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			Rheumatic diseases

			Reactive arthritis and Mycoplasma fermentans and Mycoplasma pneumoniae infection
			Reactive arthritis is classified as an autoimmune condition that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. Usually, by the time the patient presents with symptoms, oftentimes the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. The arthritis often is coupled with other characteristic symptoms; this is called Reiter's Syndrome or Reiter's arthritis. The manifestations of Reiter's Syndrome include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Reactive arthritis is an RF-seronegative, HLA-B27-linked arthritis often precipitated by genitourinary or gastrointestinal infections. Repeated attacks over many years are common, and patients sometimes end up with chronic and disabling arthritis, heart disease, amyloid deposits, ankylosing spondylitis, immunoglobulin A nephropathy, cardiac conduction abnormalities, or aortitis with aortic regurgitation. However, most people with reactive arthritis can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved organs. Eye involvement occurs in about 50% of men with urogenital Reiter's Syndrome and about 75% of men with enteric reactive arthritis. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go. In the oral cavity, the patients may suffer from recurrent aphthous stomatitis, geographic tongue and migratory stomatitis in higher prevalence than the general population. In addition, some individuals with reactive arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some patients suffer serious gastrointestinal problems similar to those of the Crohn's disease. Mycoplasma pneumoniae is a human pathogen that is known to cause respiratory infections, and some patients with serologically verified M. pneumoniae infections developed arthritis In humans, Mycoplasma fermentans has been isolated from the joints of rheumatoid arthritis (RA) patients and other seronegative patients with inflammatory arthritides and a cellular infiltrate. Mycoplasma fermentans had previously been isolated from patients with inflammatory cellular infiltrates, such as rheumatoid arthritis, therefore, t is possible that these organisms may contribute to chronic inflammation within the joints. Presence of Mycoplasma fermentans in the bloodstream of Mexican patients with rheumatoid arthritis and IgM and IgG antibodies against whole microorganism S. Johnson, D. Pitcher, Distribution of ecto 5'-nucleotidase on Mycoplasma species associated with arthritis, FEMS Microbiol Lett 192 (2000) 59-65. J. Haier, M. Nasralla, A.R. Franco, G.L. Nicolson, Detection of mycoplasmal infections in blood of patients with rheumatoid arthritis, Rheumatology (Oxford) 38 (1999) 504-509. C. Schlesinger, S. Veeraraghavan, M.N. Koss, Constructive (obliterative) bronchiolitis, Curr Opin Pulm Med 4 (1998) 288-293. H. Brunner, Models of mycoplasma respiratory and genital tract infections, Wien Klin Wochenschr 109 (1997) 569-573. K. Oen, M. Fast, B. Postl, Epidemiology of juvenile rheumatoid arthritis in Manitoba, Canada, 1975-92: cycles in incidence, J Rheumatol 22 (1995) 745-750. Y. Misaki, W.J. Van Venrooij, G.J. Pruijn, Prevalence and characteristics of anti-56K/annexin XI autoantibodies in systemic autoimmune diseases, J Rheumatol 22 (1995) 97-102. L.G. Gorina, S.A. Goncharova, A.V. Igumnov, [Laboratory diagnosis of human Mycoplasma infection], Vestn Akad Med Nauk SSSR (1991) 44-47. O. Faye-Petersen, S.R. Frankel, P.E. Schulman, H. Raucher, H. Spiera, M.R. Dische, Giant cell vasculitis with extravascular granulomas in an adolescent, Pediatr Pathol 11 (1991) 281-295. M.F. Barile, H. Yoshida, H. Roth, Rheumatoid arthritis: new findings on the failure to isolate or detect mycoplasmas by multiple cultivation or serologic procedures and a review of the literature, Rev Infect Dis 13 (1991) 571-582. N. Cimolai, P. Malleson, E. Thomas, P.J. Middleton, Mycoplasma pneumoniae associated arthropathy: confirmation of the association by determination of the antipolypeptide IgM response, J Rheumatol 16 (1989) 1150-1152. H. Tuokko, The detection of measles specific immunoglobulin M antibodies using biotinylated antigens, Apmis 96 (1988) 491-496. K. Lind, M. Hoier-Madsen, A. Wiik, Autoantibodies to the mitotic spindle apparatus in Mycoplasma pneumoniae disease, Infect Immun 56 (1988) 714-715. H.W. Clark, M.R. Coker-Vann, J.S. Bailey, T.M. Brown, Detection of mycoplasmal antigens in immune complexes from rheumatoid arthritis synovial fluids, Ann Allergy 60 (1988) 394-398. M.L. Christensen, L.M. Pachman, R. Schneiderman, D.C. Patel, J.M. Friedman, Prevalence of Coxsackie B virus antibodies in patients with juvenile dermatomyositis, Arthritis Rheum 29 (1986) 1365-1370. M. Schlesier, C. Ramb-Lindhauer, M. Gartner, H.H. Peter, Analysis of T-cell cultures and clones from a patient with classic rheumatoid arthritis--evidence for the existence of autoreactive T-cell clones in blood and synovial fluid, Rheumatol Int 4 Suppl (1984) 1-9. E. Jansson, A. Backman, K. Hakkarainen, A. Miettinen, B. Seniusova, Mycoplasmas and arthritis, Z Rheumatol 42 (1983) 315-319. A.J. van Griethuysen, C.L. van der Zee, F. Hoevenaars, [Acute polyarthritis in Mycoplasma pneumoniae infection], Ned Tijdschr Geneeskd 126 (1982) 61-63. D. Taylor-Robinson, Mycoplasmal arthritis in man, Isr J Med Sci 17 (1981) 616-621. P.C. Roberts, S.J. Hobbs, Evaluation of a new test system for rubella haemagglutination inhibiting antibodies, J Clin Pathol 30 (1977) 1011-1014. L.A. Hernandez, G.E. Urquhart, W.C. Dick, Mycoplasma pneumoniae infection and arthritis in man, Br Med J 2 (1977) 14-16. G. Taylor, D. Taylor-Robinson, The part played by cell-mediated immunity in mycoplasma respiratory infections, Dev Biol Stand 28 (1975) 195-210. B.C. Cole, M.B. Taylor, J.R. Ward, Studies on the infectious etiology of human rheumatoid arthritis. II. Search for humoral and cell-bound antibodies against mycoplasmal antigens, Arthritis Rheum 18 (1975) 435-441. M.P. Weinstein, C.B. 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			Rheumatoid arthritis and Mycoplasma infectious diseases
			Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. Rheumatoid arthritis can also produce diffuse inflammation in the lungs, membrane around the heart (pericardium), the membranes of the lung (pleura), and white of the eye (sclera), and also nodular lesions, most common in subcutaneous tissue. Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role in both its chronicity and progression, and RA is considered a systemic autoimmune diseas. About 1% of the world's population is afflicted by rheumatoid arthritis, women three times more often than men. Onset is most frequent between the ages of 40 and 50, but people of any age can be affected. In addition, individuals with the HLA-DR1 or HLA-DR4 serotypes have an increased risk for developing the disorder. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated. Signs and symptoms While rheumatoid arthritis primarily affects joints, problems involving other organs of the body are known to occur. Extra-articular ("outside the joints") manifestations other than anemia (which is very common) are clinically evident in about 15–25% of individuals with rheumatoid arthritis. ・Joints The arthritis of joints known as synovitis is inflammation of the synovial membrane that lines joints and tendon sheaths. Joints become swollen, tender and warm, and stiffness limits their movement. With time RA nearly always affects multiple joints (it is a polyarthritis), most commonly small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. ・Lungs Fibrosis of the lungs is a recognized response to rheumatoid disease. Pleural effusions are also associated with rheumatoid arthritis. It is estimated that about one quarter of Americans with RA develop Rheumatoid Lung Disease ・ Heart and blood vessels People with rheumatoid arthritis are more prone to atherosclerosis, and risk of myocardial infarction (heart attack) and stroke is markedly increased. Other possible complications that may arise include: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis. ・Eye The eye is directly affected in the form of episcleritis which when severe can very rarely progress to perforating scleromalacia. Rather more common is the indirect effect of keratoconjunctivitis sicca, which is a dryness of eyes and mouth caused by lymphocyte infiltration of lacrimal and salivary glands. When severe, dryness of the cornea can lead to keratitis and loss of vision. Preventive treatment of severe dryness with measures such as nasolacrimal duct occlusion is important. ・Hematological Anemia is by far the most common abnormality of the blood cells. Rheumatoid arthritis may cause a warm autoimmune hemolytic anemia. The red cells are of normal size and colour (normocytic and normochromic). A low white blood cell count (neutropenia) usually only occurs in patients with Felty's syndrome with an enlarged liver and spleen. The mechanism of neutropenia is complex. An increased platelet count (thrombocytosis) occurs when inflammation is uncontrolled, as does the anemia. Constitutional symptoms Constitutional symptoms including fatigue, low grade fever, malaise, morning stiffness, loss of appetite and loss of weight are common systemic manifestations seen in patients with active rheumatoid arthritis. Differential diagnoses Osteoarthritis, Systemic lupus erythematosus (SLE), psoriatic arthritis resembles, Lyme disease, Reactive arthritis (previously Reiter's disease, usually associated with urethritis, conjunctivitis, iritis, painless buccal ulcers), Ankylosing spondylitis (RA-like symmetrical small-joint polyarthritis), Hepatitis C (RA-like symmetrical small-joint polyarthritis), etc. Possible infectious triggers It has long been suspected that certain infections could be triggers for this disease. The "mistaken identity" theory suggests that an infection triggers an immune response, leaving behind antibodies that should be specific to that organism. The antibodies are not sufficiently specific, though, and set off an immune attack against part of the host. Because the normal host molecule "looks like" a molecule on the offending organism that triggered the initial immune reaction—this phenomenon is called molecular mimicry. Some infectious organisms suspected of triggering rheumatoid arthritis include Mycoplasma, parvovirus B19 and rubella, etc. Epidemiological studies have confirmed a potential association between RA and two herpesvirus infections: Epstein-Barr virus (EBV) and Human Herpes Virus 6 (HHV-6).