A comparison of self-reported joint symptoms following infection with different enteric pathogens: effect of HLA-B27

J Rheumatol. 2008 Mar;35(3):480-7. Epub 2008 Jan 15.

Abstract

Objective: We conducted a case-case comparison study to estimate the attack-rate of reactive joint pain (JPrea) following intestinal infections, and evaluated whether the susceptibility and severity of joint symptoms was associated with the tissue-type HLA-B27.

Methods: Consecutive patients with positive fecal culture for Salmonella, Campylobacter, Yersinia, Shigella, and E. coli were addressed by questionnaires inquiring about gastrointestinal (GI) symptoms and the occurrence of joint pain in a previously healthy joint within 4 weeks after onset of infection. A blood sample was requested for HLA-B27 typing.

Results: Of 3146 patients invited, 2105 (67%) responded to the survey questionnaire. The triggering infections were Campylobacter, 1003; Salmonella, 619; E. coli, 290; Shigella, 102; and Yersinia, 91. JPrea was reported by 294 subjects: Campylobacter, 131 (13.1%); Salmonella, 104 (16.8%); Yersinia, 21 (23.1%); Shigella, 10 (9.8%); and E. coli, 28 (9.7%). There was a significant association between severity of gastroenteritis and development of arthralgia (p = 0.001). The odds ratio (OR) for JPrea in an HLA-B27-positive individual was 2.62 (95% CI 1.67-3.93) for the entire group. A significant association between JPrea and HLA-B27 was found for Salmonella, Shigella, and Yersinia; not, however, for Campylobacter and E. coli. HLA-B27-positive patients had a significantly increased risk for severe joint symptoms.

Conclusion: Our study shows that JPrea after GI infection is positively correlated to severity of GI symptoms. HLA-B27 is not associated with joint pain after Campylobacter. Intestinal E. coli seems to be an arthritogenic pathogen. A significant association between HLA-B27 and severity of joint pain was observed.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arthralgia / epidemiology*
  • Arthritis, Reactive / complications*
  • Arthritis, Reactive / epidemiology
  • Arthritis, Reactive / genetics*
  • Arthritis, Reactive / immunology
  • Case-Control Studies
  • Denmark / epidemiology
  • Female
  • Gastrointestinal Diseases / epidemiology
  • Gastrointestinal Diseases / genetics*
  • Gastrointestinal Diseases / microbiology
  • Genetic Predisposition to Disease / epidemiology
  • Gram-Negative Bacterial Infections / complications
  • Gram-Negative Bacterial Infections / genetics*
  • Gram-Negative Bacterial Infections / immunology
  • HLA-B27 Antigen / blood*
  • Health Surveys*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prospective Studies

Substances

  • HLA-B27 Antigen