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Evolving patterns of reactive arthritis

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Abstract

Objective

To characterize rheumatologists’ perspectives on evolving trends of reactive arthritis (ReA).

Methods

After ethics approval, 548 members of the Canadian Rheumatology Association were surveyed with 37 questions covering their demographic information, subspecialty, level of experience, practice setting and opinions on prevalence, treatment, and causes of ReA. Results were analyzed with descriptive statistics.

Results

Ninety-seven responded to the survey (18% response rate); 66 fully completed it. Nearly half of respondents believed that the incidence of ReA is declining and causes of ReA may be changing. Physicians reported that most of the ReA cases in their practices were caused by an unknown organism, sexually transmitted, or gastrointestinal infection. Full triad ReA increased the chance of recurrence according to their impressions. Common investigations in ReA included inflammatory markers, HLA-B27, chlamydia and gonorrhea testing, stool cultures, synovial fluid analyses, SI joint imaging. ReA treatment included NSAIDs, intra-articular corticosteroid injections, and DMARDs. Two-thirds said they used TNF alpha inhibitors in chronic ReA occasionally or more frequently.

Conclusion

ReA may be decreasing in frequency and severity in Canada. Changes could be due to less food borne illness, cleaner water, or more rapid treatment of sexually transmitted infections. The cause is often unknown in clinical practice.

Key Points

• Reactive arthritis (ReA) is likely decreasing in prevalence and severity.

• Patients with classic trial of arthritis, urethritis, and conjunctivitis are more likely to have recurrent and/or chronic ReA.

• The causal organisms are often not detected and seem to be changing over time.

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References

  1. Willkens RF, Arnett FC, Bitter T, Calin A, Fisher L, Ford DK, Good AE, Masi AT (1981) Reiter’s syndrome. Evaluation of preliminary criteria for definite disease. Arthritis Rheum 24:844–849

    Article  CAS  PubMed  Google Scholar 

  2. Hamdulay SS, Glynne SJ, Keat A (2006) When is arthritis reactive? Postgrad Med J 82:446–453

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Petersel DL, Sigal LH (2005) Reactive arthritis. Infect Dis Clin N Am 19:863–883

    Article  Google Scholar 

  4. Kim PS, Klausmeier TL, Orr DP (2009) Reactive arthritis: a review. J Adolesc Health 44:309–315

    Article  PubMed  Google Scholar 

  5. Singh R, Shasany AK, Aggarwal A, Sinha S, Sisodia BS, Khanuja SPS, Misra R (2007) Low molecular weight proteins of outer membrane of Salmonella typhimurium are immunogenic in Salmonella induced reactive arthritis revealed by proteomics. Clin Exp Immunol 148:486–493

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Pacheco-Tena C, Alvarado De La Barrera C, López-Vidal Y, Vázquez-Mellado J, Richaud-Patin Y, Amieva RI et al (2001) Bacterial DNA in synovial fluid cells of patients with juvenile onset spondyloarthropathies. Rheumatology (Oxford) 40:920–927

    Article  CAS  Google Scholar 

  7. Granfors K, Merilahti-Palo R, Luukkainen R, Möttönen T, Lahesmaa R, Probst P et al (1998) Persistence of Yersinia antigens in peripheral blood cells from patients with Yersinia enterocolitica O:3 infection with or without reactive arthritis. Arthritis Rheum 41:855–862

    Article  CAS  PubMed  Google Scholar 

  8. Kuipers JG, Jürgens-Saathoff B, Bialowons A, Wollenhaupt J, Köhler L, Zeidler H (1998) Detection of Chlamydia trachomatis in peripheral blood leukocytes of reactive arthritis patients by polymerase chain reaction. Arthritis Rheum 41:1894–1895

    Article  CAS  PubMed  Google Scholar 

  9. Bas S, Griffais R, Kvien TK, Glennås A, Melby K, Vischer TL (1995) Amplification of plasmid and chromosome Chlamydia DNA in synovial fluid of patients with reactive arthritis and undifferentiated seronegative oligoarthropathies. Arthritis Rheum 38:1005–1013

    Article  CAS  PubMed  Google Scholar 

  10. Ramos M, López de Castro JA (2002) HLA-B27 and the pathogenesis of spondyloarthritis. Tissue Antigens 60:191–205

    Article  CAS  PubMed  Google Scholar 

  11. Fiorillo MT, Maragno M, Butler R, Dupuis ML, Sorrentino R (2000) CD8(+) T-cell autoreactivity to an HLA-B27-restricted self-epitope correlates with ankylosing spondylitis. J Clin Invest 106:47–53

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kim T-H, Uhm W-S, Inman RD (2005) Pathogenesis of ankylosing spondylitis and reactive arthritis. Curr Opin Rheumatol 17:400–405

    Article  PubMed  Google Scholar 

  13. Luthra-Guptasarma M, Singh B (2004) HLA-B27 lacking associated beta2-microglobulin rearranges to auto-display or cross-display residues 169-181: a novel molecular mechanism for spondyloarthropathies. FEBS Lett 575:1–8

    Article  CAS  PubMed  Google Scholar 

  14. Weitzul S, Duvic M (1997) HIV-related psoriasis and Reiter’s syndrome. Semin Cutan Med Surg 16:213–218

    Article  CAS  PubMed  Google Scholar 

  15. Sieper J, Rudwaleit M, Braun J, van der Heijde D (2002) Diagnosing reactive arthritis: role of clinical setting in the value of serologic and microbiologic assays. Arthritis Rheum 46:319–327

    Article  PubMed  Google Scholar 

  16. Kvien TK, Glennås A, Melby K, Granfors K, Andrup O, Karstensen B, Thoen JE (1994) Reactive arthritis: incidence, triggering agents and clinical presentation. J Rheumatol 21:115–122

    CAS  PubMed  Google Scholar 

  17. Hanova P, Pavelka K, Holcatova I, Pikhart H (2010) Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic. Scand J Rheumatol 39:310–317

    Article  CAS  PubMed  Google Scholar 

  18. Feltkamp TE, Mardjuadi A, Huang F, Chou CT (2001) Spondyloarthropathies in eastern Asia. Curr Opin Rheumatol 13:285–290

    Article  CAS  PubMed  Google Scholar 

  19. Brackel CLH, Noordzij JG (2015) Group A streptococcal-associated arthritis in children. Ned Tijdschr Geneeskd 159:A9083

    PubMed  Google Scholar 

  20. Liao C-H, Huang J-L, Juvenile YK-W (2004) Reiter’s syndrome: a case report. J Microbiol Immunol Infect 37:379–381

    PubMed  Google Scholar 

  21. Iliopoulos A, Karras D, Ioakimidis D, Arvanitis A, Tsamis N, Iakovou I, Anagnostopoulos I, Giannikos N (1995) Change in the epidemiology of Reiter’s syndrome (reactive arthritis) in the post-AIDS era? An analysis of cases appearing in the Greek Army. J Rheumatol 22:252–254

    CAS  PubMed  Google Scholar 

  22. Csonka GW (1979) Long-term follow-up and prognosis of Reiter’s syndrome. Ann Rheum Dis 38(Suppl 1):24–28

    Article  PubMed Central  Google Scholar 

  23. Csonka GW (1958) The course of Reiter’s syndrome. Br Med J 1:1088–1090

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Csonka GW (1960) Recurrent attacks in Reiter’s disease. Arthritis Rheum 3:164–169

    Article  CAS  PubMed  Google Scholar 

  25. Michet CJ, Machado EB, Ballard DJ, McKenna CH (1988) Epidemiology of Reiter’s syndrome in Rochester, Minnesota: 1950-1980. Arthritis Rheum 31:428–431

    Article  CAS  PubMed  Google Scholar 

  26. Sairanen E, Paronen I, Mähönen H (1969) Reiter’s syndrome: a follow-up study. Acta Med Scand 185:57–63

    Article  CAS  PubMed  Google Scholar 

  27. Freeman MC, Garn JV, Sclar GD, Boisson S, Medlicott K, Alexander KT, Penakalapati G, Anderson D, Mahtani AG, Grimes JET, Rehfuess EA, Clasen TF (2017) The impact of sanitation on infectious disease and nutritional status: a systematic review and meta-analysis. Int J Hyg Environ Health 220:928–949

    Article  PubMed  Google Scholar 

  28. Taylor DL, Kahawita TM, Cairncross S, Ensink JHJ (2015) The impact of water, sanitation and hygiene interventions to control cholera: a systematic review. PLoS One 10:e0135676

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Wetten S, Mohammed H, Yung M, Mercer CH, Cassell JA, Hughes G (2015) Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000-2011: a population-based study using data from the UK clinical practice research datalink. BMJ Open 5:e007776

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yamamoto N, Ejima K, Nishiura H (2018) Modelling the impact of correlations between condom use and sexual contact pattern on the dynamics of sexually transmitted infections. Theor Biol Med Model 15:6

    Article  PubMed  PubMed Central  Google Scholar 

  31. Lewis D, Newton DC, Guy RJ, Ali H, Chen MY, Fairley CK, Hocking JS (2012) The prevalence of chlamydia trachomatis infection in Australia: a systematic review and meta-analysis. BMC Infect Dis 12:113

    Article  PubMed  PubMed Central  Google Scholar 

  32. Choudhri Y, Miller J, Sandhu J, Leon A, Aho J (2018) Chlamydia in Canada, 2010-2015. Can Commun Dis Rep 44:49–54

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Choudhri Y, Miller J, Sandhu J, Leon A, Aho J (2018) Gonorrhea in Canada, 2010-2015. Can Commun Dis Rep 44:37–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Wang H, Zhang L, Zhou Y, Wang K, Zhang X, Wu J, Wang G (2018) The use of geosocial networking smartphone applications and the risk of sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. BMC Public Health 18:1178

    Article  PubMed  PubMed Central  Google Scholar 

  35. Smieja M, MacPherson DW, Kean W, Schmuck ML, Goldsmith CH, Buchanan W, Hart LE, Mahony JB (2001) Randomised, blinded, placebo controlled trial of doxycycline for chronic seronegative arthritis. Ann Rheum Dis 60:1088–1094

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Barber CE, Kim J, Inman RD, Esdaile JM, James MT (2013) Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis. J Rheumatol 40:916–928

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Claire McGowan, project coordinator of the Canadian Rheumatology Association, for her assistance in the distribution of our survey. We are grateful to Marie Préfontaine for translating our survey to French. We would also like to thank all participants for their time answering our survey to make this work possible.

Author information

Authors and Affiliations

  1. Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada

    Kaitlyn M. Hayes & Janet E. Pope

  2. Department of Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada

    Reid J. P. Hayes

  3. Division of Rheumatology, Department of Medicine, St. Joseph’s Health Care, 268 Grosvenor St, London, ON, N6A 4V2, Canada

    Matthew A. Turk & Janet E. Pope

Authors
  1. Kaitlyn M. Hayes
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  2. Reid J. P. Hayes
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Corresponding author

Correspondence to Janet E. Pope.

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Disclosures

None to declare. Kaitlyn Hayes had funding for a summer studentship from the Canadian Rheumatology Association.

Ethics

This study was approved by the Canadian SHIELD Ethics Review Board # 17-10-003.

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Hayes, K.M., Hayes, R.J.P., Turk, M.A. et al. Evolving patterns of reactive arthritis. Clin Rheumatol 38, 2083–2088 (2019). https://doi.org/10.1007/s10067-019-04522-4

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  • DOI: https://doi.org/10.1007/s10067-019-04522-4

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