|
|
 |
|
|
|
|
 |
Symptomatic Acute Reactive Arthritis After An Outbreak of Salmonella
SHERRY ROHEKAR, FLORENCE W.L. TSUI, HING WO TSUI, NANCY XI, REENA RIARH, ROSE BILOTTA, and ROBERT D. INMAN
ABSTRACT. 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. (First Release June 1 2008; J Rheumatol 2008;35:1599–602) Key Indexing Terms:
REACTIVE ARTHRITIS
From the Toronto Western Hospital, University Health Network, Toronto; and Public Health Division, Ministry of Health and Long Term Care, Toronto, Ontario, Canada. Supported by an unrestricted educational grant from Pfizer Canada Inc. S. Rohekar, BSc, MD, FRCPC, Adjunct Professor, Schulich School of Medicine, University of Western Ontario, London, Ontario; F.W.L. Tsui, PhD, Senior Scientist, Genetics and Development Division, Toronto Western Research Institute, Associate Professor, Department of Immunology, University of Toronto; H.W. Tsui, PhD, Research Associate, Toronto Western Research Institute; N. Xi, BHSc, Medical Student, University of Toronto; R. Riarh, BSc, Research Analyst, University of Toronto; R. Bilotta, MD, BSc, MHSc, CCFP, FRCPC, Assistant Professor, Department of Public Health Services, University of Toronto, Senior Medical Consultant, Public Health Branch, Ministry of Health and Long-Term Care; R.D. Inman, MD, Professor, Departments of Medicine and Immunology, University of Toronto, Senior Scientist, Genetics and Development Division, Toronto Western Research Institute. Address reprint requests to Dr. R.D. Inman, Arthritis Center of Excellence, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8. E-mail: robert.inman@uhn.on.ca Accepted March 18, 2008. |
