Incidence Of Reactive Arthritis Research Articles

Evolving patterns of reactive arthritis.

To characterize rheumatologists' perspectives on evolving trends of reactive arthritis (ReA). After ethics approval, 548 members of the Canadian Rheumatology Association were surveyed with 37 questions covering their demographic information, subspecialty, level of experience, practice setting and opinions on prevalence, treatment, and causes of ReA. Results were analyzed with descriptive statistics. Ninety-seven responded to the survey (18% response rate); 66 fully completed it. Nearly half of respondents believed that the incidence of ReA is declining and causes of ReA may be changing. Physicians reported that most of the ReA cases in their practices were caused by an unknown organism, sexually transmitted, or gastrointestinal infection. Full triad ReA increased the chance of recurrence according to their impressions. Common investigations in ReA included inflammatory markers, HLA-B27, chlamydia and gonorrhea testing, stool cultures, synovial fluid analyses, SI joint imaging. ReA treatment included NSAIDs, intra-articular corticosteroid injections, and DMARDs. Two-thirds said they used TNF alpha inhibitors in chronic ReA occasionally or more frequently. ReA may be decreasing in frequency and severity in Canada. Changes could be due to less food borne illness, cleaner water, or more rapid treatment of sexually transmitted infections. The cause is often unknown in clinical practice.Key Points• Reactive arthritis (ReA) is likely decreasing in prevalence and severity.• Patients with classic trial of arthritis, urethritis, and conjunctivitis are more likely to have recurrent and/or chronic ReA.• The causal organisms are often not detected and seem to be changing over time.

Factors Associated with Sequelae of Campylobacter and Non-typhoidal Salmonella Infections: A Systematic Review

Despite the significant global burden of gastroenteritis and resulting sequelae, there is limited evidence on risk factors for sequelae development. We updated and extended previous systematic reviews by assessing the role of antibiotics, proton pump inhibitors (PPI) and symptom severity in the development of sequelae following campylobacteriosis and salmonellosis. We searched four databases, including PubMed, from 1 January 2011 to 29 April 2016. Observational studies reporting sequelae of reactive arthritis (ReA), Reiter's syndrome (RS), irritable bowel syndrome (IBS) and Guillain-Barré syndrome (GBS) following gastroenteritis were included. The primary outcome was incidence of sequelae of interest amongst cases of campylobacteriosis and salmonellosis. A narrative synthesis was conducted where heterogeneity was high. Of the 55 articles included, incidence of ReA (n=37), RS (n=5), IBS (n=12) and GBS (n=9) were reported following campylobacteriosis and salmonellosis. A pooled summary for each sequela was not estimated due to high level of heterogeneity across studies (I2>90%). PPI usage and symptoms were sparsely reported. Three out of seven studies found a statistically significant association between antibiotics usage and development of ReA. Additional primary studies investigating risk modifying factors in sequelae of GI infections are required to enable targeted interventions.

THU0440 Yersinia Enterocolitica Biotype 1A Infection can Trigger Reactive Arthritis

BackgroundYersinia enterocolitica (YE) is a well-known trigger of reactive arthritis (ReA) [1]. Studies of YE-related ReA have concentrated on the traditionally pathogenic serotypes O:3 and O:9 (biotypes 4 and 2,...

A Review of Serological Tests to Assist Diagnosis of Reactive Arthritis: Critical Appraisal on Methodologies

On a population-based level, the incidence of reactive arthritis (ReA) is 0.6–27/100,000. The definition of ReA varies and its pathogenesis is not yet clear. Attempts in basic immunology to suggest hypotheses for proliferation of forbidden B cell clones, molecular mimicry, and involvement of cross-reactive antibodies are helpful but not sufficient. Importantly, for the clinical diagnosis of the preceding infection, serology is widely used. Unfortunately, the accuracy of associations between serologic findings and clinical conclusions is plagued by poor standardization of methods. So far, few attempts have been done to examine the pitfalls of different approaches. Here, we review several serologic techniques, their performance and limitations. We will focus on serology for Yersinia, Campylobacter, Salmonella, Shigella, and Chlamydia trachomatis because these bacteria have a longer history of being associated with ReA. We also address controversies regarding the role of serology for some other bacteria linked to autoimmune disorders.

Reactive Arthritis and Other Musculoskeletal Sequelae Following an Outbreak of Salmonella hadar in Castellon, Spain

In 2005 a large outbreak of Salmonella hadar occurred in Spain following the consumption of commercial precooked roast chicken. We estimated the incidence and risk factors for reactive arthritis (ReA) and other musculoskeletal sequelae in the patients of this outbreak in 2 health departments of Castellon province. A prospective cohort study of the patients and their families was carried out. Clinical infection with Salmonella was considered as the exposure factor. The cohort was studied for ReA symptoms using a telephone questionnaire. Telephone interviews or medical examinations of subjects with musculoskeletal symptoms were conducted by a rheumatologist. Robust Poisson regression models were used in the analysis. From the cohort of 262 people, 248 (94.7%) participated in the telephone survey, 155 with clinical salmonellosis (infected), 78 noninfected, and 15 with some symptoms but not clinical salmonellosis. One hundred one infected patients (65%) reported musculoskeletal symptoms, compared to 19 noninfected (24%) (adjusted relative risk = 2.60, 95% CI 1.73-3.90). Of the infected group, 16 ReA (incidence 10%, 95% CI 6.0-16.2), 7 enthesopathies, and 2 arthralgias were detected, and zero in the noninfected group. The risk factors for ReA were age, weight loss, and duration of diarrhea. Antibiotic treatment for the infection protected against symptoms of peripheral or axial arthritis (adjusted relative risk = 0.73, 95% CI 0.55-0.98). The incidence of ReA and musculoskeletal symptoms after the infection was high. The use of antibiotics for S. hadar infection offered some protection against musculoskeletal symptoms.

Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic

Objective: To estimate the annual incidence and prevalence of psoriatic arthritis (PsA), ankylosing spondylitis (AS), and reactive arthritis (ReA) in a sample of the Czech population.Methods: The population-based study was conducted in two regions of the Czech Republic (with a total population of 186000 inhabitants) in 2002–2003. Incident cases were registered on condition of confirming a definite diagnosis according to existing classification criteria during the study period (1 March 2002 to 1 March 2003). Prevalence was studied on the basis of identification of established diagnoses (before 1 March 2002) from registers of living patients of participating rheumatologists and other specialists. The age-standardized estimates of incidence and prevalence were calculated using the European standard population.Results: The total annual incidence of PsA in adults aged ≥ 16 years was 3.6/100000 [95% confidence interval (CI) 1.4–7.6/100000] and the prevalence of PsA was 49.1/100000 (95% CI 39.5–60.4/100000). The annual incidence of AS in adults was 6.4/100000 (95% CI 3.3–11.3/100000) and the prevalence of AS was 94.2/100000 (95% CI 80.8‐109.2/100 000). The annual incidence of ReA in adults was 9.3/100000 (95% CI 5.5–14.8/100000) and the prevalence of ReA was 91.3/100000 (95% CI 78.1–106.2/100000).Conclusion: The annual incidence and prevalence rates of PsA, AS, and ReA in the first population-based survey in the Czech Republic compared well with data reported from other countries.

Patient-reported complications associated with Campylobacter jejuni infection

This study aimed to investigate the occurrence of complications, especially musculoskeletal symptoms, after sporadic Campylobacter jejuni enteritis of domestic origin in Finland. This multi-centre cross-sectional study was conducted during a seasonal peak in 2002. Questionnaires were sent to Campylobacter-positive patients, representing different geographical areas, 2 months after collection of positive stool samples. Medical records were viewed in several cases. Besides antimicrobial susceptibility testing C. jejuni isolates were serotyped. A total of 235 patients (58%) returned the questionnaire and 201 C. jejuni-positive patients were finally included in the study. Musculoskeletal symptoms associated with C. jejuni enteritis were frequent (39%); joint pain was most commonly reported (81%). The incidence of reactive arthritis was 4% and that of Achilles enthesopathy and/or heel pain was 9%. Stomach ache during enteritis was associated with the later development of joint pain. Antimicrobial treatment was common but did not prevent complications.

Salmonella as an Inducer of Autoimmunity.

A clear etiological link has been established between infection with several gram-negative enteric pathogens, including Salmonella spp., and the incidence of reactive arthritis (ReA), an autoimmune disease that largely affects the joints. ReA is sometimes referred to as Reiter's syndrome, particularly when accompanied by uveitis and urethritis. This review reviews the evidence etiologically linking Salmonella infection with autoimmune disease and addresses the roles that bacterial and host elements play in controlling disease outcome. ReA is an autoimmune disease that largely consists of painful joint inflammation but also can include inflammation of the eye, gastrointestinal tract, and skin. ReA is a member of a broad spectrum of chronic inflammatory disorders termed the seronegative spondyloarthropathies (SNSpAs) that includes ankylosing spondylitis (AS), psoriatic arthritis, and enteropathic arthritis. Salmonella species, as well as other enteric pathogens associated with postgastroenteritis ReA, are facultative intracellular gram-negative bacteria. Many studies have analyzed the association of the HLA class I molecule, HLA-B27, with SNSpAs. Whereas B27 has been shown to be present in 90 to 95% of cases of AS, the association of the B27 haplotype with other SNSpAs is more tenuous. The clear association between ReA and infection with Salmonella or other gram-negative enteric pathogens has led to the suggestion that the adaptive immune response to infection has an autoimmune component. In addition to various Salmonella species, other gram-negative enteric pathogens have been linked to the development of ReA. Given their close relationship to Salmonella, this review considers the involvement of Shigella species in ReA.

Reactive arthritis following an outbreak of Salmonella bovismorbificans infection

A large, single-source Salmonella outbreak caused by a rare serovar Bovismorbificans (6,8:r:1,5) occurred in southern Finland in 1994. The origin of the outbreak was sprouted alfalfa seeds. A questionnaire was mailed to all 210 subjects with positive stool culture. Ninety-one percent (191/210) returned the questionnaire. One hundred and fifty-three (80%) were adults. One hundred and fifty-nine out of one hundred and ninety-one (83%) reported diarrhoea, 109 (57%) fever, 104 (54%) abdominal pains, 83 (43%) fatigue, 66 (35%) articular symptoms and 20 (10%) had no symptoms. The median duration of diarrhoea was 5 days (range 1-35), that of other symptoms 4 days (range 1-30). Those reporting articular symptoms were examined (51 patients) or contacted by telephone (13 patients). Twelve percent (22/191) fulfilled the criteria for reactive arthritis (ReA). The difference in the incidence of ReA between children and adults was not significant (8%, vs. 12%). The median onset of joint symptoms was 8.5 days; symptoms were oligoarticular in 14 (67%) and polyarticular in four (19%) patients. Mostly ReA was mild, but in four patients (18%) the joint symptoms lasted for more than 4 months. Ten (45%) ReA patients had HLA-B27 tissue type. The duration and severity of ReA did not differ between HLA-B27 positive and negative patients. Fourteen (64%) ReA patients had received fluoroquinolone treatment before reactive joint or tendon symptoms manifested, but this treatment did not prevent ReA symptoms.