Cat‐scratch disease–associated arthropathy

Abstract

Objective. To characterize the articular manifestations of cat-scratch disease (CSD) and to evaluate the long-term clinical outcome of those manifestations.Methods. A community-and hospital-based surveillance study of CSD was conducted in Israel between 1991 and 2002. CSD was defined as present in a patient when a compatible clinical syndrome and a positive confirmatory finding of Bartonella henselae (by serology and/or polymerase chain reaction) were identified. CSD patients with arthropathy (arthritis/arthralgia) that limited or precluded usual activities of daily living constituted the study group. Patients were followed up until >6 weeks after resolution of symptoms, or if symptoms persisted, for >12 months. CSD patients without arthropathy served as controls.Results. Among 841 CSD patients, 24 (2.9%) had rheumatoid factor-negative arthropathy that was often severe and disabling. Both univariate and multivariate analyses identified female sex (67% of arthropathy patients versus 40% of controls; relative risk [RR] 2.5, P ‫؍‬ 0.047), age older than 20 years (100% of arthropathy patients versus 43% of controls; RR 4.9, P ‫؍‬ 0.001), and erythema nodosum (21% of arthropathy patients versus 2% of controls; RR 7.9, P ‫؍‬ 0.001) as variables significantly associated with arthropathy. Knee, wrist, ankle, and elbow joints were most frequently affected. Ten patients (42%) had severe arthropathy in the weight-bearing joints, which substantially limited their ability to walk, and 4 of these patients were hospitalized. All of the patients had regional lymphadenopathy, 37.5% had nocturnal joint pain, and 25% had morning stiffness. Nineteen patients (79.2%) recovered after a median duration of 6 weeks (range 1-24 weeks), whereas 5 patients (20.8%) developed chronic disease persisting 16-53 months (median 30 months) after the onset of arthropathy.Conclusion. This is the first comprehensive study of arthropathy in CSD. CSD-associated arthropathy is an uncommon syndrome affecting mostly young and middle-age women. It is often severe and disabling, and may take a chronic course.Cat-scratch disease (CSD) is a common zoonosis caused principally by Bartonella henselae. Typical CSD, which occurs in ϳ90% of CSD cases, is characterized by subacute regional lymphadenitis that is often associated with systemic symptoms such as fever and malaise. When CSD affects other organs, as occurs in ϳ10% of patients, the disease is designated atypical CSD. Atypical CSD includes Parinaud's oculoglandular syndrome, neuroretinitis, encephalitis, peripheral neuritis, granulomatous hepatitis, and/or splenitis, osteomyelitis, erythema nodosum, pneumonitis, and prolonged fever of unknown origin (1). Over the last decade we have occasionally observed CSD patients with severe, protracted, and often disabling arthropathy. A literature search identified only a few CSD patients with arthropathy having been reported since 1950 (2-7), when "la maladie des griffes de chat" was first defined as a syndrome (8), raising doubts regarding whether arthropathy is a r...

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