), undifferentiated arthritis (UA), and rheumatoid arthritis (RA) patients. We compared their sensitivity in assays of clinical SF samples with our in-house developed C. trachomatis specific nested PCR.
SF was spiked with purified C. trachomatis elementary bodies (EB) and analyzed by the commercial assays. Clinical SF samplesfrom ReA (n=21), UA (n=79) and RA (n=50) patients were examined by the two commercial assays and our in-house PCR.
Using SF samples spiked with defined numbers of C. trachomatis EB, the sensitivity of the commercial tests was high and similar to published PCR sensitivity. In clinical SF specimens the commercial assays was also able to detect CT; however, the in-house PCR was more sensitive. Out of 10 PCR-positive SF samples Amplicor tested positive in only 4/10 and LCX in only 3/10. The in-house PCR detected chlamydial DNA in synovialfluidfrom 5/21 ReA (24%), 5/79 UA (6%) and in none of the 50 RA patients.
Commercial amplification assays allow the detection of C. trachomatis in clinical specimens, although with a lower sensitivity than optimized PCR. Potential explanations are discussed.
Clinical and experimental rheumatology 20(2):185-92. · 2.15 Impact Factor