A Comparison of Self-reported Joint Symptoms Following Infection with Different Enteric Pathogens: Effect of HLA-B27

PETER SCHIELLERUP, KAREN A. KROGFELT, and HENNING LOCHT

ABSTRACT.

Objective. We conducted a case-case comparison study to estimate the attack-rate of reactive joint pain (JP_rea) 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. JP_rea 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 JP_rea in an HLA-B27-positive individual was 2.62 (95% CI 1.67–3.93) for the entire group. A significant association between JP_rea 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 JP_rea 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. (First Release Jan 15 2008; J Rheumatol 2008;35:480-7)

Key Indexing Terms:

JOINT PAIN
REACTIVE ARTHRITIS
HLA-B27
SALMONELLA
YERSINIA
SHIGELLA
CAMPYLOBACTER
E. COLI

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From the Department of Gastrointestinal Infections and Department of Autoimmunology, Statens Serum Institut, Copenhagen, Denmark.

P. Schiellerup, MD; K.A. Krogfelt, PhD, Department of Gastrointestinal Infections; H. Locht, MD, Department of Autoimmunology.

Address reprint requests Dr. H. Locht, Department of Autoimmunology, Building 81/524, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. E-mail: hlo@ssi.dk

Accepted for publication October 24, 2007.

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