Clinical Rheumatology

, Volume 32, Issue 8, pp 1139–1145 | Cite as

Outcome of reactive arthritis after an extensive Finnish waterborne gastroenteritis outbreak: a 1-year prospective follow-up study

  • Terhi M Uotila
  • Jaakko A Antonen
  • Antti S Paakkala
  • Jukka T Mustonen
  • Markku M Korpela
  • for the Pirkanmaa Waterborne Outbreak Study Group
Original Article

Abstract

The purpose of the study was to assess the 1-year outcome of definitive reactive arthritis (ReA) after a waterborne outbreak. A cohort of 21 patients (15 females and 6 males, median age 54 years) with ReA related to an extensive waterborne outbreak in Finland was clinically followed-up by rheumatologists with visits at baseline, at 1 month and 3, 6 and 12 months. Although the outcome was in general favourable, 1/3 of the patients had chronic course; 7 (33 %) of the 21 patients needed disease-modifying anti-rheumatic drugs (DMARDs) and even 8 (38 %) of them used glucocorticoids at 12 months. Four (19 %) were using non-steroidal anti-inflammatory drugs and nine (43 %) other analgesics. Many patients had articular pain and impaired physical function still at 12 months, even though inflammatory parameters and the number of swollen joints were low. Only one patient (5 %) was human leucocyte antigen-B27-positive. She had the most severe ReA and also additional infectious arthritis caused by Salmonella serotype enteritidis leading to osteonecrosis of her hip joint with subsequent need for arthroplasty. ReA as observed in our study was overall fairly mild, but in many individuals, postinfectious arthralgia and DMARD use continued at least up to 1 year.

Keywords

Follow-up Gastroenteritis Outbreak Reactive Arthritis 

Notes

Acknowledgments

The following investigators are members of the Pirkanmaa Waterborne Outbreak Study Group: J Antonen, P Collin, J Helenius, J Herrala, T Katto, M Korpela, E Kujansuu, A-L Kuusela, M Kuusi, J Laine, J Lumio, S Mustajoki, J Mustonen, H Oksa, P Ruutu, S Räsänen and T Uotila. This study was financially supported by the Competitive Research Funding of Tampere University Hospital (Grants 9 L002, 9 M124)

Disclosures

None.

References

  1. 1.
    Laine J, Huovinen E, Virtanen M, Snellman M, Lumio J, Ruutu P et al (2011) An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland. Epidemiol Infect 139:1105–1113CrossRefGoogle Scholar
  2. 2.
    Uotila T, Antonen J, Laine J, Kujansuu E, Haapala A-M, Lumio J et al (2011) Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland. Scand J Rheumatol 40:358–362CrossRefPubMedGoogle Scholar
  3. 3.
    Carter J, Hudson A (2009) Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin N Am 35:21–44CrossRefGoogle Scholar
  4. 4.
    Dougados M, van der Linden S, Leirisalo-Repo M, Huitfeldt B, Juhlin R, Veys E et al (1995) Sulfasalazine in the treatment of spondylarthropathy. A randomized, multicentre, double-blind, placebo-controlled study. Arthritis Rheum 38:618–627CrossRefPubMedGoogle Scholar
  5. 5.
    Clegg DO, Reda DJ, Weisman MH, Cush JJ, Vasey FB, Schumacher HR Jr et al (1996) Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter’s syndrome). A Department of Veterans Affairs Cooperative Study. Arthritis Rheum 39:2021–7CrossRefPubMedGoogle Scholar
  6. 6.
    Egsmose C, Hansen T, Andersen L, Beier J, Christensen L, Ejstrup L et al (1997) Limited effect of sulphasalazine treatment in reactive arthritis. A randomised double blind placebo controlled trial. Ann Rheum Dis 56:32–36CrossRefPubMedGoogle Scholar
  7. 7.
    Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M et al (2000) Effect of a three month course of ciprofloxacin on the outcome of reactive arthritis. Ann Rheum Dis 59:565–570CrossRefPubMedGoogle Scholar
  8. 8.
    Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M et al (2003) Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis. Ann Rheum Dis 62:880–884CrossRefPubMedGoogle Scholar
  9. 9.
    Laasila K, Laasonen L, Leirisalo-Rep M (2003) Antibiotic treatment and long term prognosis of reactive arthritis. Ann Rheum Dis 62:655–658CrossRefPubMedGoogle Scholar
  10. 10.
    Meyer A, Chatelus E, Wendling D, Berthelot J-M, Dernis E, Houvenagel E et al (2011) Safety and efficacy of anti-tumor necrosis factor α therapy in ten patients with recent-onset refractory reactive arthritis. Arthritis Rheum 63:1274–1280CrossRefPubMedGoogle Scholar
  11. 11.
    Sairanen E, Paronen I, Mahonen H (1969) Reiter’s syndrome: a follow-up study. Acta Med Scand 185:57–63CrossRefPubMedGoogle Scholar
  12. 12.
    Leirisalo-Repo M, Suoranta H (1988) Ten-year follow-up of patients with Yersinia arthritis. Arthritis Rheum 31:533–537CrossRefPubMedGoogle Scholar
  13. 13.
    Herrlinger J, Asmussen J-U (1992) Long term prognosis in Yersinia arthritis: clinical and serological findings. Ann Rheum Dis 51:1332–1334CrossRefPubMedGoogle Scholar
  14. 14.
    Bremell T, Bjelle A, Svedhem Å (1991) Rheumatic symptoms following an outbreak of Campylobacter enteritis: a five year follow up. Ann Rheum Dis 50:934–938CrossRefPubMedGoogle Scholar
  15. 15.
    Leirisalo-Repo M, Helenius P, Hannu T, Lehtinen A, Kreula J, Taavitsainen M et al (1997) Long term prognosis of reactive Salmonella arthritis. Ann Rheum Dis 56:516–520CrossRefPubMedGoogle Scholar
  16. 16.
    Thomson GT, DeRubeis DA, Hodge MA, Rajanayagam C, Inman RD (1995) Post-Salmonella reactive arthritis: late clinical sequelae in a point source cohort. Am J Med 98:13–21CrossRefPubMedGoogle Scholar
  17. 17.
    Glennås A, Kvien TK, Melby K, Overboo A, Andrup O, Karstensen B, Thoen JE (1994) Reactive arthritis: a favourable 2 year course and outcome, independent of triggering agent and HLA-B27. J Rheumatol 21:2274–2280PubMedGoogle Scholar
  18. 18.
    Garg A, Pope J, Thiessen-Philbrook H, Clark W, Ouimet J (2008) Arthritis risk after acute bacterial gastroenteritis. Rheumatology 47:200–204CrossRefPubMedGoogle Scholar
  19. 19.
    Townes J, Deodhar A, Laine E, Smith K, Krug H, Barkhuizen A et al (2008) Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis 67:1689–1696CrossRefPubMedGoogle Scholar
  20. 20.
    Laine J, Uotila T, Antonen J, Korpela M, Kujansuu E, Lumio J et al (2012) Joint symptoms after a large waterborne gastroenteritis outbreak—a controlled, population-based questionnaire study. Rheumatology 51:513–518CrossRefPubMedGoogle Scholar
  21. 21.
    Doorduyn Y, van Pelt W, Siezen C, van der Horst F, van Duynhoven Y, Hoebee B et al (2008) Novel insight in the association between salmonellosis or campylobacteriosis and chronic illness, and the role of host genetics in susceptibility to these diseases. Epidemiol Infect 136:1225–1234CrossRefPubMedGoogle Scholar
  22. 22.
    Stafford L, Kane D, Murphy E, Duffy T, Lassere M, Youssef PP et al (2001) Psoriasis predicts a poor short-term outcome in patients with spondylarthropathy. Arthritis Rheum 45:485–493CrossRefPubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Terhi M Uotila
    • 1
  • Jaakko A Antonen
    • 2
  • Antti S Paakkala
    • 3
  • Jukka T Mustonen
    • 2
    • 4
  • Markku M Korpela
    • 1
  • for the Pirkanmaa Waterborne Outbreak Study Group
  1. 1.Department of Internal Medicine, Centre for Rheumatic DiseasesTampere University HospitalTampereFinland
  2. 2.Department of Internal MedicineTampere University HospitalTampereFinland
  3. 3.Medical Imaging CentreTampere University HospitalTampereFinland
  4. 4.School of MedicineUniversity of TampereTampereFinland

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