Objective. Identify the clinical, laboratory, and instrumental manifestations of spondyloarthritis associated with Chlamydophila pneumoniae infection.

Materials and methods. Clinical manifestations, laboratory parameters and instrumental data of 21 patients with spondyloarthritis associated with Chlamydophila pneumoniae infection aged from 18 to 57 years. The average age of patients was 32.5±2.4 years. The average disease duration was 4,4±0,98 years. Diagnosis of Chlamydophila pneumoniae infection was carried out using 2 methods: real-time PCR in samples from the oral cavity, urethra, cervical canal, synovial fluid, as well as the detection of specific antibodies (Ig M, Ig A, Ig G) in the blood by ELISA. Data processing was carried out using MS Exel and Statistica 10 (serial number BXXR207F383402FA-V).

Conclusion. Infection Chlamydophila pneumoniae can be associated with both reactive spondyloarthritis and can be detected in patients with ankylosing spondylitis. Spondyloarthritis associated with Chlamydophila pneumoniae infection usually occurs in men (85.7%) of a young age (85.7%) and may manifest as a variant with a primary lesion of the peripheral joints, as a rule, of the lower extremities (p = 0.039). In the debut of the disease may lesion any part of the spine.

In patients with spondyloarthritis, Chlamydophila pneumoniae DNA is found in samples from the oral cavity (in 16 of 18 examined), synovial fluid (in 3 of 4 examined) and even in the genital tract (in 2 of 9 examined).

As the disease progresses, prevails the variant of spondyloarthritis with a primary lesion of the peripheral joints (p = 0.005), of which the large and medium joints of the extremities are most often involved in the inflammatory process (71.4%). Both with reactive spondyloarthritis and ankylosing spondylitis, the body can react to an infection in the form of fever, changing the color of the skin over the joints in the form of hyperemia or cyanosis, inflammation of the eye layers in the form of conjunctivitis, uveitis or iridocyclitis, periarticular tissues in the form of enthesitis, perichondritis, achilite and heel spurs.

The lesion of the small joints of the hands and feet in the debut of the disease distinguishes spondyloarthritis, associated with Chlamydophila pneumoniae infection, from spondyloarthritis, without association with infection. In general, spondyloarthritis associated with Chlamydophila pneumoniae infection, unlike spondyloarthritis, without association with infection, is characterized by recurrent febrile syndrome (p = 0.042), lesion of the metatarsophalangeal joints (p = 0.023), high laboratory activity of the disease and predominantly unilateral lesion of the sacroiliac joints (p = 0.021).

1. Kunder E. V. The modern concept of diagnosis and treatment of spondyloarthritis: educational and methodical manual. Minsk: BelMAPO; 2012. 47. (in Russian).

2. Carter J., Gérard H., Espinoza L., Ricca L., et al. Chlamydiae as Etiologic Agents for Chronic Undifferentiated Spondyloarthritis. Arthritis Rheum. 2009; 60(5): 1311–1316.

3. Contini C., Grilli A., Badia L., et al. Detection of Chlamydophila pneumoniae in patients with arthritis: significance and diagnostic value. Rheum. Int. 2011; 31(10): 1311–1316.

4. Gerard H. C., Schumacher H. R., El-Gabalawy H., et al. Chla­ mydia pneumoniae present in the human synovium are viable and metabolically active.Microb. Pathog. 2000; 29(1): 17–24.

5. Feng X. G., Xu X. J., Ye S., et al. Recent Chlamydia pneumoniae infection is highly associated with active ankylosing spondylitis in a Chinese cohort. Scand. J. Rheum. 2011; 40(4): 289–291.

6. Zeidler H., Hudson A. P. Causality of Chlamydiae in arthritis and spondiloarthritis: a: plea for increased translational research. Curr. Rheum. Rep. 2016; 18(9): 10 p.