Chlamydia trachomatis – a “new/old” unconventional predictor of rheumatoid arthritis progression?
N.A. Martusevich, S.A. Kostyuk, N. А. Paulouskaya, N.P. Mitkovskaya
Introduction. The theory of mucosal development of rheumatoid arthritis (RA) is of considerable interest in relation to the search for unconventional predictors of RA progression, among which Chlamydia trachomatis (C. trachomatis) occupies a special place.
Objective: To study the effect of C. trachomatis on early and late outcomes of RA, as a potentially unfavorable predictor of the disease course.
Materials and methods. The study included 106 patients with a confirmed diagnosis of RA, lasting up to one year, without basic therapy. Patients were examined for the presence of C. trachomatis by PCR and ELISA and divided into two groups. The first (n = 69) included patients with C. trachomatis, the second (n = 37), patients without it. Clinical and laboratory parameters and markers of disease activity were assessed in the groups. The control group consisted of 34 healthy volunteers. The group of C. trachomatis+ patients was divided into two subgroups. The first consisted of patients (n = 30) with a course of antibacterial therapy (AB); the second, without AB therapy (n = 39). In both subgroups, the chances of development/non-development of short-term (12 months) and long-term (5; 10; 15 years) outcomes were assessed.
Results. Patients with RA with C. trachomatis were characterized by longer morning stiffness (49.1 [0.0; 102.0] vs. 14.9 [0.0; 27.2]; p = 0.043), CRP level (14.0 [0.5; 17.0] vs. 9.0 [5.0; 16.0]; p = 0.046). Eradication of C. trachomatis increased the chance of clinical and laboratory remission / low activity at 12 months of follow-up by 3.9 time (OR 3.9; 95% CI: 1.4–10.9; p = 0.009); and functional remission according to HAQ-DI by 4.3 times (OR 4.3; 95% CI: 1.4–13.5; p = 0.011) after 10 years; 8.1 times higher chance of not developing hand/foot deformities by the 5th year of observation (OR 8.1; 95% CI: 1.1–59.1; p = 0.039).
Conclusion. C. trachomatis can be considered an additional unconventional predictor of an unfavorable course of RA, the effect of which is apparently carried out indirectly through other arthritogenic factors.
For citation: Martusevich NA, Kostyuk SA, Pavlovskaya NА, Mitkovskaya NP. Chlamydia trachomatis – a “new/old” unconventional predictor of rheumatoid arthritis progression? Therapy (Moscow). 2026;12(5S):22–30.
https://doi.org/10.18565/therapy.2026.5-s5.22-30
Ключевые слова
arthritogenic factors of microbial etiology
clinical and laboratory remission
mucosal theory
persistence
polymerase chain reaction
early rheumatoid arthritis
radiographic progression of Chlamydia trachomatis
functional class
functional remission
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Об авторах / Для корреспонденции
Natalya A. Martusevich, MD, PhD (Medicine), associate professor, professor of the Department of cardiology and internal medicine, Belarusian State Medical University, Minsk, Republic of Belarus.E-mail: martusevitch@mail.ru
ORCID: https://orcid.org/0000-0002-8222-4344. Scopus ID: 57194007082
Svetlana A. Kostyuk, MD, Dr. Sci. (Medicine), professor, head of the Laboratory of molecular genetic diagnostics of the Research Institute of Experimental and Clinical Medicine, Belarusian State Medical University, Minsk, Republic of Belarus.
ORCID: https://orcid.org/0000-0002-1394-433X. eLibrary SPIN: 2460-3444
Natalya A. Pavlovskaya, MD, therapist at 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
E-mail: napavlovskaya13@gmail.com
ORCID: https://orcid.org/0009-0009-7767-6694
Natalya P. Mitkovskaya, MD, Dr. Sci. (Medicine), professor, head of the Department of cardiology and internal medicine, Belarusian State Medical University, Minsk, Republic of Belarus.
E-mail: mitkovskaya1@mail.ru
ORCID: https://orcid.org/0000-0002-9088-721X. Scopus ID: 6507367973
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