Abstract
BackgroundReactive arthritis (ReA) is a recognized sequela of infectious gastroenteritis (IGE). However, the population-based incidence of IGE-related ReA is poorly defined, and the risk of disease has not previously been characterized in a military population. The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S. military population.MethodsUsing active duty US military medical encounter data from the Defense Medical Surveillance System, we conducted a matched case-control study to assess the risk of ReA following IGE. Both specific and nonspecific case definitions were utilized to address ICD-9 coding limitations; these included specific ReA (Reiter's Disease or postdysenteric arthritis) and nonspecific arthritis/arthralgia (N.A.A) (which included several related arthropathy and arthralgia diagnoses). Incidence was estimated using events and the total number of active duty personnel for each year.Results506 cases of specific ReA were identified in active duty personnel between 1999 and 2007. Another 16,365 cases of N.A.A. were identified. Overall incidence was 4.1 (95% CI: 3.7, 4.5) and 132.0 (95% CI, 130.0-134.0) per 100,000 for specific ReA and N.A.A, respectively. Compared to the youngest age category, the incidence of both outcomes increased 7-fold with a concurrent increase in symptom duration for cases over the age of 40. Specific IGE exposures were documented in 1.4% of subjects. After adjusting for potential confounders, there was a significant association between IGE and ReA (specific reactive arthritis OR: 4.42, 95% CI: 2.24, 8.73; N.A.A OR: 1.76, 95% CI: 1.49, 2.07).ConclusionsReactive arthritis may be more common in military populations than previously described. The burden of ReA and strong association with antecedent IGE warrants continued IGE prevention efforts.
Highlights
Reactive arthritis (ReA) is a recognized sequela of infectious gastroenteritis (IGE)
Incidence rates for specific ReA and N.A.A were 4.1 and 132.0 per 100,000, respectively
For Reiter’s disease (RD) and postdysenteric arthritis (PA), cases were more commonly deployed to a high risk region in the 6 months pre-censure (7.5% and 9.4%, respectively) than controls (3.8% and 3.1%, respectively) (p = 0.001 and p = 0.14, respectively)
Summary
Reactive arthritis (ReA) is a recognized sequela of infectious gastroenteritis (IGE). The population-based incidence of IGE-related ReA is poorly defined, and the risk of disease has not previously been characterized in a military population. The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S military population. Total IGE morbidity is likely underestimated due to unmeasured chronic sequelae, including reactive arthritis (ReA)[2,3,4,5,6,7,8]. IGE-associated ReA is most commonly described after infection with Campylobacter [11,12,13,14,15], Salmonella [16,17,18,19], Shigella[4,20], and Yersinia[21,22]. Other ReA case reports have implicated asymptomatic enteric infections[23], enterotoxigenic E. coli (ETEC)[10,24], Cryptosporidium spp[25,26], Giardia lamblia[27], Strongyloides stercoralis[28], and possibly Schistosoma mansoni[23], and Clostridium difficile[29,30,31,32,33]
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