強直性脊椎炎とその関連疾患の免疫病理学的研究

抄録

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder of the axial skeleton, and peripheral joints including the elbow, wrist, knee and ankle may also be involved. Its etiology is not fully understood, but there is a strong predisposition in association with HLA-B27. AS, the arthritides associated with inflammatory bowel disease, and reactive arthritis followed by an enteric bacterial infection show some striking clincal similarities, and all can present as peripheral mono-or poly-arthritis. In order to search for enterobacterial antigens involved in the etiology of AS and its related diseases, an immunohistological study was carried out concerning gonitis of AS, synovitis of the elbow in ulcerative colitis (US), and gonitis of juvenile arthritis (JA) . An avidin-biotin-peroxidase complex method with a rabbit antiserum against heat-killed E. coil O : 14 was used to detect enterobacterial common antigen (ECA) . Staining was observed in the cytoplasm of macrophages in a granular pattern in synovial tissues in all cases. In bowel tissue samples taken from patients with Crohn' s disease, lymphocytes were attached to macrophages containing ECA. In addition, many enteric bacteria positively stained with anti-ECA antibody were observed. Less common immune complexes were noted in AS, UC and JA. These findings suggest that ECA may initiate synovitis due to an allergic response (mainly cell-mediated hypersenitivity) and maintain chronic granulomatous inflammation under the genetic background of AS, UC and JA.