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Reactive Arthritis Following an Outbreak of Campylobacter jejuni Infection
TIMO HANNU, MARKKU KAUPPI, MARJA TUOMALA, IRJA LAAKSONEN, PETER KLEMETS, and MARKKU KUUSI
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 £ 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. (J Rheumatol 2004;31:528-30) Key Indexing Terms:
REACTIVE ARTHRITIS
From the Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki; Rheumatism Foundation Hospital, Heinola; Jyväskylä Central Hospital, Jyväskylä; Municipal Health Centre, Asikkala; and Department of Infectious Disease Epidemiology, National Public Health Institute, Helsinki, Finland. T. Hannu, MD, PhD, Helsinki University Central Hospital; M. Kauppi, MD, PhD, Rheumatism Foundation Hospital; M. Tuomala, MD, Jyväskylä Central Hospital; I. Laaksonen, MD, Municipal Health Centre; P. Klemets, MD; M. Kuusi, MD, National Public Health Institute. Address reprint requests to Dr. T. Hannu, Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, PO Box 263, FIN-00029 HUS, Finland. E-mail: Timo.Hannu@ttl.fi Submitted March 10, 2003; revision accepted August 11, 2003. |