Pathogenesis of Yersinia-triggered reactive arthritis: immunological, microbiological and clinical aspects

Immunol Rev. 1985 Aug;86:47-70. doi: 10.1111/j.1600-065x.1985.tb01137.x.


When a patient develops reactive arthritis after Yersinia enteritis, the following conditions are often fulfilled: the patient is HLA-B27-positive; however, some B27-negative individuals develop severe arthritis and some positives do not, in the initial phase, the diarrhea is milder, the anti-Yersinia antibody response of IgG class is more vigorous and persists longer, the anti-Yersinia antibody response of IgA class is more vigorous and persists much longer, the anti-Yersinia antibodies of IgA1 and IgA2 subclass, those with J-chain and, especially, those with secretory piece are produced more vigorously, indicating local immunostimulation close to the intestinal epithelium, in the early phase, Yersinia-IgM immune complexes are found in the circulation, and the lymphocyte transformation response against not only Yersinia but also against other gram-negative enteric bacteria is weaker. When all these aspects are considered together a strong suspicion arises that the patients who are destined to develop reactive arthritis fail in their first line of defense against the invading organism when contracting a Yersinia enteritis. This may lead to persistence of the microorganism within the body, e.g., in the intestinal epithelium or in the mesenteric lymphoid tissues, maintaining a stimulus for a prolonged--apparently futile and perhaps harmful--antibody production. Finally, the initiating and decisive factor should not be forgotten: the Yersinia. Why and how it triggers the process is at present one of the enigmas of the pathogenesis of reactive arthritis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antibodies, Bacterial / biosynthesis
  • Antibody Formation*
  • Antibody Specificity
  • Antigen-Antibody Complex
  • Antigens, Bacterial / immunology
  • Arthritis / etiology*
  • Arthritis / immunology
  • Arthritis / microbiology
  • Cross Reactions
  • Enteritis / complications*
  • Enteritis / immunology
  • Enteritis / microbiology
  • HLA Antigens / immunology
  • HLA-B27 Antigen
  • Humans
  • Immunity, Cellular*
  • Immunoglobulin A / biosynthesis
  • Immunoglobulin A, Secretory / biosynthesis
  • Immunoglobulin G / biosynthesis
  • Immunoglobulin J-Chains / biosynthesis
  • Immunoglobulin M / biosynthesis
  • Klebsiella pneumoniae / immunology
  • Lymphocyte Activation
  • Molecular Weight
  • Serotyping
  • T-Lymphocytes / immunology
  • Yersinia Infections / complications*
  • Yersinia Infections / immunology
  • Yersinia enterocolitica / immunology


  • Antibodies, Bacterial
  • Antigen-Antibody Complex
  • Antigens, Bacterial
  • HLA Antigens
  • HLA-B27 Antigen
  • Immunoglobulin A
  • Immunoglobulin A, Secretory
  • Immunoglobulin G
  • Immunoglobulin J-Chains
  • Immunoglobulin M