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Persistent or severe course of reactive arthritis following Salmonella enteritidis infection. A prospective study of
F Kanakoudi-Tsakalidou1, G Pardalos, P Pratsidou-Gertsi
1A Department of Pediatrics, Aristotle University, Ippokration Hospital, Thessaloniki, Greece.
Insights
This study investigated juvenile reactive arthritis (JReA) in children following Salmonella enteritidis infection. While some patients developed Reiter's syndrome or psoriatic lesions, no long-term radiological damage was observed.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Juvenile reactive arthritis (JReA) is a significant concern in pediatric rheumatology.
- Salmonella enteritidis (Se) is a known trigger for reactive arthritis.
- Understanding the diverse clinical presentations and long-term outcomes of JReA is crucial for effective management.
Purpose of the Study:
- To prospectively study children with juvenile reactive arthritis (JReA) caused by Salmonella enteritidis (Se).
- To characterize unusual onset and disease course patterns in pediatric patients.
- To evaluate the association of HLA-B27 and psoriatic lesions with JReA prognosis.
Main Methods:
- Prospective study of 9 children diagnosed with JReA due to Se over a 7-year period.
- Clinical data collection included disease presentation (oligoarthritis, polyarthritis, systemic JCA), complications (pericarditis, Reiter's syndrome), and HLA-B27 status.
- Follow-up assessments monitored disease activity duration, development of psoriatic lesions, and long-term radiological outcomes.
Main Results:
- JReA presented with asymmetrical oligoarthritis (5 patients), polyarthritis (2 patients), or systemic JCA (2 patients).
- Two patients experienced pericarditis, and three developed complete or incomplete Reiter's syndrome.
- Five patients were HLA-B27 positive, and three of these developed psoriatic lesions; HLA-B27 and psoriasis correlated with a prolonged JReA course, but no late radiological lesions or sacroiliitis were observed.
Conclusions:
- Juvenile reactive arthritis following Salmonella enteritidis infection can manifest in various forms of juvenile chronic arthritis.
- Complications such as pericarditis and Reiter's syndrome can occur, and HLA-B27 positivity with subsequent psoriasis may indicate a longer disease duration.
- Despite potential complications and associations, this cohort showed no development of late radiological damage or sacroiliitis during the follow-up period.
Abstract:
During a 7 year-period 9 children (7 boys, 2 girls) with juvenile reactive arthritis (JReA) due to Salmonella enteritidis (Se) were prospectively studied because of an unusual type of onset and/or course of the disease. The mean duration of JReA activity was 9 +/- 3.6 months. The mean follow-up time was 55.2 +/- 17.4 months. JReA presented as any of the three types of juvenile chronic arthritis (JCA), namely, as asymmetrical oligoarthritis, polyarthritis, or systemic JCA in 5, 2, and 2 patients respectively. Two patients had pericarditis and three developed the complete or incomplete Reiter's syndrome during the disease or during a recurrence. Five patients carried the HLA-B27 and 3/5 developed psoriatic lesions 1 to 15 months after the onset of JReA. The presence of HLA-B27 and psoriasis was associated with a more prolonged course of JReA. However, no patient developed late radiological lesions or sacroiliitis during follow-up.