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Spondyloarthritis
Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC)
  1. Riitta Tuompo1,
  2. Tinja Lääveri2,3,
  3. Timo Hannu4,
  4. Sari H Pakkanen3,
  5. Juha Kirveskari5,6,
  6. Marjatta Leirisalo-Repo1,
  7. Anu Kantele2,3,7
  1. 1 Inflammation Center, Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2 Inflammation Center, Department of Infectious diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  3. 3 Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  4. 4 Department of Public Health, University of Helsinki, Helsinki, Finland
  5. 5 Department of Bacteriology, Helsinki University Hospital Laboratory, Helsinki, Finland
  6. 6 Mobidiag Ltd, Espoo, Finland
  7. 7 Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Riitta Tuompo, Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki 00290, Finland; riitta.tuompo{at}hus.fi

Abstract

Objectives Using a prospective research design, we evaluated the association between acquisition of diarrhoeagenic Escherichia coli (DEC) and development of reactive arthritis (ReA) and other reactive musculoskeletal (MSK) symptoms among international travellers.

Methods A total of 526 study participants were asked to provide pretravel and post-travel stool samples and fill in questionnaires (pretravel, post-travel and 3-week follow-up). A multiplex quantitative PCR assay was deployed to detect five DEC comprising enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli, enterohaemorrhagic E. coli and enteroinvasive E. coli and Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio cholerae. Multivariate analysis was employed to identify factors predisposing to MSK symptoms. New post-travel MSK symptoms reported by participants with DEC were assessed by phone interviews and, if needed, clinically confirmed.

Results From among the total of 224 volunteers who returned all questionnaires and stool specimens, 38 (17.0%) reported MSK symptoms. Multivariate analysis revealed that acquisition of DEC was associated with MSK symptoms (OR 3.9; 95% CI 1.2 to 13.3). Of the 151 with only-DEC, four (2.6%) had ReA, two (1.3%) reactive tendinitis and three (2.0%) reactive arthralgia. ReA was mostly mild, and all patients with ReA were negative for human leucocyte antigen B27. Antibiotic treatment of travellers’ diarrhoea did not prevent development of MSK symptoms.

Conclusion A total of 17% of volunteers reported post-travel MSK symptoms. DEC acquisition was associated with an increased risk of developing them, yet the ReA incidence remained low and the clinical picture mild. Antibiotic treatment did not protect against development of MSK symptoms.

  • reactive arthritis
  • infections
  • arthritis
  • spondyloarthritis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/annrheumdis-2019-216736

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors Study concept and design: AK and JK; acquisition of data: RT, SHP, JK and AK; analysis and interpretation of results: RT, TL and AK; drafting of manuscript: RT, TL and AK; statistical analysis: TL; critical comments: TH, SHP and ML-R; final approval of version published: all authors.

    • Funding The work was supported by the Finnish Governmental Subsidy for Health Science Research, the SSAC Foundation, the Paulo Foundation, the Sigrid Jusélius Foundation, the Finnish Cultural Foundation and the Finnish Society for Rheumatology.

    • Disclaimer The funding sources had no involvement in study design, data collection, analysis, interpretation of data, writing of report, and decision to submit the article for publication.

    • Competing interests AK has received honorary for lectures (Valneva and Immuron) and investigator-initiated grants (Pfizer and Valneva), none of these relevant to the current manuscript. JK is an employee of Mobidiag developing diagnostics test for infectious diseases. No commercial tests, however, are used in the study.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the Ethics Committee of Helsinki University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Any other data are available from the corresponding author.