A comparison of self-reported joint symptoms following infection with different enteric pathogens: effect of HLA-B27

• Published in: Journal of rheumatology 2008-03, Vol.35 (3), p.480-487
• Main Authors: SCHIELLERUP, Peter, KROGFELT, Karen A, LOCHT, Henning
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arthralgia - epidemiology; Arthritis, Reactive - complications; Arthritis, Reactive - epidemiology; Arthritis, Reactive - genetics; Arthritis, Reactive - immunology; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Case-Control Studies; Denmark - epidemiology; Diseases of the osteoarticular system; Female; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - genetics; Gastrointestinal Diseases - microbiology; Genetic Predisposition to Disease - epidemiology; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - genetics; Gram-Negative Bacterial Infections - immunology; Health Surveys; HLA-B27 Antigen - blood; Human bacterial diseases; Humans; Incidence; Infectious diseases; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Prospective Studies
• ISSN: 0315-162X; 1499-2752

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.