Jsh. Gaston et al., Clinical and experimental evidence for persistent Yersinia infection in reactive arthritis, ARTH RHEUM, 42(10), 1999, pp. 2239-2242
The findings of bacterial antigens in the joint and persistent triggering i
nfection elsewhere in the body are thought to be important in the pathogene
sis of reactive arthritis (ReA), We describe a patient with clinical and la
boratory features consistent with this. The initial presentation with eryth
ema nodosum and periarthritis due to infection with Yersinia pseudotubercul
osis IV was followed 13 months later by recurrent erythema nodosum with joi
nt effusion. At that time, synovial fluid was shown to contain Yersinia ant
igens, and, surprisingly, Yersinia-specific 16S ribosomal RNA (rRNA) sequen
ces were also identified by reverse transcriptase-polymerase chain reaction
and sequencing. Since there was no serologic evidence of reinfection, we p
ostulate that a silent persistent Yersinia infection was reactivated, leadi
ng to dissemination of organisms to the joint, with consequent induction of
ReA, Although the finding of synovial Yersinia antigens years after the or
iginal infection in ReA has previously been reported, the presence of Yersi
nia 16S rRNA indicates that viable organisms were also able to reach the jo
int.