Abstract: Infections Preceding Early Arthritis in Southern Sweden: a Prospective Population-Based Study

Infections Preceding Early Arthritis in Southern Sweden: a Prospective Population-Based Study

MARIA K. SÖDERLIN, HANNU KAUTIAINEN, MIRJA PUOLAKKAINEN, KLAUS HEDMAN, MARIA SÖDERLUND-VENERMO, THOMAS SKOGH, and MARJATTA LEIRISALO-REPO

ABSTRACT.

Objective. To detect evidence of infections preceding early arthritis in Southern Sweden and to compare the clinical outcome of remission during a 6-month followup for patients with and without signs of prior infection.

Methods. Adult patients with arthritis of less than 3 months' duration were referred from primary health care centers to rheumatologists. All patients were systematically screened for infections caused by Salmonella typhimurium and Salmonella enteritidis, Yersinia enterocolitica, Campylobacter jejuni, Borrelia burgdorferi, Chlamydia trachomatis, Chlamydia pneumoniae, and parvovirus B19.

Results. Seventy-one patients were included in this study. Twenty-seven (38%) patients had reactive arthritis (ReA), 17 (24%) undifferentiated arthritis, 15 (21%) rheumatoid arthritis (RA), 4 (6%) psoriatic arthritis, and the rest (11%) other diagnoses. Of all the patients, 45% had evidence of a recent infection preceding the arthritis, as indicated by laboratory tests and/or disease history. C. jejuni dominated the ReA group. The occurrence of recent C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections was low. Overall, 58% of the patients went into remission during the 6-month followup. Of the patients with a preceding infection, 69% went into remission as compared to 38% of the patients without a preceding infection (p = 0.011). Thirty-three percent of the patients with RA were in remission after 6 months.

Conclusion. In this population-based cohort, 45% of the patients presenting with a new-onset arthritis had had a prior infection. Campylobacter ReA dominated the ReA group. There were only a few cases preceded by infections by C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections. Remission during the first 6 months was especially frequent in the group of patients with a prior infection, but the remission rate was relatively high even for arthritis without prior infection. (J Rheumatol 2003;30:459-64)

Key Indexing Terms:

INCIDENCE
REACTIVE ARTHRITIS
CAMPYLOBACTER
CHLAMYDIA
PARVOVIRUS B19

From the Department of Internal Medicine, Växjö Central Hospital, Växjö, Sweden; Rheumatism Foundation Hospital, Heinola, Finland; Departments of Virology and Medicine, Helsinki University Central Hospital, Helsinki, Finland; Department of Rheumatology, Linköping University Hospital, Linköping, Sweden.

Supported by research grants from the Swedish Rheumatology Association; the Research Council of Kronoberg (FoU-Center), Region Skåne; Helsinki University Central Hospital Research Funds; and the Commission of the European Community (QLK2-CT-2001-00877).

M.K. Söderlin, MD, Consultant Physician, Department of Internal Medicine, Växjö Central Hospital; H. Kautiainen, BA, Rheumatism Foundation Hospital; M. Puolakkainen, MD, PhD; K. Hedman, MD, PhD; M. Söderlund-Venermo, PhD, Department of Virology, Haartman Institute and Helsinki University Central Hospital; T. Skogh, MD, Professor, Department of Rheumatology, Linköping University Hospital; M. Leirisalo-Repo, MD, Professor, Helsinki University Central Hospital, Department of Medicine, Division of Rheumatology.

Address reprint requests to Dr. M. Söderlin, Department of Internal Medicine, Växjö Central Hospital, SE-351 85 Växjö, Sweden. E-mail: maria.soderlin@ltkronoberg.se

Submitted July 8, 2002; revision accepted August 28, 2002.