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Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study
  1. J M Townes1,6,
  2. A A Deodhar1,
  3. E S Laine2,
  4. K Smith2,
  5. H E Krug3,
  6. A Barkhuizen4,
  7. M E Thompson5,
  8. P R Cieslak6,
  9. J Sobel7
  1. 1
    Oregon Health and Science University, Portland, Oregon, USA
  2. 2
    Minnesota Department of Health, St Paul, Minnesota, USA
  3. 3
    Department of Veterans Affairs Medical Center and the University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
  4. 4
    Portland Rheumatology Clinic, LLC, Portland, Oregon, USA
  5. 5
    Northwest Rheumatology Associates, PC, Portland, Oregon, USA
  6. 6
    Oregon Department of Human Services, Portland, Oregon, USA
  7. 7
    Centers for Disease Control and Prevention Atlanta, Georgia, USA
  1. J M Townes, Oregon Health and Science University, Mailcode L457, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239-3098, USA; townesj{at}


Objective: To describe the epidemiology and clinical spectrum of reactive arthritis (ReA) following culture-confirmed infection with bacterial enteric pathogens in a population-based study in the USA.

Methods: We conducted telephone interviews of persons age >1 year with culture confirmed Campylobacter, Escherichia coli O157, Salmonella, Shigella and Yersinia infections reported to FoodNet ( in Minnesota, USA and Oregon, USA between 2002 and 2004. Subjects with new onset joint pain, joint swelling, back pain, heel pain and morning stiffness lasting ⩾3 days within 8 weeks of culture (possible ReA) were invited to complete a detailed questionnaire and physical examination.

Results: A total of 6379 culture-confirmed infections were reported; 70% completed screening interviews. Of these, 575 (13%) developed possible ReA; incidence was highest following Campylobacter (2.1/100 000) and Salmonella (1.4/100 000) infections. Risk was greater for females (relative risk (RR) 1.5, 95% CI, 1.3 to 1.7), adults (RR 2.5, 95% CI, 2.0 to 3.1) and subjects with severe acute illness (eg, fever, chills, headache, persistent diarrhoea). Risk was not associated with antibiotic use or human leukocyte antigen (HLA)-B27. A total of 54 (66%) of 82 subjects examined had confirmed ReA. Enthesitis was the most frequent finding; arthritis was less common. The estimated incidence of ReA following culture-confirmed Campylobacter, E coli O157, Salmonella, Shigella and Yersinia infections in Oregon was 0.6–3.1 cases/100 000.

Conclusions: This is the first population-based study of ReA following infections due to bacterial enteric pathogens in the USA. These data will help determine the burden of illness due to these pathogens and inform clinicians about potential sequelae of these infections.

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  • Competing interests: The US Centers for Disease Control (CDC) assisted with organisation and management of data and funds for study personnel. The article has a CDC author who participated in the design and supervision of the study and in revision of the manuscript. The manuscript went through a standard CDC “clearance” process and was approved for publication. Oregon Health and Science University (OHSU) General Clinical Research Center (GCRC) provided a venue for patient examinations and supported the collection, processing and storage of blood specimens. The GCRC was not involved in the analysis or interpretation of data, or in preparation, review or approval of the manuscript.

  • Funding: This study was supported by primarily by Centers for Disease Control and Prevention (CDC). It was also was supported in part by the Oregon Health and Science University (OHSU) General Clinical Research Center (GCRC) through PHS grant M01 RR000334.

  • Ethics approval: The study was reviewed and approved by the investigational review boards at each participating medical institution, state health department and CDC. Informed consent was obtained from all participating subjects.