Extended report
Frequency of triggering bacteria in patients with reactive
arthritis and undifferentiated oligoarthritis and the relative
importance of the tests used for diagnosis
C Fendlera b, S Laitkoc, H Sörensend, C Gripenberg-Lerchee, A Grohf, J Uksilag, K Granforse, J Brauna, J Siepera b
a Department of
Medicine, Rheumatology, Klinikum Benjamin Franklin, Free University,
Berlin, Germany, b Deutsches Rheuma- forschungszentrum, Berlin, c Rheumaklinik
Buch, Berlin, d Immanuel-
Krankenhaus, Berlin, e National Public Health Institute, Department in
Turku, Finland, f Department of Microbiology, Jena, Germany, g Department of Medical
Microbiology, University of Turku, Finland
Correspondence to: Professor J Sieper, Rheumatology, Department of Medicine, Benjamin Franklin Hospital, Hindenburgdamm 30, 12200 Berlin, Germany hjsieper{at}zedat.fu-berlin.de
Accepted for publication 17 August
2000
OBJECTIVE
Reactive
arthritis (ReA) triggered by Chlamydia
trachomatis or enteric bacteria such as yersinia, salmonella,
Campylobacter jejuni, or shigella is an
important differential diagnosis in patients presenting with the
clinical picture of an undifferentiated oligoarthritis (UOA). This
study was undertaken to evaluate the best diagnostic approach.
PATIENTS AND
METHODS52 patients with ReA, defined by arthritis
and a symptomatic preceding infection of the gut or the urogenital
tract, and 74 patients with possible ReA, defined by oligoarthritis
without a preceding symptomatic infection and after exclusion of other diagnoses (UOA), were studied. The following diagnostic tests were
applied for the identification of the triggering bacterium: for
yersinia induced ReAstool culture, enzyme immunoassay (EIA), and
Widal's agglutination test for detection of antibodies to yersinia;
for salmonella or campylobacter induced ReAstool culture, EIA for the
detection of antibodies to salmonella and
Campylobacter jejuni; for infections with
shigellastool culture; for infections with
Chlamydia trachomatisculture of the
urogenital tract, microimmunofluorescence and immunoperoxidase
assay for the detection of antibodies to Chlamydia
trachomatis.
RESULTSA causative
pathogen was identified in 29/52 (56%) of all patients with ReA. In 17 (52%) of the patients with enteric ReA one of the enteric bacteria was
identified: salmonella in 11/33 (33%) and yersinia in 6/33 (18%).
Chlamydia trachomatis was the causative
pathogen in 12/19 (63%) of the patients with urogenic ReA. In patients
with the clinical picture of UOA a specific triggering bacterium was
also identified in 35/74 (47%) patients: yersinia in 14/74 (19%),
salmonella in 9/74 (12%), and Chlamydia
trachomatis in 12/74 (16%).
CONCLUSIONSChlamydia
trachomatis, yersinia, and salmonella can be identified as the
causative pathogen in about 50% of patients with probable or possible
ReA if the appropriate tests are used.
© 2001 by Annals of the Rheumatic Diseases
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