A Pilot Study for Detection of Intra-articular Chromosomal and Extra-Chromosomal Genes of Chlamydia trachomatis among Genitourinary Reactive Arthritis Patients in India

摘要

Chlamydia trachomatis is reportedly the most frequent sexually transmitted pathogen associated with genitourinary Reactive Arthritis (gReA) in developed countries. However, there is a paucity of reliable data on the intra-articular presence of C. trachomatis in seronegative spondyloarthropathies such as reactive arthritis from developing countries like India. As genital infection with C. trachomatis is fairly common in our country, it is quite possible that C. trachomatis is either underdiagnosed or else, underestimated in gReA patients. The aim of the present study was to investigate C. trachomatis in joint fluid of gReA patients by targeting C. trachomatis-specific chromosomal and extra-chromosomal genes by Polymerase Chain Reaction (PCR) assay. A case control pilot study was designed and carried out in collaboration with a tertiary care large government hospital in New Delhi (India) to calculate the frequency of C. trachomatis in gReA while patients with Rheumatoid Arthritis (RA) served as controls. Joint fluid was aspirated during arthrocentesis in 57 arthritic (gReA/ RA) age-matched patients. DNA was isolated using a commercially available kit (QIA Amp DNA Blood mini kit; Qiagen, Germany). PCR was performed using primers for C. trachomatis 16s-rRNA (150 bp) and plasmid (201 bp) genes. 7/25 (28%) gReA patients were found positive for plasmid/ 16s-rRNA gene while 3.1% (1/32) RA patients were also found to be C. trachomatis-positive. The presence of intra-articular infection with C. trachomatis in patients with gReA is cause of concern in Indian set-up. We recommend screening of larger number of gReA patients for determining the exact magnitude of C. trachomatis infection and to evaluate the effect of treatment on the persistent state of chlamydial infection in the synovium.