Association between rheumatoid arthritis and urinary tract infections caused by Proteus spp.: a review

Abstract

Rheumatoid arthritis (RA) is a systemic and arthritic autoimmune disease that affects millions of people worldwide. The World Health Organization has reinforced its concerns regarding RA morbidity. Characterized by inflammation of the joints which can lead to the destruction of the periarticular tissue, causing pain and joint deformities. During the last four decades, scientific data has suggested that urinary tract infections (UTI) caused by Proteus spp. have a key role in the aetiopathogenesis of RA. Here, we performed a qualitative systematic review of the available literature regarding the association between RA and UTI caused by Proteus spp . in a worldwide perspective. We selected four studies that either show increased isolation of Proteus spp . in the urine of patients with RA or show elevated levels of anti- Proteus antibodies in the serum of RA patients, of the population of different countries from three continents, always comparing with healthy and/or non-RA disease controls. This work reinforces the evidence linking Proteus spp . to RA, from the recurrent sub-clinical Proteus UTIs to the full development of RA. Antimicrobial susceptibility testing guided therapy must be considered crucial to ensure therapeutic success and prevent or minimize the occurrence of RA associated with UTI and future research should be performed with the aim to access if the usage of antibiotics against Proteus spp. from the urinary tract could be implemented as adjuvant therapies to treat RA. Additionally, due to the fact that no research regarding the described association has been performed in Portugal, we suggest the development of a future research project, to access if the Portuguese population follows the trend of the countries referred to in this review.