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.
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References
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 139:1105–1113
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 40:358–362
Carter J, Hudson A (2009) Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin N Am 35:21–44
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 38:618–627
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 39:2021–7
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 56:32–36
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 59:565–570
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 62:880–884
Laasila K, Laasonen L, Leirisalo-Rep M (2003) Antibiotic treatment and long term prognosis of reactive arthritis. Ann Rheum Dis 62:655–658
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 63:1274–1280
Sairanen E, Paronen I, Mahonen H (1969) Reiter’s syndrome: a follow-up study. Acta Med Scand 185:57–63
Leirisalo-Repo M, Suoranta H (1988) Ten-year follow-up of patients with Yersinia arthritis. Arthritis Rheum 31:533–537
Herrlinger J, Asmussen J-U (1992) Long term prognosis in Yersinia arthritis: clinical and serological findings. Ann Rheum Dis 51:1332–1334
Bremell T, Bjelle A, Svedhem Å (1991) Rheumatic symptoms following an outbreak of Campylobacter enteritis: a five year follow up. Ann Rheum Dis 50:934–938
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 56:516–520
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 98:13–21
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 21:2274–2280
Garg A, Pope J, Thiessen-Philbrook H, Clark W, Ouimet J (2008) Arthritis risk after acute bacterial gastroenteritis. Rheumatology 47:200–204
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 67:1689–1696
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 51:513–518
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 136:1225–1234
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 45:485–493
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)
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This study is attributed to the Department of Internal Medicine and Medical Imaging Centre, Tampere University Hospital, Tampere, Finland.
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Uotila, T.M., Antonen, J.A., Paakkala, A.S. et al. Outcome of reactive arthritis after an extensive Finnish waterborne gastroenteritis outbreak: a 1-year prospective follow-up study. Clin Rheumatol 32, 1139–1145 (2013). https://doi.org/10.1007/s10067-013-2247-x
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DOI: https://doi.org/10.1007/s10067-013-2247-x