Læknablaðið : fylgirit - 01.10.1980, Blaðsíða 6

4
common form of acute rheumatism in
Sweden. In our Department we have been
especially interested in the role of Neisse-
ria gonorrhoeae in uro-arthritis.
Our aim has been to investigate if there
exists an aseptic post-gonorrhoeal arthritis
which does not respond to penicillin treat-
ment. We have observed 16 patients with
aseptic arthritis developing after gonorr-
hoea and 16 patients with arthritis after
non-gonococcal urogenital infection with
respect to clinical course, roentgenologic
or scintigraphic signs, serological reaction
and lymphocyte reactivity to gonococcal
antigen. 58 healthy blood donors were used
as controls. In the clinical examination
synovitis, tendinitis, eye involvement, skin
changes, and mucosal lesions were recor-
ded. Urologic or gynaeologic examinations
were also performed. The serologic ana-
lysis included gonococcal complement fixa-
tion test (GCFT) and rheumatoid factor
test. Lymphocyte reactivity to gonococcal
antigen (GC) and tuberculin (PPD) was
studied by quantitation of radioactive
thymidine uptake in cell cultures.
Results. The clinical pattern of the post-
gonorrhoic arthritis group had no charac-
teristic features that would make it possi-
ble to differentiate it from other forms of
uro-arthritis. Conjunctivitis was found in
4 patients and keratodermia blennorrhagica
in one other patient in the postgonorrhoic
group. In comparative non-gonococcal
group there were 5 cases with symptoms of
conjunctivitis and one patient in whom
Chlamydia trachomatis were isolated in
conjunctiva and urethra, the patient how-
ever being symptom-free. Signs of sacroiliac
arthritis were found in 8 and 7 patients
respectively.
Evidence for septic gonococcal arthritis in
the form of positive synovial fluid culture
was missing, and there was no dramatic
effect of penicillin or other antibiotics on
the articular symptoms. Positive GCFT
was found in 9 of 16 of the post-gonorrhoeal
arthitis patients and in none of the pa-
tients with arthritis after non-gonococcal
urogenital infection.
The differences in lymphocyte reactivity
to gonococcal antigen between the three
tested groups, post-gonorrhoeal arthritis
(PGA), non-gonococcal uro-arthritis (NG
U), and healthy controls (C) were recorded
separately for the years 1971, 1973 and
1977 as different isotope methods were
used. We find that there is a highly signi-
ficant difference between PGA and C in
1971 as well as in 1973, P/0.001, there is a
significant difference in the lymphocyte
reactivity to GC between PGA and NGU,
000.1/P/0.01, and there is no significant
difference between NGU and C. Earlier it
had been shown by Rosenthal and Sand-
ström of our Department that the lympho-
cyte stimulation induced by virulent gono-
coccal antigen in cell cultures from patients
with single or multiple gonococcal ure-
thritis and from control showed no differ-
ence in the 14C-thymidine uptake. On the
other hand, patients with gonococcal sepsis
showed a poor cellular immune responce.
The fact that penicillin clears the Gono-
coccus from urethra without preventing
the subsequent development of Reiter's
syndrome (or without influencing the
established condition) has been taken as an
argument against a gonococcal aetiology of
the syndrome. However, recent investiga-
tions have shown that the prostate and the
seminal vesicles are invaded by gonococci
in a least 40 per cent of male patients with
uncomplicated gonococcal urethritis and
also that the gonococci remain in these
glands for up to at least 3 weeks after cure
of the urethritis, in some cases up to 2
years. It had been shown earlier that the
penetration of penicillin into the prostate
is rather low.
Most patients with acute uro-arthritis
are between 20 and 30 years and at least
90 per cent of them are males. It is reported
that 1 to 2 per cent of patients with non-
gonorrhoic urethritis develop symptoms
within 2 to 3 weeks of the onset. After
gonorrhoea the frequency has been repor-
ted to be 0.2 to 0.4 per cent. It is not clear
why here is such a difference. It might
depend on earlier and more effective treat-
ment of the gonorrhoea. Besides the exo-
genic factor there is the endogenously
conditioned succeptibility that has its ex-
pression through the presence of HLA-B27