Relationship Between Foodborne Bacterial Pathogens and the Reactive Arthritides

Certain individuals suffer complications after diarrheic episodes caused by Campylobacter, Salmonella, Shigella, or Yersinia. One of these complications may be a sterile arthritis such as reactive arthritis, Reiter's syndrome and anklylosing spondylitis. Reactive arthritis and Reiter's syndrome have been shown to have a bacterial etiology; however, such etiology, while suspected, has not been definitely confirmed for ankylosing spondylitis. These arthritides show a strong familial assocation and here, reactive arthritis, Reiter's syndrome and ankylosing spondylitis are characterized and the relationship of the diseases to the major histocompatility complex antigen, HLA‐B27, is described. Studies have indicated that there may be molecular mimicry between certain microbial antigens and HLA‐B27. Molecular mimicry is discussed in terms of its possible explanation of the etiology of the reactive arthritides. The roles of antibodies, lymphocytes, bacterial antigens, and stress proteins in the symptomology of the arthritides are reviewed.