A clinical profile of reactive arthritis in a peruvian series: a pilot study

Enteric pathogens are an endemic cause of acute diarrheal diseases among Peruvians. The frequency of HLA-B27 in the general population (0%-3%) is lower than that among Caucasians in the United States, Canada, and Europe (6%-14%). It was believed that both of these factors were likely to interact to modulate the clinical expression of reactive arthritis (ReA) or Reiter's Syndrome (RS). The objective of our study was to define the clinical characteristics of ReA in a group of patients treated in a general hospital in Lima, Peru. Between December 1, 1976, and June 30, 1993, using a standardized protocol, we studied all patients who presented with peripheral arthritis that occurred within 1 month after urethritis and/or diarrhea. Additional inclusion and exclusion criteria were defined to rule out well-known causes of arthritis. Patients with complete and incomplete RS of undetermined origin were also included. Fifty-five patients (44 males, 11 females) met established criteria; the mean age at onset was 19 +/- 9.8 years (range 7-51). Fever was the most frequent manifestation (63.3%), followed by conjunctivitis/uveitis (61.8%), urethritis/cervicitis (58.2%), diarrhea (45.5%), and balanitis (14.5%). Keratoderma blennorrhagica was absent. Compared with Caucasians, Peruvians were younger at the onset of disease, and their female/male ratio was higher. Additionally, the Peruvians experienced a higher frequency of fever and diarrhea and a lower frequency of balanitis and genitourinary manifestations. Different lines of evidence, including poor public health facilities, the patients' histories, demographics, and the extra-articular constellation of symptoms and signs, suggest that enteropathogenic microorganisms are at least as prevalent as sexually transmitted triggers of ReA in our series. Accordingly, clinicians treating patients with ReA in the Third World should tailor preventive measures and therapy to address the suspected infectious origin. Furthermore, the lower frequency of certain extra-articular manifestations, such as keratoderma blenorrhagica, uveitis, and enthesopathy, as well as a better outcome may be a result of the low frequency of HLA-B27 positivity in this population.