Ureaplasma urealyticum in Reiter's syndrome

Objective. To evaluate the role of Ureaplasma urealyticum (Uu) in the pathogenesis of Reiter's syndrome (RS). Methods. Infection with Uu was determined in 31 patients with RS and 28 patients with other arthritides by urethral, cervical and synovial fluid (SF) culture and by measuring anti-Uu serum antibody. Infection with Chlamydia trachomatis was determined by examining SF by a direct immunofluorescence technique, by a polymerase chain reaction and by measuring anti-C. trachomatis serum antibody. The proliferative response of SF and peripheral blood mononuclear cells (PBMC) to Uu antigens in patients with RS was compared to that of a control group. The effect that treatment of 6 patients with RS with cipronoxacin had on repeated cultures, on titer of anti-Uu antibody and on mononuclear cell reactivity was measured sequentially. Results. The colonization rate of Uu in patients with RS (74%) was significantly greater than in patients with other arthritides (14%). Genital C. trachomatis isolation and serum anti-C. trachomatis antibody were uncommon in both groups (11 and 13%, respectively). SF mononuclear cells of the patients with RS proliferated specifically in response to Uu antigens [up to 6.9 stimulation index (SI)], as did their PBMC (up to 14.5 SI). In some patients, high anti-Uu antibody titers were measured in the serum. Clinical remission was observed in 4 of 6 patients and correlated with eradication of Uu, decrease in antibody titers and disappearance of mononuclear cell reactivity to Uu antigens. Conclusion. Our findings suggest that Uu might be a causative agent or a trigger in the development of sexually acquired RS.