SYNOVIAL CELLULAR IMMUNE-RESPONSE TO BACT ERIAL MICROBES IN PATIENTS WITH JUVENILE CHRONIC ARTHRITIS

Juvenile chronic arthritis is a heterogenous disease with an illdefine d pathogenesis. In our study, synovial fluid (SF) and peripheral blood (PB) of 70 children with oligoarthritis were investigated; bacteria-s pecific lymphocyte proliferation and antibodies to arthritogenic bacte ria were determined. Specific cellular immune responses in SF but not in PB were found in 4/7 patients with either Lyme- or reactive arthrit is (60%). In comparison, in subgroup JCA II (n = 45) encompassing main ly elder HLA B27 positive boys, a specific response in SF but again no t in PB was detected in 10 children to Yersinia enterocolitica (YE), i n four children either to Borrelia burgdorferi (BB) and Chlamydia trac homatis (CT), and in one child to Campylobacter jejuni (CJ). In contra st, in subgroup JCA I (n = 17) encompassing mainly young ANA-positive girls with chronic iridocyclitis, no specific response was found. The correlation of the synovial cellular and the humoral immune responses was 100% in the case of BB and 50% for YE; no antibodies against CT or CJ were detectable. Neither specific cellular nor humoral immune resp onses were detected against Salmonella or Shigella. We conclude that, in the pathogenesis of some patients with JCA, bacterial microbes have a triggering role. Mainly YE, but also BB and CT are responsible for cases of JCA in which no symptomatic infection preceded.