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Patients with prior Infection by Chlamydia pneumoniae are vulnerable to Infection by Chlamydia trachomatis -Serum IgA Antibodies to Diagnose early-onset Chlamydia-induced reactive Arthritis

Shigeru Kotake, Tsuyoshi Kobashigawa, Hiroki Yabe, Yuki Nanke

Background: Reactive Arthritis (ReA), a subtype of spondyloarthritis, is defined as sterile, transient, typically lower-limb oligoarthritis following distant mucosal, genitourinary or gastrointestinal infection. The accurate diagnosis of early-onset Chlamydia-induced Reactive Arthritis (Chl-i ReA) is important because antibiotics are effective against Chl-i ReA in the early stage. However, diagnosing early-onset Chl-i ReA is challenging because patients frequently exhibit asymptomatic genital infections. Thus, in the current study, we hypothesized that it is important to detect serum IgA against Chlamydia trachomatis and Chlamydia pneumoniae to diagnose early-onset Chl-i ReA without urogenital or respiratory symptoms (Hypothesis #1). In addition, it has been reported that prior exposure to infection by C. pneumoniae can influence the T-cell mediated response to C. trachomatis. Thus, we also hypothesized that patients with prior exposure to infection by C. pneumoniae are vulnerable to infection by C. trachomatis (Hypothesis #2).

Patients and Methods: We performed a retrospective study using Enzyme-linked Immunosorbent Assay (ELISA) to detect serum IgA or IgG against C. trachomatis or C. pneumoniae in patients with arthralgia or arthritis who visited our outpatient clinic for 2 years. ELISA demonstrated high sensitivity and specificity, which was also confirmed to have no cross-reactivity with antibodies.

Results: Eleven (7.1%) Chl-i ReA patients, including 8 Chl-i ReA patients who were C. pneumonia IgA-positive and C. trachomatis IgA-negative, were diagnosed among the 155 total patients. The rate of positivity of C. pneumoniae IgA was significantly higher in patients with C. trachomatis IgA than in those without C. trachomatis IgA.

Conclusions: This study supported both Hypotheses #1 and #2. The prevention or treatment of C. pneumoniae infection can prevent infection by C. trachomatis inducing ReA, infertile, and visual impairment by trachoma.

Keywords: Chlamydia-induced Reactive Arthritis, Chlamydia trachomatis, Chlamydia pneumonia