Abstract
Essential relation of arthritis to microbial agent is not identical to usual conception of microbial infection, because abnormal microbiome may participate in pathway of joint pathology. Normal mucosal microbiome of digestive system (i. e. especially oral and intestinal) is a symbiotic part of "superorganism" with host system, but sequential analysis of microbiotic DNA demonstrated oral/intestinal dysbiosis, important in pathway of autoimmunity, especially as "gut-joint" axis in rheumatoid arthritis and celiac disease.
On the contrary, dysbiosis should not be always a pathogenic phenomenon. For example, using a special manipulation with P. histocoli in humanized HLA DQ8+ mice model, the risk of arthritis was suppressed, and possibility of novel strategy in prophylaxis/therapy was proposed.
This observation should be important in rheumatoid arthritis, because preclinical and early phases are "hot spots" of this disease. In relation to reactive arthritis is actual, that especially enteropathic form is associated to HLA B27+ Ag, i. e. a typical biomarker of spondyloarthritis family.
It appears in this connection, that namely Y. enterocolitica related reactive arthritis is actual in daily practice. Native (non-gonococcal) septic arthritis is persistently a serious emergency in rheumatology with ~ 30 % mortality in case of comorbid arthropathy; augmented frequency of this disorder in gout (acute gouty attacks, periarticular urate deposits, ect.) is accentuated.
The most important predictors of fatal prognosis in native (non-gonococcal) septic arthritis may be defined as a triade: age over 65 y., polyarticular manifestation, and especially confusional presentation. In precise at time diagnosis, the rheumatologist is specialist of first line; the review should be a help also in this responsible task.