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Expert Rev Clin Immunol. 2017 Mar;13(3):197-206. doi: 10.1080/1744666X.2017.1233816. Epub 2016 Sep 20.

Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis.

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a Department of Internal Medicine, Division of Rheumatology , University of South Florida School of Medicine , Tampa , FL , USA.
b Department of Immunology and Microbiology , Wayne State University School of Medicine , Detroit , MI , USA.


Reactive arthritis (ReA) is an inflammatory disease that can follow gastrointestinal or genitourinary infections. The primary etiologic agent for post-venereal ReA is the bacterium Chlamydia trachomatis; its relative, C pneumoniae, has also been implicated in disease induction although to a lesser degree. Studies have indicated that the arthritis is elicited by chlamydiae infecting synovial tissue in an unusual biologic state designated persistence. We review clinical aspects, host-pathogen interactions, and treatments for the disease. Areas covered: We briefly discuss both the historic and,more extensively, the current medical literature describing ReA, and we provide a discussion of the biology of the chlamydiae as it relates to elicitation of the disease. A summary of clinical aspects of Chlamydia-induced ReA is included to give context for approaches to treatment of the arthritis. Expert commentary: Basic research into the biology and host-pathogen interactions characteristic of C trachomatis has provided a wealth of information that underlies our current understanding of the pathogenic processes occurring in the ReA synovium. Importantly, a promising approach to cure of the disease is at hand. However, both basic and clinical research into Chlamydia-induced ReA has lagged over the last 5 years, including required studies relating to cure of the disease.


Chlamydia pneumoniae; Chlamydia trachomatis; Chlamydia-induced arthritis; combination antibiotic therapy; persistent bacterial infection; reactive arthritis; spondyloarthritis

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