Abstract
The aim of this study was to investigate the triggering micro-organisms and the clinical as well as laboratory differences between Chlamydial and non-chlamydial reactive arthritis (ReA) in a prospective study on 98 patients with acute/subacute arthritis. An inciting organism was found in 42 patients. Eighteen of these were chlamydial. Fifty-seven percent of all ReA patients were carriers for HLA-B27, which increased to 67% in the chlamydial group. Chlamydial ReA patients had more urethritis (P<0.05) with a longer period between arthritis and inciting infection, significantly lower CRP levels, and involved joint counts (P<0.05). Additionally, sacroiliitis was more frequent besides extra-articular manifestations in chlamydial ReA group. This study shows that chlamydial ReA differs in some points from non-chlamydial ReA, which in turn may affect the evaluation of an arthritic patient. ReA due to chlamydia more frequently encompasses a monoarticular or oligoarticular clinical picture with predominant distal extremity involvement. Non-chlamydial ReA presents higher joint counts and may involve upper extremity joints.
Similar content being viewed by others
References
Sigal LH (2001) Update on reactive arthritis. Bull Rheum Dis 50:1–4
Wuorela M (1998) Infectious agents as triggers of reactive arthritis. Am J Med Sci 316:264–270
Toivanen A (1998) Rheumatology In: Klippel JH, Diappe PA (eds) Mosby, 2nd edn. London, pp 6.11.1–7
Cush JJ (1997) Koopman and Allied Conditions. A text book of Rheumatolgy. Williams and Wilkins, Pennsylvania, pp S1209–S1227
Flores D, Morquez J, Garza M, Espinoza LR (2003) Reactive arthritis: never developments. Rheum Dis Clin N Am 29:37–59
Calin A (1998) The Spondylarthritides In: Calin A, Taurog JD (eds) Oxford University press, Oxford, pp 41–57
Erlacher L, Wintersberger W, Menschik M, Benke-Studnicka A, Machold K, Stanek G, et al (1995) Reactive Arthritis: Urogenital swab culture ıs the only useful diagnostic method for the detection of the arthritogenic ınfection in extra-articularly asymptomatic patients with undifferentiated oligoarthritis. Br J Rheumatol 34:838–842
Barth WF, Segal K (1999) Reactive arthritis (Reiter’s syndrome). Am Fam Physician 60:499–503
Hopkinson N (2000) Sexually-acquired reactive arthritis. Hosp Med 62:83–85
Frendler C, Laitko S, Sörensen H, Groh A (2001) Frequency of triggering bacteria in patients with reactive arthritis and undifferentiated oligoarthritis and the relative importance of the tests used for diagnosis. Ann Rheum Dis 60:337–343
Hannu T, Puolakkainen M, Leirisalo-Repo M (1999) Chlamydia pneumoniae as a triggering infection in reactive arthritis. Rheumatology 38:411–414
Weyand CM, Goronzy J (1992) Clinically silent infections in patients with oligoarthritis: results of a prospective study. Ann Rheum Dis 51:253–258
Zeidler H, Kuipers J, Köhler L (2004) Chlamydia-induced arthritis. Curr Opin Rheumatol 16:380–392
Braun J, Laitko S, Treharne J, Eggens U (1994) Chlamydia pneumoniae—a new causative agent of reactive atrhritis and undifferentiated oligoarthritis. Ann Rheum Dis 53:100–105
Fan PT, Yu DTY (1997) Reiter’s syndrome. In: Kelley N, Ruddy S, Harris E, Seledge C (eds) Textbook of rheumatology. WB Saunders, Philadelphia, pp S983–S997
Zeidler HK, Schumacher HR (1998) Chlamydia-induced arthritis. In: Calin A, Taurog J (eds) The spondylarthritides. Oxford University Press, NY, pp 69–96
Fink CW (1988) Reactive arthritis. Pediatr Infect Dis J 7(1):58–65
Otterness IG (1994) The value C-reactive protein measurement in rheumatoid arthritis. Semin arthritis Rheum 24:91–104
Eberl G, Studnicka-Benke A, Hitzelhammer H, Gschnait F, Smolen JS (2003) Development of a disease activity index for the assessment of reactive arthritis (DAREA). Rheumatology (Oxford) 39:148–155
Schumacher HR (2000) Chlamydia-associated reactive arthritis. IMAJ 2:532–535
Zeidler H, Wollenhaupt J (1991) Chlamydia-induced arthritis: the clinical spectrum, serology, and prognosis. In: Lipsy PE, Taurog JD (eds) HLA-B27 Spondyloarthropathies. Elsevier, NY, pp 175–187
Arnett FC (1989) The lyme spirocheta: another cause of Reiter’s S? Arthritis Rheum 32:1182–1184
Goobar JP (1977) Joint symptoms in giardiasis (letter). Lancet 1:1010–1011
Doury P, Eulry F, Pattin S (1983) Clinical aspects of reactive arthritis caused by Chlamydia. Rev Rhum Mal Osteoartic 50(11):753–757
Dubost JJ, Constantin A, Soubrier M, Ristori JM, Cantagrel A, Bussiere JL (1997) Does reactive arthritis caused Brucella exist? Apropos of 4 cases. Presse Med 26(5):207–210
Ozgul A, Yazıcıoğlu K, Gunduz S, Kalyon TA, Arpacıoğlu O (1998) Acute brucella sacroiliitis: clinical features. Clin Rheumatol 17(6):521–523
Maki-Ikola O, Gransfors K (1992) Salmonella-triggered reactive arthritis. The Lancet 339:1096–1098
Locht H, Molbak K, Krogfelt KA (2002) High frequency of reactive joint symptoms after an outbreak of Salmonella enteridis. J Rheumatol 29:767–771
Tupchong M, Sımor A, Dewar C (1999) Beaver fever-A rare cause of reactive arthritis. J Rheumatol 26:2701–2702
Shulman St, Ayoub EA (2002) Poststreptococcal reactive arthritis. Curr Opin Rheumatol 14:562–565
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Özgül, A., Dede, I., Taskaynatan, M.A. et al. Clinical presentations of chlamydial and non-chlamydial reactive arthritis. Rheumatol Int 26, 879–885 (2006). https://doi.org/10.1007/s00296-005-0094-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-005-0094-z