Long term prognosis of reactive salmonella arthritis

Abstract

Objectives-Reactive joint complications triggered by salmonella gastroenteritis are increasingly reported, but the outcome and long term prognosis of the patients is incompletely known. This study looked at the prognosis of salmonella arthritis in patients hospitalised in 1970-1986. Methods-Hospital records from two hospitals in southern Finland were screened for patients with the discharge diagnosis of salmonellosis or reactive, postinfectious arthritis or Reiter's disease. For the patients with confirmed diagnosis of reactive salmonella arthritis, data about the acute disease were collected from the hospital records. A follow up study was performed. Results-There were 63 patients (28 women, 35 men, mean age 36.5 years) with salmonella arthritis. Urethritis occurred in 27%, eye inflammation in 13%, and low back pain in 44% of the patients. HLA-B27 was present in 88%. More men than women were HLA-B27 positive. HLA-B27 positive patients had higher erythrocyte sedimentation rate (mean 80.9 v 46.5 mm 1st h, p = 0.0180). Also, extra-articular features and radiological sacroiliitis were seen only in HLA-B27 positive patients. A follow up study was performed on 50 patients mean 11.0 (range 5-22 years) later. Twenty patients had recovered completely. Ten patients had mild joint symptoms, 11 patients had had a new acute transient arthritis, and five acute iritis. Eight patients had developed chronic spondyloarthropathy. Radiological sacroiliitis was seen in six of 44 patients, more frequently in male than in female patients (32% v 0%; p = 0.0289). Recurrent or chronic arthritis, iritis or radiological sacroiliitis developed only in HLA-B27 positive patients. Conclusion-Joint symptoms are common after reactive salmonella arthritis. HLA-B27 contributes to the severity of acute disease and to the late prognosis.

Synovial Fibroblasts Infected with Salmonella enterica Serovar Typhimurium Mediate Osteoclast Differentiation and Activation

“…While ReA in many cases follows a self-limited course, we found that of 27 patients with acute post-Salmonella ReA, 18 still had persisting disease activity at a 5-year follow-up (20). PostSalmonella ReA can be accompanied by erosive sacroiliitis (13). Despite the strong temporal association with antecedent infection, the pathogenesis of ReA is not resolved, but there is strong evidence of local persistence of microbial antigens (6) and microbial nucleic acids (4).…”

“…There is evidence clinically, in the case of post-Salmonella ReA (13), and experimentally, in the case of synovial fibroblast-packaged pathogens (9), that antecedent infection can set in motion a pathological sequence of events resulting in erosive arthritis, particularly of the sacroiliac joint. However, the re- lationship between the microbial trigger and the resulting sacroiliitis is not known.…”

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

“…Leirisalo-Repo et al reported that only 20% of their cases of inpatient Salmonella arthritis were completely normal at a mean of 11 years (119). A prolonged (Ͼ1-year) extension of acute arthritis has been described in about 4% of cases of Yersinia arthritis, in 19% of cases of Salmonella arthritis, in 19% of cases of Shigella arthritis, and in 17% of cases Chlamydia arthritis (91,119,120). Depending on the triggering infection and on the follow-up time, chronic arthritis is observed in 2 to 18% of patients, sacroiliitis is observed in 14 to 49%, and AS is observed in 12 to 26% (91,117,200).…”

“…When all symptoms are taken into account, 75% of patients are in complete remission at the end of the second year after onset. In the Finnish study, 15% of patients developed chronic sequelae or proceeded into chronic SpA (89,120). Leirisalo-Repo et al reported that only 20% of their cases of inpatient Salmonella arthritis were completely normal at a mean of 11 years (119).…”

Juvenile Spondyloarthritis

“…If arthritis, conjunctivitis and urethritis are present as a triad, reactive arthritis might be referred to as Reiter's syndrome. c. A number of children, particularly those with HLA-B27, develop a chronic course, and may even develop AS (Leirisalo, Skylv et al 1982;Hussein 1987;Artamonov, Akhmadi et al 1991;Cuttica, Scheines et al 1992;Yli-Kerttula, Tertti et al 1995;Leirisalo-Repo, Helenius et al 1997;Leirisalo-Repo 1998). Children without HLA-B27 who have ReA, particularly when the disease is triggered by Yersinia or Campylobacter, usually have a rather short and benign course.…”