Objectives-The purpose of this study was to analyse retrospectively adult patients with acute joint or muscle symptoms and a high antistreptolysin 0 (ASO) titre to find out which syndromes of clinical arthritis are associated with serological evidence of streptococcal infection. Methods-Seventy six adult patients with an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high ASO titre (¢500 Todd units) were
In order to analyse possible triggering or contributing infections and HLA-B27 frequency in patients with acute febrile joint syndrome fulfilling the proposed criteria of adult Still's disease (AOSD), we studied prospectively the serological findings of 25 patients. They were aged 15-62 years and diagnosed between 1978-1992. We then compared results with a control group consisting of 119 healthy persons. Positive viral or bacterial serology was found in 12 patients (48%) in the AOSD group compared with 13 cases (11%) in the control group (p < 0.001). Fourfold or higher viral antibody rise was found in two patients and bacterial antibody rise in three patients. High stable viral antibody titre was observed in one patient and high stable bacterial antibody titre in six patients. HLA-B27 was not overrepresented in the study group (12%) compared with a healthy Finnish population (14%). We conclude that many different bacterial and viral infections may trigger or contribute to AOSD.
To analyse which rheumatic syndromes are associated with serological evidence of recent Staphylococcus aureus infection, we studied retrospectively 44 adult patients, gathered between 1979-1990, having an acute arthritis syndrome or an exacerbation in their chronic rheumatic disease and simultaneously a high antistaphylolysin (ASTA > 4,0) and/or high teichoic acid antibody titre (TAA > 8). Patients with septic arthritis or endoprosthetic infections were not included. 25 patients had arthritis/arthralgia associated with a known rheumatic disease, 9 patients had reactive arthritis and 8 patients had arthralgia. The frequency of HLA-B27 in tested patients was significantly higher in the whole patient group than in the healthy Finnish population (43% v 14%, p < 0.001). It is concluded that high ASTA and/or TAA titres are associated with various acute rheumatic syndromes including reactive arthritis.
The HLA-B27 tissue antigen is associated with reactive arthritis caused by different bacterial infections but its occurrence in purulent arthritis has not been studied earlier. We analysed the frequency of HLA-B27 in patients with culture proven purulent arthritis caused by Staphylococcus aureus or beta-haemolytic streptococci. The study included 41 patients treated during the years 1979-96 (15 female and 26 male) with a mean age of 52 years (range 16-80 years). HLA-B27 was found in 24% (9/37) of the tested patients compared with 14% in the healthy Finnish population, but the difference was not statistically significant (P < 0.50). No statistical difference in disease activity according to febrile days or duration of the disease could be found between HLA-B27 positive and negative patients. We conclude that HLA-B27 is not a risk factor for purulent arthritis, and when present it has no significant modifying effect on the clinical picture of purulent arthritis.
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