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Namakin K, Sadeghzadeh S, Tamimi A, Abdolzadeh A, Khanjani Z, Ebrahimi N, Abdolmohammadi G, Golshan A, Fardoost S, Masrouri S, Hajikhani B, Salimi Chirani A, Zangiabadian M, Javad Nasiri M. The Association between COVID-19 and Reactive Arthritis: A Systematic Review of Case Reports and Case Series. Curr Rheumatol Rev 2023; 19:420-438. [PMID: 36927426 DOI: 10.2174/1573397119666230316091809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/19/2022] [Accepted: 01/12/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Reactive arthritis (ReA) is a joint inflammation that follows an infection at a distant site, often in the gastrointestinal or urogenital tract. Since the emergence of COVID-19 in January 2020, several case reports have suggested a relation between reactive arthritis and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), due to the novelty of the disease, most findings were reported in the form of case reports or case series, and a comprehensive overview is still lacking. METHODS We searched PubMed/Medline and Embase to identify studies addressing the association between ReA and COVID-19. The following terms were used: ("Reactive Arthritis" OR "Post-Infectious Arthritis" OR "Post Infectious Arthritis") AND ("COVID-19" OR "SARS-CoV-2" OR "2019-nCoV"). RESULTS A total number of 35 reports published up to February 16th, 2022, were included in this study. A wide range of ages was affected (mean 41.0, min 4 max 78), with a higher prevalence of males (61.0%) from 16 countries. The number and location of the affected joints were different in included patients, with a higher prevalence of polyarthritis in 41.5% of all cases. Cutaneous manifestations and visual impairments were found as the most common associated symptoms. Most patients (95.1%) recovered, with a mean recovery time of 24 days. Moreover, arthritis induced by COVID-19 seems to relieve faster than ReA, followed by other infections. CONCLUSION ReA can be a possible sequel of COVID-19 infection. Since musculoskeletal pain is a frequent symptom of COVID-19, ReA with rapid onset can easily be misdiagnosed. Therefore, clinicians should consider ReA a vital differential diagnosis in patients with post-COVID-19 joint swelling. Additional studies are required for further analysis and to corroborate these findings.
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Affiliation(s)
- Kosar Namakin
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atena Tamimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ayfar Abdolzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Khanjani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Ebrahimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golara Abdolmohammadi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Golshan
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shakiba Fardoost
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroush Masrouri
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bekaryssova D, Joshi M, Gupta L, Yessirkepov M, Gupta P, Zimba O, Gasparyan AY, Ahmed S, Kitas GD, Agarwal V. Knowledge and Perceptions of Reactive Arthritis Diagnosis and Management Among Healthcare Workers During the COVID-19 Pandemic: Online Survey. J Korean Med Sci 2022; 37:e355. [PMID: 36573387 PMCID: PMC9792259 DOI: 10.3346/jkms.2022.37.e355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Reactive arthritis (ReA) is an often neglected disease that received some attention during the coronavirus disease 2019 (COVID-19) pandemic. There is some evidence that infection with severe acute respiratory syndrome coronavirus 2 can lead to "reactive" arthritis. However, this does not follow the classical definition of ReA that limits the organisms leading to this condition. Also, there is no recommendation by any international society on the management of ReA during the current pandemic. Thus, a survey was conducted to gather information about how modern clinicians across the world approach ReA. METHODS An e-survey was carried out based on convenient sampling via social media platforms. Twenty questions were validated on the pathogenesis, clinical presentation, and management of ReA. These also included information on post-COVID-19 arthritis. Duplicate entries were prevented and standard guidelines were followed for reporting internet-based surveys. RESULTS There were 193 respondents from 24 countries. Around one-fifth knew the classical definition of ReA. Nearly half considered the triad of conjunctivitis, urethritis and asymmetric oligoarthritis a "must" for diagnosis of ReA. Other common manifestations reported include enthesitis, dermatitis, dactylitis, uveitis, and oral or genital ulcers. Three-fourths opined that no test was specific for ReA. Drugs for ReA were non-steroidal anti-inflammatory drugs, intra-articular injections, and conventional disease-modifying agents with less than 10% supporting biological use. CONCLUSION The survey brought out the gap in existing concepts of ReA. The current definition needs to be updated. There is an unmet need for consensus recommendations for the management of ReA, including the use of biologicals.
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Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Prakash Gupta
- Virgen Milagrosa University Foundation College of Medicine, San Carlos City, Pangasinan, Philippines
| | - Olena Zimba
- Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
| | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Bekaryssova D, Yessirkepov M, Zimba O, Gasparyan AY, Ahmed S. Revisiting reactive arthritis during the COVID-19 pandemic. Clin Rheumatol 2022; 41:2611-2612. [PMID: 35796848 PMCID: PMC9261121 DOI: 10.1007/s10067-022-06252-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Dana Bekaryssova
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands UK
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024 India
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Zeidler H, Hudson AP. Quo vadis reactive arthritis? Curr Opin Rheumatol 2022; 34:218-224. [PMID: 35699331 DOI: 10.1097/bor.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW We provide an overview of recent articles which describe new thinking regarding HLA-B27-associated reactive arthritis (ReA), including those additional infection-related arthritides triggered by microbes that often are grouped under the term ReA. RECENT FINDINGS With the advent and continuation of the pandemic, an increasing number of cases and case series of post-COVID-19 arthritis have been reported and classified as ReA. Further, arthritis after COVID-19 vaccination is a new entity included within the spectrum of ReA. New causative microorganisms identified in case reports include Clostridium difficile, Mycoplasma pneumoniae, Giardia lamblia, Leptospira , and babesiosis. SARS-CoV-2 is emerging as a significant etiologic agent for apparent ReA. SUMMARY It is now clear that comprehensive clinical and laboratory investigations, synovial fluid analyses, and close follow-up of patients all are essential to differentiate ReA from diseases that may present with similar clinical attributes. Further, and importantly, additional research is required to define the wide diversity in causative agents, epidemiology, and rare case presentations of these arthritides. Finally, new classification and diagnostic criteria, and updated treatment recommendations, are essential to the advancement of our understanding of ReA.
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Affiliation(s)
- Henning Zeidler
- Clinic of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alan P Hudson
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Walker TA, Grainger R, Quirke T, Roos R, Sherwood J, Mackereth G, Kiedrzynski T, Eyre R, Paine S, Wood T, Jagroop A, Baker MG, Jones N. Reactive arthritis incidence in a community cohort following a large waterborne campylobacteriosis outbreak in Havelock North, New Zealand. BMJ Open 2022; 12:e060173. [PMID: 35667727 PMCID: PMC9171216 DOI: 10.1136/bmjopen-2021-060173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/16/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES In August 2016, Campylobacter spp contaminated an untreated reticulated water supply resulting in a large-scale gastroenteritis outbreak affecting an estimated 8320 people. We aimed to determine the incidence of probable reactive arthritis (ReA) cases in individuals with culture-confirmed campylobacteriosis (CC), self-reported probable campylobacteriosis (PC) and those reporting no diarrhoea (ND). DESIGN We conducted a retrospective cohort study to identify incidence of probable ReA cases. We identified cases with new ReA symptoms using an adapted acute ReA (AReA) telephone questionnaire. Those reporting ≥1 symptom underwent a telephone interview with the study rheumatologist. Probable ReA was defined as spontaneous onset of pain suggestive of inflammatory arthritis in ≥1 previously asymptomatic joint for ≥3 days occurring ≤12 weeks after outbreak onset. SETTING Population-based epidemiological study in Havelock North, New Zealand. PARTICIPANTS We enrolled notified CC cases with gastroenteritis symptom onsets 5 August 2016-6 September 2016 and conducted a telephone survey of households supplied by the contaminated water source to enrol PC and ND cases. RESULTS One hundred and six (47.3%) CC, 47 (32.6%) PC and 113 (34.3%) ND cases completed the AReA telephone questionnaire. Of those reporting ≥1 new ReA symptom, 45 (75.0%) CC, 13 (68.4%) PC and 14 (82.4%) ND cases completed the rheumatologist telephone interview. Nineteen CC, 4 PC and 2 ND cases developed probable ReA, resulting in minimum incidences of 8.5%, 2.8% and 0.6% and maximum incidences of 23.9%, 12.4% and 2.15%. DISCUSSION We describe high probable ReA incidences among gastroenteritis case types during a very large Campylobacter gastroenteritis outbreak using a resource-efficient method that is feasible to employ in future outbreaks.
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Affiliation(s)
- Tiffany A Walker
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, The New Zealand
| | - Terence Quirke
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Rebekah Roos
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Jill Sherwood
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Graham Mackereth
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | | | - Rachel Eyre
- Hawke's Bay District Health Board, Napier, The New Zealand
| | - Shevaun Paine
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Tim Wood
- Institute of Environmental Science and Research Ltd, Porirua, The New Zealand
| | - Anita Jagroop
- School of Health and Sport Science, Eastern Institute of Technology, Napier, The New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Dunedin, The New Zealand
| | - Nicholas Jones
- Hawke's Bay District Health Board, Napier, The New Zealand
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Perez-Garcia LF, Röder E, Goekoop RJ, Hazes JMW, Kok MR, Smeele HTW, Tchetverikov I, van der Helm-van Mil AHM, van der Kaap JH, Kok P, Krijthe BP, Dolhain RJEM. Impaired fertility in men diagnosed with inflammatory arthritis: results of a large multicentre study (iFAME-Fertility). Ann Rheum Dis 2021; 80:1545-1552. [PMID: 34373257 PMCID: PMC8600610 DOI: 10.1136/annrheumdis-2021-220709] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The impact of inflammatory arthritis (IA) on male fertility remains unexplored. Our objective was to evaluate the impact of IA on several male fertility outcomes; fertility rate (number of biological children per man), family planning, childlessness and fertility problems. METHODS We performed a multicentre cross-sectional study (iFAME-Fertility). Men with IA 40 years or older who indicated that their family size was complete were invited to participate. Participants completed a questionnaire that included demographic, medical and fertility-related questions. To analyse the impact of IA on fertility rate, patients were divided into groups according to the age at the time of their diagnosis: ≤30 years (before the peak of reproductive age), between 31 and 40 years (during the peak) and ≥41 years (after the peak). RESULTS In total 628 participants diagnosed with IA were included. Men diagnosed ≤30 years had a lower mean number of children (1.32 (SD 1.14)) than men diagnosed between 31 and 40 years (1.60 (SD 1.35)) and men diagnosed ≥41 years (1.88 (SD 1.14)).This was statistically significant (p=0.0004).The percentages of men diagnosed ≤30 and 31-40 years who were involuntary childless (12.03% vs 10.34% vs 3.98%, p=0.001) and who reported having received medical evaluations for fertility problems (20.61%, 20.69% and 11.36%, p=0.027) were statistically significant higher than men diagnosed ≥41 years. CONCLUSIONS This is the first study that shows that IA can impair male fertility. Men diagnosed with IA before and during the peak of reproductive age had a lower fertility rate, higher childlessness rate and more fertility problems. Increased awareness and more research into the causes behind this association are urgently needed.
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Affiliation(s)
| | - Esther Röder
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc R Kok
- Rheumatology and Clinical Immunology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Ilja Tchetverikov
- Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Annette H M van der Helm-van Mil
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos H van der Kaap
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Petra Kok
- Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Bouwe P Krijthe
- Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands
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Braithwaite T, Adderley NJ, Subramanian A, Galloway J, Kempen JH, Gokhale K, Cope AP, Dick AD, Nirantharakumar K, Denniston AK. Epidemiology of Scleritis in the United Kingdom From 1997 to 2018: Population-Based Analysis of 11 Million Patients and Association Between Scleritis and Infectious and Immune-Mediated Inflammatory Disease. Arthritis Rheumatol 2021; 73:1267-1276. [PMID: 33728815 DOI: 10.1002/art.41709] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/24/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To estimate 22-year trends in the prevalence and incidence of scleritis, and the associations of scleritis with infectious and immune-mediated inflammatory diseases (I-IMIDs) in the UK. METHODS The retrospective cross-sectional and population cohort study (1997-2018) included 10,939,823 patients (2,946 incident scleritis cases) in The Health Improvement Network, a nationally representative primary care records database. The case-control and matched cohort study (1995-2019) included 3,005 incident scleritis cases and 12,020 control patients matched by age, sex, region, and Townsend deprivation index. Data were analyzed using multivariable Poisson regression, multivariable logistic regression, and Cox proportional hazards multivariable models adjusted for age, sex, Townsend deprivation index, race/ethnicity, smoking status, nation within the UK, and body mass index. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Scleritis incidence rates per 100,000 person-years declined from 4.23 (95% CI 2.16-6.31) to 2.79 (95% CI 2.19-3.39) between 1997 and 2018. The prevalence of scleritis per 100,000 person-years was 93.62 (95% CI 90.17-97.07) in 2018 (61,650 UK patients). Among 2,946 patients with incident scleritis, 1,831 (62.2%) were female, the mean ± SD age was 44.9 ± 17.6 years (range 1-93), and 1,257 (88.8%) were White. Higher risk of incident scleritis was associated with female sex (adjusted IRR 1.53 [95% CI 1.43-1.66], P < 0.001), Black race/ethnicity (adjusted IRR 1.52 [95% CI 1.14-2.01], P = 0.004 compared to White race/ethnicity), or South Asian race/ethnicity (adjusted IRR 1.50 [95% CI 1.19-1.90], P < 0.001 compared to White race/ethnicity), and older age (peak adjusted IRR 4.95 [95% CI 3.99-6.14], P < 0.001 for patients ages 51-60 years versus those ages ≤10 years). Compared to controls, scleritis patients had a 2-fold increased risk of a prior I-IMID diagnosis (17 I-IMIDs, P < 0.001) and significantly increased risk of subsequent diagnosis (13 I-IMIDs). The I-IMIDs most strongly associated with scleritis included granulomatosis with polyangiitis, Behçet's disease, and Sjögren's syndrome. CONCLUSION From 1997 through 2018, the UK incidence of scleritis declined from 4.23 to 2.79/100,000 person-years. Incident scleritis was associated with 19 I-IMIDs, providing data for rational investigation and cross-specialty engagement.
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Affiliation(s)
- Tasanee Braithwaite
- Centre for Rheumatic Diseases and School of Life Course Sciences, King's College London, The Medical Eye Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK, and the Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - James Galloway
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - John H Kempen
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, and MyungSung Christian Medical Center General Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew P Cope
- Centre for Rheumatic Diseases, King's College London, UK, and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Andrew D Dick
- Institute of Ophthalmology, University College London, London, UK, and University of Bristol, Bristol, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK, and Health Data Research UK, London, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK, and NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, Institute of Ophthalmology, University College London, and Health Data Research UK, London, UK
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Tugelbayeva А, Ivanova R, Goremykina М, Rymbayeva Т, Toktabayeva B. REACTIVE ARTHRITIS IN CHILDREN (REVIEW). Georgian Med News 2021:130-135. [PMID: 33814406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Reactive arthritis is an aseptic inflammatory arthritis that is associated with intestinal, urogenital, and nasopharyngeal infections, and represents a systemic clinical presentation of these infections. Reactive arthritis among children still remains an issue in pediatric rheumatology. The variety of the clinical manifestations makes it difficult to diagnose and detect reactive arthritis. Moreover, there is a risk that reactive arthritis without a proper treatment can lead to chronic destructive joint diseases. As the articles' analysis has shown, this topic in pediatrics has been neglected over the past 10 years. Thus, the paper presents data on the epidemiology, pathophysiology, clinical presentation and diagnosis of this disease, as well as recommendations for further studies.
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Affiliation(s)
| | - R Ivanova
- NCJSC «Semey Medical University», Kazakhstan
| | | | - Т Rymbayeva
- NCJSC «Semey Medical University», Kazakhstan
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Stephen DM, Barnett AG. Using Microsimulation to Estimate the Future Health and Economic Costs of Salmonellosis under Climate Change in Central Queensland, Australia. Environ Health Perspect 2017; 125:127001. [PMID: 29233795 PMCID: PMC5963579 DOI: 10.1289/ehp1370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 05/31/2023]
Abstract
BACKGROUND The incidence of salmonellosis, a costly foodborne disease, is rising in Australia. Salmonellosis increases during high temperatures and rainfall, and future incidence is likely to rise under climate change. Allocating funding to preventative strategies would be best informed by accurate estimates of salmonellosis costs under climate change and by knowing which population subgroups will be most affected. OBJECTIVE We used microsimulation models to estimate the health and economic costs of salmonellosis in Central Queensland under climate change between 2016 and 2036 to inform preventative strategies. METHODS We projected the entire population of Central Queensland to 2036 by simulating births, deaths, and migration, and salmonellosis and two resultant conditions, reactive arthritis and postinfectious irritable bowel syndrome. We estimated salmonellosis risks and costs under baseline conditions and under projected climate conditions for Queensland under the A1FI emissions scenario using composite projections from 6 global climate models (warm with reduced rainfall). We estimated the resulting costs based on direct medical expenditures combined with the value of lost quality-adjusted life years (QALYs) based on willingness-to-pay. RESULTS Estimated costs of salmonellosis between 2016 and 2036 increased from 456.0 QALYs (95% CI: 440.3, 473.1) and AUD29,900,000 million (95% CI: AUD28,900,000, AUD31,600,000), assuming no climate change, to 485.9 QALYs (95% CI: 469.6, 503.5) and AUD31,900,000 (95% CI: AUD30,800,000, AUD33,000,000) under the climate change scenario. CONCLUSION We applied a microsimulation approach to estimate the costs of salmonellosis and its sequelae in Queensland during 2016-2036 under baseline conditions and according to climate change projections. This novel application of microsimulation models demonstrates the models' potential utility to researchers for examining complex interactions between weather and disease to estimate future costs. https://doi.org/10.1289/EHP1370.
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Affiliation(s)
- Dimity Maree Stephen
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adrian Gerard Barnett
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Sato S, Uejima Y, Suganuma E, Takano T, Kawano Y. A retrospective study: Acute rheumatic fever and post-streptococcal reactive arthritis in Japan. Allergol Int 2017; 66:617-620. [PMID: 28442182 DOI: 10.1016/j.alit.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/10/2017] [Accepted: 03/22/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Acute rheumatic fever (ARF) and post-streptococcal reactive arthritis (PSRA) are immune-mediated consequences of group A streptococcal pharyngitis. ARF has declined in developed nations. No prevalence survey of PSRA has been conducted. This study evaluated the incidence and characteristics of ARF and PSRA in Japanese children. METHODS From 2010 to 2015, ARF and PSRA were evaluated using clinical data retrospectively collected by chart review from 528 hospitals. RESULTS From 323 hospitals (61% response rate), 44 cases of ARF and 21 cases of PSRA were reported. Patients with ARF and/or PSRA were mainly from large cities in Japan. The mean age of ARF occurrence was 8.5 years, and the ratio of female/male patients was 16:28. Major manifestations in the acute phase included carditis, 27 cases (61.4%); polyarthritis, 22 cases (50%); erythema marginatum, 7 cases (15.9%); Sydenham chorea, 3 cases (6.8%); and subcutaneous nodules, 1 case (2.3%). Twenty-one (58.3%) patients had migratory arthritis. During the follow-up period, 6 patients (13.6%) showed mild carditis. For PRSA, the mean age was 8.2 years, and the ratio of female/male patients was 12:9. Six (28.6%) patients had monoarthritis, and 4 (19%) patients had migratory arthritis. No patient had carditis. CONCLUSIONS Although ARF and PSRA are rare in the Japanese pediatric population, substantial numbers of patients with both conditions were identified in this study. We observed a high incidence of arthritis and carditis in ARF patients. No PSRA case was complicated with carditis. General pediatricians need to have updated information about ARF and PSRA, even in industrialized countries.
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Affiliation(s)
- Satoshi Sato
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan.
| | - Yoji Uejima
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Eisuke Suganuma
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Tadamasa Takano
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Kawano
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
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11
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Simms I, Fleming DM, Lowndes CM, Smith GE, Chapman RS. Surveillance of sexually transmitted diseases in general practice: a description of trends in the Royal College of General Practitioners Weekly Returns Service between 1994 and 2001. Int J STD AIDS 2016; 17:693-8. [PMID: 17059640 DOI: 10.1258/095646206780070992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes the incidence of sexually transmitted infections (STIs) recorded in the Weekly Returns Service (WRS) between 1994 and 2001. There were approximately 76,500 new diagnoses of STIs (7500 males, 71,000 females) and associated syndromes. Candidiasis was the commonest condition reported in males and females followed by pelvic inflammatory disease. The ratio of males to females was 7.1 for non-specific urethritis, and 9.1 and 2.1 for Reiter's syndrome and pediculosis pubis, respectively. The incidence of anogenital warts and genital herpes changed little over time. New diagnoses of genital herpes were higher in females than in males (ratio 2.8:1), whereas the mean annual incidence of genital warts was similar in males and females. The WRS provides an insight into the burden of STI diagnoses, and diagnoses related to STIs that are managed in general practice, and as such has the potential to make a substantial contribution to STI surveillance in England.
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Affiliation(s)
- I Simms
- Health Protection Agency, Centre for Infections, London, UK.
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12
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Nogaeva MG. [Urogenic reactive arthritis morbidity in Kazakhstan]. Klin Med (Mosk) 2014; 92:63-66. [PMID: 25782310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Statistical data on osteo-muscular morbidity in Kazakhstan are presented. Their comparative analysis revealed a 5% rise in general morbidity and a 1% rise in the frequency of urogenic Chlamydial infection. The frequency of inflammatory joint diseases including urogenic reactive arthritis among the patients of a military hospital amounted to 51%.
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13
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Ajene AN, Fischer Walker CL, Black RE. Enteric pathogens and reactive arthritis: a systematic review of Campylobacter, salmonella and Shigella-associated reactive arthritis. J Health Popul Nutr 2013; 31:299-307. [PMID: 24288942 PMCID: PMC3805878 DOI: 10.3329/jhpn.v31i3.16515] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Reactive arthritis (ReA) is a spondyloarthropathic disorder characterized by inflammation of the joints and tissues occurring after gastrointestinal or genitourinary infections. Diagnostic criteria for ReA do not exist and, therefore, it is subject to clinical opinion resulting in cases with a wide range of symptoms and definitions. Using standardized diagnostic criteria, we conducted a systematic literature review to establish the global incidence of ReA for each of the three most commonly-associated enteric pathogens: Campylobacter, Salmonella, and Shigella. The weighted mean incidence of reactive arthritis was 9, 12, and 12 cases per 1,000 cases of Campylobacter, Salmonella and Shigella infections respectively. To our knowledge, this is the first systematic review of worldwide data that use well-defined criteria to characterize diarrhoea-associated ReA. This information will aid in determining the burden of disease and act as a planning tool for public-health programmes.
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Affiliation(s)
- Anuli N Ajene
- Department of International Health Johns Hopkins Bloomberg School of Public Health 615 North Wolfe St., Room E5608 Baltimore, MD 21205 USA
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14
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Shapovalov VM, Rikun OV, Gladkov RV, Averkiev DV, Kuz'min AV. [Outlook of surgical treatment of servicemen with pathology of knee joint in the specialized orthopedo-traumatology department]. Voen Med Zh 2012; 333:4-12. [PMID: 22830110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Analyzed data from annual reports of major trauma districts, chiefs of departments of hospitals and centers and reviewed the frequency and structure of surgical interventions on the knee, made in the last 5 years (2005-2010) in health care facilities the Defense Ministry. The frequency of the most typical injuries and diseases of the knee joint in different categories of servicemen. An integrated laboratory and endoscopic examination of patients with reactive arthritis, associated with latent urogenital infection and how the underlying disease and disease associated surgical pathology knee. Formulated evidence-based recommendations for improving the organization of surgical treatment of soldiers with the pathology of the knee.
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Abstract
Reactive arthritis (ReA) can be defined as the development of sterile inflammatory arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. Although no generally agreed-upon diagnostic criteria exist, the diagnosis is mainly clinical, and based on acute oligoarticular arthritis of larger joints developing within 2-4 weeks of the preceding infection. According to population-based studies, the annual incidence of ReA is 0.6-27/100,000. In addition to the typical clinical picture, the diagnosis of ReA relies on the diagnosis of the triggering infection. Human leucocyte antigen (HLA)-B27 should not be used as a diagnostic tool for a diagnosis of acute ReA. In the case of established ReA, prolonged treatment of Chlamydia-induced ReA may be of benefit, not only in the case of acute ReA but also in those with chronic ReA or spondylarthropathy with evidence of persisting chlamydia antigens in the body. In other forms of ReA, there is no confirmed evidence in favour of antibiotic therapy to shorten the duration of acute arthritis. The outcome and prognosis of ReA are best known for enteric ReA, whereas studies dealing with the long-term outcome of ReA attributable to Chlamydia trachomatis are lacking.
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Affiliation(s)
- Timo Hannu
- Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUCH, Finland.
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16
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Spas'ka GO. [Clinical and epidemiological analysis hospitalization indicators Ministry's of Defense of Ukraine servicemen with reactive arthritis]. Lik Sprava 2011:143-149. [PMID: 22416381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Our researches showed high occurrence of the reactive arthritises among servicemen Ministry of Defense of Ukraine and improvement of the treatment outcomes of this patients during the last years.
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17
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Glasnović M. [Epidemiology of spondylarthritides]. Reumatizam 2011; 58:24-35. [PMID: 22232943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Epidemiologic studies on spondyloarttritides (SpA) encompass mode descriptions on disease appearance within the population, levels of disease frequency: incidence and prevalence, comorbidity, mortality, geographical distribution and clinical features, as well as risk factors for disease appearance. Ethnical, genetic, environmental performers are linked with appearance and expression of the disease. Clear distinction among SpA subgroups, especially in their early phases might not always be possible due to clinical picture overlapping, thus within the initial phase of the disease, the diagnosis of certain SpA diseases might be underestimated. SpA prevalence with various different populations varies between 0.21% up to 1.9% worldwide, and it varies between 1% up to 2% within Europe. With Eskimo population on Alaska and population of Siberia, prevalence rates appear to be from 2% up to 3.4%. SpA are rare with African and Japanese populations. Differences between ethnical groups might be explained by different criteria for selection of a target population, but with differences in HLA-B27 frequency as well. HLA-B27 subtypes distribution plays significant impact on AS prevalence with different race/ethnical groups. Challenges that aggravate the exact evaluation of the SpA diseases with the population, include comprise heterogeneity of population, lack of application feasibility of valid criteria (like testing on HLA-B27 antigen, pelvis radiography and MR), but also transition issue of certain SpA symptoms (eg. peripheral arthritis, enthesitis). Spondyloarthtritis (SpA) present a serious health, social and economical problem everywhere in the world. Uniform data for all populations are significant for making a proper picture on this disease group arduousness, and for epidemiological studies such data, because of their mutual overlapping, should be united within one single group.
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Affiliation(s)
- Marija Glasnović
- Klinicki odjel za reumatologiju i klinicku imunologiju, Klinika za internu medicinu, Klinicki bolnicki centar Osijek, Josipa Huttlera 4, 31000 Osijek
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18
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Curry JA, Riddle MS, Gormley RP, Tribble DR, Porter CK. The epidemiology of infectious gastroenteritis related reactive arthritis in U.S. military personnel: a case-control study. BMC Infect Dis 2010; 10:266. [PMID: 20836849 PMCID: PMC2944352 DOI: 10.1186/1471-2334-10-266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/13/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Reactive 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. METHODS Using 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. RESULTS 506 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). CONCLUSIONS Reactive 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.
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Affiliation(s)
- Jennifer A Curry
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark S Riddle
- Naval Medical Research Center, Silver Spring, Maryland, USA
| | | | - David R Tribble
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Chad K Porter
- Naval Medical Research Center, Silver Spring, Maryland, USA
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Dumbrăveanu L, Cuşnir V, Groppa L, Calinina L. [HLA B 27 uveitis in ankylosing spondylitis and reactive arthritis]. Oftalmologia 2010; 54:29-35. [PMID: 20540366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Clinical features of uveitis HLA B27 in patients with uveitis associated with ankylosing spondylitis and reactive arthritis. The study was made on 64 patients with uveitis treated in the municipal hospital between 2005-2008. The diagnosis was established after a complex ophthalmologic investigation. Histocompatibility HLA-B27 was determined in all groups of patients. Each patient was consulted by the rheumatologist. In the study were included 50 (78%) men and 14 (22%) women. The frequency of HLA B27+ was 72%. At HLA B27+ associated with ankylosing spondylitis and reactive arthritis is present in the anterior form in 85%, unilateral affection in 92%. Their evolution is chronic in 17% and has a tendency for recidivism in 11% of patients. HLA B27 is a genetic factor of uveitis associated with spondylarthropathies in 72%. The study determined the disease in 78% of men, 72% were acute, 85% were anterior and 92% were unilateral. The study of HLA B27 in patients with uveitis is one of the shortest ways for the earlier diagnosis of ankylosing spondylitis.
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Affiliation(s)
- Lilia Dumbrăveanu
- Catedra Oftalmologie, USMF "N.Testemiţanu", Chişinaău, Republica Moldova
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20
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Abstract
Analysis of 25 skeletons from Late Medieval cemetery Uzdolje-Grablje near Knin, Croatia, revealed three cases of systematic pathological changes to joints. Observed pathological lesions were examined macroscopically and radiologically and compared to the available paleopathological standards in order to formulate a differential diagnosis. In all three cases observed changes were most consistent with autoimmune joint diseases including ankylosing spondylitis, juvenile idiopathic arthritis and psoriatic arthritis. Based on published clinical studies, we suggest that the high prevalence of autoimmune diseases in our skeletal sample stems from the genetic basis of the autoimmunity, and that three individuals describe here are possibly closely related.
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MESH Headings
- Adolescent
- Adult
- Archaeology/methods
- Arthritis, Juvenile/epidemiology
- Arthritis, Juvenile/history
- Arthritis, Juvenile/immunology
- Arthritis, Psoriatic/epidemiology
- Arthritis, Psoriatic/history
- Arthritis, Psoriatic/immunology
- Arthritis, Reactive/epidemiology
- Arthritis, Reactive/history
- Arthritis, Reactive/immunology
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/history
- Arthritis, Rheumatoid/immunology
- Arthrography
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/history
- Autoimmune Diseases/immunology
- Biomarkers/analysis
- Croatia/epidemiology
- Female
- HLA Antigens/analysis
- History, 15th Century
- History, 16th Century
- Humans
- Joint Diseases/epidemiology
- Joint Diseases/history
- Joint Diseases/immunology
- Joints/immunology
- Joints/pathology
- Male
- Middle Aged
- Prevalence
- Skeleton
- Spondylitis, Ankylosing/epidemiology
- Spondylitis, Ankylosing/history
- Spondylitis, Ankylosing/immunology
- Young Adult
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Rohekar S, Tsui FWL, Tsui HW, Xi N, Riarh R, Bilotta R, Inman RD. Symptomatic acute reactive arthritis after an outbreak of salmonella. J Rheumatol 2008; 35:1599-1602. [PMID: 18528961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE In 2005, 592 individuals in Ontario developed acute gastroenteritis, predominantly after consuming bean sprouts contaminated with Salmonella enteritidis. Salmonella is a known trigger of reactive arthritis (ReA). We describe the population affected by the Salmonella outbreak in terms of clinical presentation of self-reported arthritic symptoms and HLA-B27 genotyping. METHODS Subjects were mailed a questionnaire, which assessed symptoms consistent with ReA. Subsequently, subjects were asked to submit saliva samples, which were analyzed for HLA-B27. Simple descriptive statistics were performed for analysis of survey responses, and the genetic component was analyzed by chi-square or Fisher's exact tests. RESULTS Most respondents were female (71.3%), with a mean age of 46.0 years. The mean duration of diarrhea symptoms was 16.5 days. 62.5% of respondents reported extraintestinal symptoms that were consistent with ReA. The most commonly reported features were joint pain, swelling or stiffness (46.2%), stiffness > 30 min (35.6%), ocular symptoms (24.0%), and visibly swollen joints (19.2%). Subjects with Salmonella infection had a similar incidence of HLA-B27, regardless of whether they developed symptoms consistent with ReA or not. Notably, HLA-B27 was present more frequently in those who developed Salmonella infection than in healthy controls (OR 3.0). CONCLUSION The study, one of the largest for a dysenteric outbreak, revealed a high event rate of self-reported symptoms consistent with ReA in those infected with Salmonella. Our results showed that HLA-B27 may have rendered individuals more susceptible to Salmonella infection, but did not contribute to the development of symptoms consistent with ReA after infection. We note that the methods used in this study, including self-report, are not ideal for diagnosis of inflammatory arthritis. However, given the rarity of large outbreaks of Salmonella, the study adds valuable knowledge about the course of ReA.
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Affiliation(s)
- Sherry Rohekar
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Schiellerup P, Krogfelt KA, Locht H. A comparison of self-reported joint symptoms following infection with different enteric pathogens: effect of HLA-B27. J Rheumatol 2008; 35:480-487. [PMID: 18203313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE We conducted a case-case comparison study to estimate the attack-rate of reactive joint pain (JPrea) following intestinal infections, and evaluated whether the susceptibility and severity of joint symptoms was associated with the tissue-type HLA-B27. METHODS Consecutive patients with positive fecal culture for Salmonella, Campylobacter, Yersinia, Shigella, and E. coli were addressed by questionnaires inquiring about gastrointestinal (GI) symptoms and the occurrence of joint pain in a previously healthy joint within 4 weeks after onset of infection. A blood sample was requested for HLA-B27 typing. RESULTS Of 3146 patients invited, 2105 (67%) responded to the survey questionnaire. The triggering infections were Campylobacter, 1003; Salmonella, 619; E. coli, 290; Shigella, 102; and Yersinia, 91. JPrea was reported by 294 subjects: Campylobacter, 131 (13.1%); Salmonella, 104 (16.8%); Yersinia, 21 (23.1%); Shigella, 10 (9.8%); and E. coli, 28 (9.7%). There was a significant association between severity of gastroenteritis and development of arthralgia (p = 0.001). The odds ratio (OR) for JPrea in an HLA-B27-positive individual was 2.62 (95% CI 1.67-3.93) for the entire group. A significant association between JPrea and HLA-B27 was found for Salmonella, Shigella, and Yersinia; not, however, for Campylobacter and E. coli. HLA-B27-positive patients had a significantly increased risk for severe joint symptoms. CONCLUSION Our study shows that JPrea after GI infection is positively correlated to severity of GI symptoms. HLA-B27 is not associated with joint pain after Campylobacter. Intestinal E. coli seems to be an arthritogenic pathogen. A significant association between HLA-B27 and severity of joint pain was observed.
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Affiliation(s)
- Peter Schiellerup
- Department of Gastrointestinal Infections, Statens Serum Institut, Copenhagen, Denmark
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Malov VA, Gorobchenko AN, Aĭvazian SR, Gorodnova EA. [Reactive arthritis after acute infectious diarrheal diseases: etiopathogenetic and clinical aspects of the problem]. TERAPEVT ARKH 2008; 80:81-85. [PMID: 19143200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Sonkar GK. Role of HLA B27 in diagnosis of seronegative spondyloarthropathies. INDIAN J PATHOL MICR 2007; 50:908-913. [PMID: 18306603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Seronegative Spondyloarthropathies (SSA) is a very common problem in our area. The main aim of present study was (1) to find the HLA B27 positivity in patients presenting with sacroileitis (2) to see the correlation of B27 positivity on haematological, radiological and extra articular manifestations. Total 110 patients of SSA were studied between July 2004 to June 2005. Routine haematological and immunological test were done by standard method. Total positivity of B27 in SSA was 43.63%, HLA B27 positivity was higher in children (68.75%). Sex wise analysis of B27 positive cases showed that 81.81% B27 positive patients were males. In HLA B27 positive cases lower spine, hip, sacroiliac, shoulder and knee joints were more involved (77.08%, 79.16%, 79.16%, 37.50% and 50.00% respectively). Urinary tract infection (UTI), diarrhoea and constipation were more common in B27 positive cases. Leukocytosis of neutrophilic type (33.33%), raised ESR (77.55%)., CRP positivity (63.63%) and anaemia (65.00%) were seen more frequently in B27 positive cases. In bilateral sacroiliitis diagnosed by X-ray, only 69.23% patient were B27 positive. Our study concludes that HLA B 27 positivity is higher in SSA seen in childhood and in young adult males. B27 positive patients have more severe disease and systemic manifestation Hence, male patients specially young adolescent or young adults with sacroileitis must be subjected for B27 typing.
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Affiliation(s)
- Gyanendra Kumar Sonkar
- UGC Advanced Immunodiagnostic Training and Research Center, Department of Pathology, IMS, BHU, Varanasi
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25
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Pope JE, Krizova A, Garg AX, Thiessen-Philbrook H, Ouimet JM. Campylobacter reactive arthritis: a systematic review. Semin Arthritis Rheum 2007; 37:48-55. [PMID: 17360026 PMCID: PMC2909271 DOI: 10.1016/j.semarthrit.2006.12.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 11/21/2006] [Accepted: 12/23/2006] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the literature on the epidemiology of Campylobacter-associated reactive arthritis (ReA). METHODS A Medline (PubMed) search identified studies from 1966 to 2006 that investigated the epidemiology of Campylobacter-associated ReA. Search terms included: "reactive arthritis," "spondyloarthropathy," "Reiter's syndrome," "gastroenteritis," "diarrhea," "epidemiology," "incidence," "prevalence," and "Campylobacter." RESULTS The literature available to date suggests that the incidence of Campylobacter ReA may occur in 1 to 5% of those infected. The annual incidence of ReA after Campylobacter or Shigella may be 4.3 and 1.3, respectively, per 100,000. The duration of acute ReA varies considerably among reports, and the incidence and impact of chronic ReA from Campylobacter infection is virtually unknown. CONCLUSIONS Campylobacter-associated ReA incidence and prevalence varies widely among reviews due to case ascertainment differences, exposure differences, lack of diagnostic criteria for ReA, and perhaps genetics and ages of exposed individuals. At the population level it may not be associated with HLA-B27, and inflammatory back involvement is uncommon. Follow-up for long-term sequelae is largely unknown. Five percent of Campylobacter ReA may be chronic or relapsing (with respect to musculoskeletal symptoms).
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Affiliation(s)
- Janet E Pope
- Division of Rheumatology, Department of Medicine, The University of Western Ontario, Ontario, Canada.
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26
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Peters KM. [Non-infective inflammations of the vertebral spine]. ACTA ACUST UNITED AC 2007; 145:R1-19; quiz R20-4. [PMID: 17345531 DOI: 10.1055/s-2007-965035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-infective inflammations of the vertebral spine can be caused by seronegative spondylarthropathies or rheumatoid arthritis, respectively. Seronegative spondylarthropathies include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel diseases and undifferentiated arthritis. This review discusses etiology and pathogenesis, epidemiology, clinical features, diagnosis and differential diagnoses of these chronic inflammatory diseases with a special focus on vertebral involvement.
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MESH Headings
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/epidemiology
- Arthritis, Psoriatic/etiology
- Arthritis, Reactive/diagnosis
- Arthritis, Reactive/epidemiology
- Arthritis, Reactive/etiology
- Cross-Sectional Studies
- Diagnosis, Differential
- Diagnostic Imaging
- HLA-B27 Antigen/analysis
- Humans
- Inflammatory Bowel Diseases/diagnosis
- Inflammatory Bowel Diseases/epidemiology
- Inflammatory Bowel Diseases/etiology
- Sacroiliac Joint/pathology
- Spinal Osteophytosis/diagnosis
- Spinal Osteophytosis/epidemiology
- Spinal Osteophytosis/etiology
- Spine/pathology
- Spondylarthropathies/diagnosis
- Spondylarthropathies/epidemiology
- Spondylarthropathies/etiology
- Spondylitis, Ankylosing/diagnosis
- Spondylitis, Ankylosing/epidemiology
- Spondylitis, Ankylosing/etiology
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Affiliation(s)
- K M Peters
- Orthopädie und Osteologie, Rhein-Sieg-Klinik, Nümbrecht, Germany.
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Wilson IG. Reactive arthritis and the investigation of novel organisms. J Postgrad Med 2007; 53:2-3. [PMID: 17244958 DOI: 10.4103/0022-3859.30315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chen YJ, Lin CH, Ou TT, Wu CC, Tsai WC, Liu HW, Yen JH. Solute Carrier Family 11 Member A1 Gene Polymorphisms in Reactive Arthritis. J Clin Immunol 2007; 27:46-52. [PMID: 17211726 DOI: 10.1007/s10875-006-9050-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 09/26/2006] [Indexed: 11/28/2022]
Abstract
To investigate the role of SLC 11A1 polymorphisms in the development of reactive arthritis, 91 patients with reactive arthritis and 163 healthy controls were enrolled in this study. The SLC 11A1 polymorphisms were determined by the method of polymerase chain reaction/restriction fragment length polymorphism. The genotype distributions of SLC 11A1 274, 823, 1703, and 1729+ 55 del 4 were significantly different between the patients with reactive arthritis and controls. The genotype frequency of SLC 11A1 274C/C was significantly decreased in the patients with reactive arthritis when compared with that of the controls. In contrast, the SLC 11A1 274C/T showed a significant association with reactive arthritis. The patients with reactive arthritis have a significantly higher frequency of SLC 11A1 823C/C than the controls. However, SLC 11A1 823T/T was resistant to the development of reactive arthritis. The allele frequencies of SLC 11A1 274T and 823C were significantly increased in the patients with reactive arthritis in comparison with those of the controls, independent of HLA-B27. On the contrary, the allele frequencies of SLC 11A1 274C and 823T were significantly decreased in the patients with reactive arthritis. The estimated haplotype frequency of SLC 11A1 274C 823T 1703G 1729+55del 4 TGTG+ was significantly decreased in the patients with reactive arthritis when compared with that of the controls. In contrast, the estimated haplotype frequency of SLC 11A1 274T 823C 1703G 1729+55 del 4 TGTG+ was significantly increased in the patients with reactive arthritis. This study shows that the SLC 11A1 274T and 823C alleles are associated with susceptibility to reactive arthritis independently of HLA-B27 in Taiwan. The SLC 11A1 274T 823C 1703G 1729+55 del 4 TGTG+ haplotype is associated with the development of reactive arthritis in Taiwan. In contrast, the SLC 11A1 274C 823T 1703G 1729+55 del 4 TGTG+ haplotype may be a protective factor.
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Affiliation(s)
- Yi-Jing Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
BACKGROUND The diagnosis of reactive arthritis is a challenging clinical problem in daily practice. Although there are many triggering infectious agents for reactive arthritis, Toxoplasmosis, a worldwide parasitic infection has not been reported. AIM We investigated the serologic evidence of Toxoplasma gondii ( T. gondii ) infection in patients with newly diagnosed reactive arthritis after six weeks of the onset of the first symptom but no demonstrable triggering agent for reactive arthritis. SETTING AND DESIGN Clinical controlled study. MATERIALS AND METHODS We screened serologically the serum toxoplasma IgM and IgG antibody (Ab) titers which revealed toxoplasma infection in 50 patients with reactive arthritis (40 female, 10 men) and no demonstrable triggering agent and control subjects (32 female, 8 male). STATISTICAL ANALYSIS SPSS 10.0 software package program was used. RESULTS The mean age of the patients and controls was similar (41.3+/- 12.0 vs. 39.6+/-11.8 years) respectively. The prevalence of IgG Ab titers of T. gondii in patients and controls were found to be 52% and 47.5%, respectively. Mean serum Toxoplasma IgG Ab levels were found to be 16.5+/-14.5 IU/ml, and 16.9+/-13.8 IU/ml in patients and control subjects respectively ( P> 0.05). We did not find any Toxoplasma IgM Ab titer demonstrating the acute or sub-acute infection in the serum of patients or controls. CONCLUSION Although past Toxoplasma infection was prevalent in both groups, we did not find any subject with acute Toxoplasma infection in patients with newly diagnosed reactive arthritis and healthy controls. Despite the fact that our study group was small, we suggest that T. gondii does not seem to be a triggering agent for reactive arthritis and past infection may be a coincidental finding.
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Affiliation(s)
- M Sert
- Cukurova University, Medical Faculty, Dept. of Internal Medicine, 01330 Adana, Turkey
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Jalava K, Hakkinen M, Valkonen M, Nakari UM, Palo T, Hallanvuo S, Ollgren J, Siitonen A, Nuorti JP. An outbreak of gastrointestinal illness and erythema nodosum from grated carrots contaminated with Yersinia pseudotuberculosis. J Infect Dis 2006; 194:1209-16. [PMID: 17041846 DOI: 10.1086/508191] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 04/27/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Outbreaks of Yersinia pseudotuberculosis infection have been epidemiologically linked to fresh produce, but the bacterium has not been recovered from the food items implicated. In May 2003, a cluster of gastrointestinal illness and erythema nodosum was detected among schoolchildren who had eaten lunches prepared by the same institutional kitchen. METHODS We conducted a case-control study and trace-back, environmental, and laboratory investigations. Case patients had culture-confirmed Y. pseudotuberculosis O:1 infection, erythema nodosum, or reactive arthritis. Bacterial isolates from clinical and environmental samples were compared using pulsed-field gel electrophoresis (PFGE). RESULTS Of 7392 persons at risk, 111 (1.5%) met the case definition; 76 case patients and 172 healthy control subjects were enrolled in the case-control study. Only raw grated carrots were significantly associated with illness in a logistic-regression model (multivariable odds ratio, 5.7 [95% confidence interval, 1.7-19.5]); a dose response was found for increasing amount of consumption. Y. pseudotuberculosis O:1 isolates from 39 stool specimens and from 5 (42%) of 12 soil samples that contained carrot residue and were obtained from peeling and washing equipment at the production farm were indistinguishable by PFGE. CONCLUSIONS Carrots contaminated early in the production process caused a large point-source outbreak. Our findings enable the development of evidence-based strategies to prevent outbreaks of this emerging foodborne pathogen.
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Affiliation(s)
- Katri Jalava
- Department of Infectious Diseases Epidemiology, National Public Health Institute, FIN-00300 Helsinki, Finland
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Beltran-Fabregat J, Arnedo-Pena A, Bellido-Blasco JB, Tirado-Balaguer MD, Fenosa-Salillas A, Pac-Sa MR. Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b. Med Clin (Barc) 2006; 126:532-4. [PMID: 16756904 DOI: 10.1157/13087140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. PATIENTS AND METHOD A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. RESULTS Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). CONCLUSIONS The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis.
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Abstract
We previously reported the case of a patient who became ill with Salmonella serotype Blockley after eating a chicken meal and who was still suffering symptoms of salmonella-reactive arthritis 10 years after the initial infection. The immunological consequences of infection were of concern and prompted a literature review because of the possibility that Salmonella Blockley may be more likely to cause long-term illness in certain patients than more common serovars. The review revealed the additional cause for concern of plasmid-borne extended spectrum beta-lactamases and the high frequency of integron-associated multidrug resistance in some isolates. The serovar was described in 1955 in the USA and Europe. It has become common in South East Asia and recently has been reported more often in Europe. A review of reactive arthritis outbreaks shows that information on the incidence and duration of the condition caused by serovars other than Salmonella serotype Enteritidis and Salmonella serotype Typhimurium is very limited. Rheumatologists can assist microbiologists and epidemiologists by reporting relevant cases of long-term reactive arthritis.
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Affiliation(s)
- Ian G Wilson
- Northern Ireland Public Health Laboratory, Bacteriology Department, Belfast City Hospital, Lisburn Road, Belfast BT9 7AD, UK.
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Abstract
Reactive arthritis (ReA) was known as Reiter's disease or Fiessinger-Leroy disease for nearly 100 years. However, during the past 30 years the disease has been known as reactive arthritis, a member of the spondyloarthritis family. Despite knowing the initiating event (infection) and genetic constitution (many patients have HLA-B27) of ReA, a model of interplay between environment and genetics, its pathogenesis is still incompletely known. This review covers the epidemiology, clinical features, treatment, and prognosis of ReA.
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Affiliation(s)
- M Leirisalo-Repo
- Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Lu DW, Katz KA. Declining use of the eponym “Reiter's syndrome” in the medical literature, 1998–2003. J Am Acad Dermatol 2005; 53:720-3. [PMID: 16198806 DOI: 10.1016/j.jaad.2005.06.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 06/06/2005] [Accepted: 06/14/2005] [Indexed: 11/24/2022]
Abstract
The German physician Hans Reiter (1881-1969) is associated eponymously with the syndrome of arthritis, urethritis, and conjunctivitis occurring during or after episodes of diarrhea or urethritis. During World War II, Reiter, a physician leader of the Nazi party, authorized medical experiments on concentration camp prisoners. Because of this, some physicians have argued against further use of the Reiter eponym. We investigated trends in use of the Reiter eponym from 1998 to 2003. We searched MEDLINE to identify English-language articles published between 1998 and 2003. Articles were classified by whether the eponym was used without qualification (ie, without mentioning its disfavored use) or not. Five hundred thirty-nine articles were identified. Use of the eponym without qualification was less common in articles published later (34.0% in 2003 vs 57.0% in 1998; adjusted relative risk [RR], 0.49, 95% confidence interval [CI], 0.27-0.71; P = .001) and in articles published in higher impact journals (36.8% vs 56.8% in journals without calculated impact factors; adjusted RR, 0.51; 95% CI, 0.29-0.73; P = .002). Use without qualification was more common in articles written by US-based authors (60.6% vs 31.1% for European-based authors; adjusted RR, 2.28; 95% CI, 1.58-2.97; P < .001). We concluded that use of the Reiter eponym without qualification decreased from 1998 to 2003.
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Affiliation(s)
- Dave W Lu
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Ozgul A, Baylan O, Taskaynatan MA, Kalyon TA. Poncet's disease (tuberculous rheumatism): two case reports and review of the literature. Int J Tuberc Lung Dis 2005; 9:822-4. [PMID: 16013782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
We report two human leukocyte antigen (HLA) B27-positive cases of urogenital tuberculosis (TB) with asymmetric polyarthritis. Stained smears with Ehrlich Ziehl-Neelsen and polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis complex (MTC) of the ejaculate were positive in both cases, despite negative cultures. Stained smear, culture and PCR results of the synovial fluid for mycobacteria were negative. The patients were diagnosed with Poncet's disease. Polyarthritis was resolved rapidly with anti-tuberculosis treatment. We suggest that in cases with unexplained arthritis and non-articular TB, Poncet's disease should be considered. PCR can be used in the routine diagnostic algorithm when conventional methods fail to identify MTC.
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Affiliation(s)
- A Ozgul
- Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Ankara, Turkey.
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Njobvu P, McGill P. Human immunodeficiency virus related reactive arthritis in Zambia. J Rheumatol 2005; 32:1299-304. [PMID: 15996068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To characterize the clinical, radiological, and diagnostic features of reactive arthritis (ReA) in indigenous Black Zambians with human immunodeficiency virus (HIV) infection. METHODS Consecutive patients attending an arthritis clinic over a 5-year period were studied prospectively. Those who satisfied diagnostic criteria for ReA were analyzed. RESULTS In total, 170 patients satisfied the ESSG criteria for ReA; 71 (45 men, 26 women) had one or more extraarticular manifestations; 30% had enteroreactive and 14% uroreactive disease. Only 59% of patients had the diagnostic features of ReA at presentation. The initial diagnosis was undifferentiated spondyloarthropathy (uSpa) in 20%, other ReA in 14%, and "arthritis alone" in 7%. Of 65 (42 men, 23 women) patients tested, 94% were HIV-positive (91% men, 100% women). In those with HIV, the arthritis was predominantly polyarticular, lower limb-predominant, and progressive; 58% of 33 with persistent disease had erosions of foot and/or hand joints (average disease duration, 24.4 mo); 6 of 10 showed early radiological spine or sacroiliac joint changes (average duration 47.7 mo). Anterior uveitis occurred in 33% of patients, while keratoderma blenorrhagicum and stomatitis occurred in 14.3% and 9.5%, respectively, of patients with enteroreactive ReA. Uroreactive ReA was more common in women. There were no significant differences in the clinical, diagnostic, or radiographic features between men and women or between those with or without a known preceding trigger. CONCLUSION HIV associated ReA in Black Zambians frequently follows an accelerated course with a strong tendency to relapse, develop early erosions and joint deformity, and become chronic. The clinical, diagnostic, and radiographic features are indistinguishable from those described in the conventional (HLA-B27 related) disease, although our HIV-positive patients have a high overall frequency of uveitis, keratoderma, and onycholysis.
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Affiliation(s)
- Panganani Njobvu
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
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Abstract
Reactive arthritis (ReA), one of the spondyloarthropathies, is an infectious related disease that occurs in a genetically predisposed individual, characterized by an immune-mediated synovitis with intra-articular persistence of viable nonculturable bacteria and/or immunogenic bacterial antigens. ReA long term prognosis is not as good as it was earlier believed. Two-thirds of patients develop prolonged joint discomfort, low back pain, or enthesopathies after acute ReA, and 15% to 30% of them develop chronic symptoms. The therapeutic options for patients with the more severe forms of the disease have been rather limited. The efficacy of tumor necrosis factor antagonists in other spondyloarthritis suggested that anticytokine therapy could also be effective for ReA. This paper reviews the latest concepts in urogenital and postenteric human leukocyte antigen-B27-associated ReA.
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39
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Affiliation(s)
- J S Hill Gaston
- University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 2QQ.
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Müller-Godeffroy E, Lehmann H, Küster RM, Thyen U. Lebensqualität und psychosoziale Anpassung bei Kindern und Jugendlichen mit juveniler idiopathischer Arthritis und reaktiven Arthritiden. Z Rheumatol 2005; 64:177-87. [PMID: 15868335 DOI: 10.1007/s00393-005-0652-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 08/02/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We sought to measure self-reported health related quality of life (HRQOL) and psychosocial adaptation in children and adolescents with juvenile idiopathic arthritis (JIA) and reactive arthritis and to determine factors associated with these outcomes. METHODS We interviewed 72 children and adolescents with chronic arthritis, age 8-16, about HRQOL (KINDL-R-Questionnaire) and functional ability in activities of daily living (Childhood Health Assessment Questionnaire-CHAQ). Mothers reported behavior problems (Child Behavior Checklist-CBCL). RESULTS Children and adolescents with juvenile idiopathic arthritis and reactive arthritis reported lower HRQOL compared to normative data in several areas. Children reported lower QOL in the dimensions self-esteem; adolescents reported lower QOL in the dimensions physical well being and total QOL. Almost 20% of the sample appeared to have serious behavior problems, mostly social isolation and depression/anxiety. Functional limitations affected HRQOL and behavior problems. Inpatient children and adolescents and those with shorter disease duration reported lower QOL than outpatient children and adolescents and those with longer disease duration. Best predictors for impaired HRQOL were functional limitations, social isolation and depression/anxiety. CONCLUSIONS Self-reported HRQOL and behavior problems may be relevant outcome measures in children and adolescents with chronic arthritis and useful to monitor psychosocial support in this population.
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Affiliation(s)
- E Müller-Godeffroy
- Universitätsklinikum Lübeck, Klinik für Kinder- und Jugendmedizin, Ratzburger Allee 160, 23538 Lübeck, Germany
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Lee ATY, Hall RG, Pile KD. Reactive joint symptoms following an outbreak of Salmonella typhimurium phage type 135a. J Rheumatol 2005; 32:524-7. [PMID: 15742447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To quantify the incidence and clinical features of reactive arthritis (ReA) developing in a cohort exposed to an outbreak of Salmonella typhimurium phage type 135a, and factors affecting host susceptibility to ReA. METHODS A screening questionnaire was mailed to 493 patients with confirmed Salmonella infection. Musculoskeletal symptoms and extraarticular manifestations of ReA were quantified. Positive responders with joint pain were invited to participate further, with a detailed history, examination, and investigations including HLA-B27 status. RESULTS A total of 261/461 (57%) subjects responded to the questionnaire, with 23/54 adults (43%) and 41/207 children (20%) reporting joint symptoms. Although joint pains were less common in children compared with adults, those children affected usually had eye (34%) or mucocutaneous (37%) symptoms. The incidence of ReA was 14.6%, with adults more frequently affected (24%) than children (12%). This may be an underestimate given the large proportion of children involved. Associated clinical features were similar to previous studies, with the distribution of arthritis affecting the lower limbs predominantly in an oligoarticular pattern, as were the extraarticular manifestations and enthesopathy. We found 17% of subjects were HLA-B27 positive, and 55% were still symptomatic after 6 months. CONCLUSION In an Australian cohort study of a S. typhimurium phage type 135a outbreak, joint symptoms were common, affecting 25% of subjects. The incidence of ReA of 14.6% and the clinical features were comparable to previous studies. There was a small effect of HLA-B27 status on the development of ReA.
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Affiliation(s)
- Anita T Y Lee
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia.
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Liang TC, Hsu CT, Yang YH, Lin YT, Chiang BL. Analysis of childhood reactive arthritis and comparison with juvenile idiopathic arthritis. Clin Rheumatol 2004; 24:388-93. [PMID: 16034649 DOI: 10.1007/s10067-004-1042-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 10/18/2004] [Indexed: 11/24/2022]
Abstract
There is currently no agreement on how to classify and diagnose reactive arthritis (ReA) and what kind of clinical and laboratory findings are specific for the diagnosis. This study retrospectively analyzed the initial clinical manifestations and laboratory findings in children diagnosed with ReA and juvenile idiopathic arthritis (JIA). A comparison was also made between these two groups to see if there were differences. A retrospective chart review was performed and 44 patients diagnosed with ReA and 80 patients with JIA were enrolled in this study. Their initial clinical manifestations and laboratory findings were also analyzed and compared. The initial clinical manifestations in ReA were analyzed including the demographic data, the preceding infection history, the duration of the infectious episode to the onset of arthritis, the duration of arthritic symptoms, and the involved joint pattern. Comparison of the initial laboratory findings between patients with ReA and JIA showed significant differences between erythrocyte sedimentation rates (ESR) in the first hour, platelet counts (p < 0.05), and ESR in the second hour (p = 0.052). Further, comparing ReA with the subtypes of JIA, significant differences were noted between ReA and the systemic type in terms of hemoglobin level, platelet counts, C-reactive protein, and first and second hour ESR (p < 0.05). However, if compared with the polyarticular or pauciarticular type, only the platelet counts showed any significant statistical difference (p < 0.05). This study summarizes clinical experiences in ReA. The differences in laboratory findings of ReA and JIA may provide a clue in making a differential diagnosis.
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Affiliation(s)
- Tien-Chi Liang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Republic of China
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Chaabouni L, Ben Hamouda S, Abdelmoula L, Ben Hadj Yahia C, Kchir MM, Zouari R. [Reactive arthritis]. Tunis Med 2004; 82:1064-9. [PMID: 15822506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Reactive arthritis are definied as steriles arthropathies using classic bacteriological techniques. They are due to extra articular infection and are often associated with HLA B27. The outcome of these arthritis is characterised by the recurrence of flares with sometimes appearition of ankylosing spondylitis. The pathogenesis of reactive arthritis is modified when bacterial antigens or alive micro-organisms are discovered in involved joints. Several current works have underlined the interest of antibiotic therapy in the chlamydial reactive arthritis. Chronic forms can justify the use of anti-rheumatic drugs such as salazopyrine.
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Affiliation(s)
- Lilia Chaabouni
- Service de Rhumatologie, EPS Charles Nicolle, Tunis, Tunisie
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Hannu T, Mattila L, Siitonen A, Leirisalo-Repo M. Reactive arthritis attributable to Shigella infection: a clinical and epidemiological nationwide study. Ann Rheum Dis 2004; 64:594-8. [PMID: 15550534 PMCID: PMC1755450 DOI: 10.1136/ard.2004.027524] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the incidence and clinical picture of Shigella associated reactive arthritis (ReA) and the arthritogenicity of various Shigella species in the population. METHODS A questionnaire on enteric and extraintestinal, especially musculoskeletal, symptoms was sent to 278 consecutive patients with Shigella positive stool culture and to 597 controls. Analysis of self reported musculoskeletal symptoms was supplemented with clinical examination of those subjects with recent symptoms. RESULTS Of the patients, 14/211 (7%) had ReA, and a further 4/211 (2%) other reactive musculoskeletal symptoms (tendonitis, enthesopathy, or bursitis). Of the 14 patients with ReA, all adults, 10 had S sonnei, three S flexneri, and one S dysenteriae infection. HLA-B27 was positive in 36% of the patients with ReA. One control subject had ReA. In the patients with Shigella infection, the odds ratio for developing ReA was 16.2 (95% confidence interval 2.1 to 123.9), p = 0.001. CONCLUSIONS ReA occurred in 7% of patients after Shigella infection, with an annual incidence of 1.3/1 000 000 in Finland. Besides S flexneri, S sonnei and S dysenteriae can also trigger ReA.
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Affiliation(s)
- T Hannu
- Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, PO Box 263, FIN-00029 HUCH, Finland.
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Lake R, Baker M, Nichol C, Garrett N. Lack of association between long-term illness and infectious intestinal disease in New Zealand. N Z Med J 2004; 117:U893. [PMID: 15156211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIMS To investigate whether the increase in notified cases of infectious intestinal disease in New Zealand from 1988 to 2001 has resulted in a concurrent increase in associated secondary illness cases. METHODS National surveillance system data were compared to hospital discharge data. RESULTS No statistically significant correlation between the number of cases of campylobacteriosis and Guillain-Barre syndrome (GBS) was found. There was no statistically significant correlation between the number of cases of campylobacteriosis, salmonellosis, shigellosis, and any of the categories of reactive arthritis; apart from two correlations with campylobacteriosis: with arthropathy associated with Reiter's disease and nonspecific urethritis (Pearson correlation R2=0.69; p<0.02) and unspecified infective arthritis (Pearson correlation R2=0.75; p<0.008). The later category is likely to include cases of both infective and non-infective aetiology. CONCLUSION In New Zealand, infectious intestinal diseases are not making a significant contribution to the burden of hospitalisation for reactive arthritis or GBS.
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Affiliation(s)
- Rob Lake
- Christchurch Science Centre, Institute of Environmental Science and Research (ESR) Ltd, Christchurch, New Zealand.
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Abstract
Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, non-culturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease.
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Affiliation(s)
- Inés Colmegna
- Section of Rheumatology, Department of Medicine, LSU Health Science Center, New Orleans, Louisiana 70112, USA
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Hannu T, Kauppi M, Tuomala M, Laaksonen I, Klemets P, Kuusi M. Reactive arthritis following an outbreak of Campylobacter jejuni infection. J Rheumatol 2004; 31:528-30. [PMID: 14994400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To study the occurrence and the clinical picture of musculoskeletal (MSK) complications including reactive arthritis (ReA) following an outbreak of Campylobacter jejuni. METHODS An outbreak of C. jejuni infection occurred in 2000 in Asikkala, Finland, during which 350 exposed subjects contacted the Municipal Health Centre (MHC). All primary care physicians in the MHC were advised to refer patients with acute MSK complications to the Rheumatism Foundation Hospital (RFH) for a specialist clinical examination, which was performed <or= 3 months after the onset of the outbreak. RESULTS Fifteen subjects with acute MSK complaints (11 women, 4 men; mean age 58 yrs) were examined in the RFH, where the following MSK diagnoses were assessed: ReA (9 patients), reactive arthralgia (2). exacerbation of previous rheumatoid arthritis (3). and previous fibromyalgia (1). In the patients with ReA, all adults, the arthritis was oligoarticular in 6 patients and polyarticular in 3; one patient had monoarthritis. The most frequently affected joints were knees and ankles. Besides peripheral arthritis, one patient had clinical sacroiliitis. Of the ReA patients, the antigen HLA-B27 was positive in 33%, including the patient with sacroiliitis. At the clinical examination, 6 ReA patients had subsiding signs of synovitis, 2 had only arthralgia, and one was symptom-free. CONCLUSION The frequency of ReA following an outbreak of C. jejuni was low: 2.6% (9 of 350). In the ReA patients, the clinical picture was mild, the primary outcome good, and the association with HLA-B27 not high.
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Affiliation(s)
- Timo Hannu
- Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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Shiba M, Fujii T, Takatera H. [Reiter syndrome after intravesical Bacillus Calmette-Guerin (BCG) immunotherapy: a case report]. Hinyokika Kiyo 2003; 49:599-601. [PMID: 14655604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
A 56-year-old man who had previously undergone transurethral resection and intra-arterial chemotherapy for bladder cancer developed irritable bladder, bilateral conjunctivitis and arthritis including the knees, ankles and sacroiliac joints after starting intravesical Calmette-Guerin bacillus (BCG) immunotherapy. These symptoms were in agreement with the features of Reiter syndrome. One month after cessation of the intravesical BCG immunotherapy and initiation of the treatment with a non-steroidal anti-inflammatory drug (NSAID), he was not complaining of symptoms. Reiter syndrome is an uncommon complication after intravesical BCG immunotherapy. Nevertheless, since the prolonged arthritis has a possibility to cause joint deformity, we must pay serious attention to this side effect.
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Hannu T, Mattila L, Nuorti JP, Ruutu P, Mikkola J, Siitonen A, Leirisalo-Repo M. Reactive arthritis after an outbreak of Yersinia pseudotuberculosis serotype O:3 infection. Ann Rheum Dis 2003; 62:866-9. [PMID: 12922960 PMCID: PMC1754663 DOI: 10.1136/ard.62.9.866] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the occurrence and clinical characteristics of reactive arthritis (ReA) after an outbreak of Yersinia pseudotuberculosis serotype O:3 infection. METHODS From 15 October to 6 November 1998, a widespread outbreak of Y pseudotuberculosis serotype O:3 occurred in Finland. A questionnaire on musculoskeletal symptoms was mailed to 38 patients with infection confirmed by culture. All patients who reported joint symptoms were interviewed by phone and their medical records of outpatient visits or hospital admission because of recent joint symptoms were reviewed. RESULTS Thirty three of 38 (87%) patients returned the questionnaire. Reactive musculoskeletal symptoms were reported by 5/33 (15%): four patients (12%) fulfilled the criteria for ReA and one additional patient had reactive enthesopathy. The patients with ReA were adults (age range 40-47 years), whereas the patient with reactive enthesopathy was a 14 year old boy. In all patients with ReA, the arthritis was polyarticular. In addition to peripheral arthritis, other musculoskeletal symptoms included sacroiliitis (one patient), pain in Achilles tendon (one patient), and heel pain (two patients). HLA-B27 was positive in all the three patients tested. In three of four patients with ReA, the duration of acute arthritis was over six months. CONCLUSION Y pseudotuberculosis serotype O:3 infection is frequently associated with ReA and the clinical picture is severe.
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Affiliation(s)
- T Hannu
- Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Finland
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Abstract
Infections and genetics play a role in the development of reactive arthritis. The clinical manifestations and severity of the features depend on the triggering infections and the epidemiologic setting. Reports from hospital-based series show the lowest frequency of reactive arthritis, but often, patients have severe arthritis associated with a high frequency of HLA-B27. At the population level, reactive arthritis occur in 7 to 15% of the infected subjects. The disease is usually mild, affects small joints, can be polyarticular, often rapidly disappears, and has a low association with HLA-B27. There also seems to be a change in the spectrum of triggering infections. Reports of Yersinia arthritis are less common, whereas arthritis in association with Campylobacter or Salmonella infections seems to be increasing. The role of early antimicrobial chemotherapy for the prevention of reactive arthritis needs to be studied.
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Affiliation(s)
- Marjatta Leirisalo-Repo
- Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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