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Abstract:
The role of infection in ankylosing spondylitis is speculative and different studies by several groups have yielded conflicting results. The role of infection, however, in reactive arthritis and Reiter's syndrome is well established. The Grampian region has experienced three outbreaks of gastroenteritis, two due to Campylobacter jejuni and one due to Salmonella typhimurium. These outbreaks have allowed a study of reactive arthritis in the affected population following these infections. These studies do not allow accurate estimate of the frequency of reactive arthritis, largely because of difficulties in defining the infected population accurately. They do, however, suggest that in the population milder cases occur than in a population referred to hospital rheumatology clinics. These milder cases have a lower frequency of HLA-B27 than patients seen in a rheumatology clinic and suggest that there may be an association between HLA-B27 and the severity of reactive arthritis. An association between gastroenteritis due to Campylobacter jejuni and Salmonella typhimurium and erythema nodosum both with and without arthritis was observed. No difference was detected in the immunoglobulin responses of immunoglobulins A, G and M between patients with reactive arthritis due to Salmonella typhimurium and patients with gastroenteritis alone.
Insights
Infection outbreaks revealed milder cases of reactive arthritis than previously seen. These milder cases showed a lower frequency of HLA-B27, suggesting a link between this gene and disease severity.
Area of Science:
- Rheumatology
- Infectious Diseases
- Immunogenetics
Background:
- The link between infection and ankylosing spondylitis remains unclear, with conflicting research findings.
- Infection's role in reactive arthritis and Reiter's syndrome is well-established.
- Gastroenteritis outbreaks in the Grampian region provided an opportunity to study reactive arthritis.
Purpose of the Study:
- To investigate the occurrence and characteristics of reactive arthritis following specific infectious outbreaks.
- To explore the association between human leukocyte antigen B27 (HLA-B27) and the severity of reactive arthritis.
- To examine the relationship between specific bacterial infections and associated conditions like erythema nodosum.
Main Methods:
- Observational study of populations affected by Campylobacter jejuni and Salmonella typhimurium outbreaks.
- Comparison of reactive arthritis cases in the general population versus those seen in rheumatology clinics.
- Analysis of HLA-B27 frequency in relation to disease severity.
- Assessment of immunoglobulin (IgA, IgG, IgM) responses in affected patients.
Main Results:
- Reactive arthritis cases in the general population appeared milder than those in rheumatology clinics.
- Milder reactive arthritis cases exhibited a lower frequency of HLA-B27.
- An association was observed between gastroenteritis (Campylobacter jejuni, Salmonella typhimurium) and erythema nodosum, with or without arthritis.
- No significant differences in immunoglobulin responses were found between patients with Salmonella typhimurium-induced reactive arthritis and those with gastroenteritis alone.
Conclusions:
- The study suggests a potential association between HLA-B27 and the severity of reactive arthritis.
- Milder forms of reactive arthritis may be more prevalent in the general population than previously recognized.
- Campylobacter jejuni and Salmonella typhimurium infections are linked to erythema nodosum, potentially with or without arthritis.