RESEARCH - Arthritis risk after acute bacterial gastroenteritis

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Rheumatology Advance Access published online on January 9, 2008

Arthritis risk after acute bacterial gastroenteritis

A. X. Garg1,2, J. E. Pope2,3,4, H. Thiessen-Philbrook1, W. F. 1,2, J.

Ouimet3,4 on behalf of the ton Health Study Investigators*

1London Kidney Research Unit, Division of Nephrology, London Health Sciences

Centre, 2Department of Medicine, Schulich School of Medicine, University of

Western Ontario, 3Division of Rheumatology, University of Western Ontario

and 4St. ph's Health Care London, Canada.

Abstract

Objectives. Reactive arthritis (ReA) may occur from bacterial

gastroenteritis. We studied the risk of arthritis after an outbreak of

Escherichia coli O157:H7 and Campylobacter species within a regional

drinking water supply to examine the relationship between the severity of

acute diarrhoea and subsequent symptoms of arthritis.

Methods. Participants with no known history of arthritis before the outbreak

participated in a long-term follow-up study. Of the 2299 participants, 788

were asymptomatic during the outbreak, 1034 had moderate symptoms of acute

gastroenteritis and 477 had severe symptoms that necessitated medical

attention. The outcomes of interest were new arthritis by self-report and a

new prescription of medication for arthritis during the follow-up period.

Results. After a mean follow-up of 4.5 yrs after the outbreak, arthritis was

reported in 15.7% of participants who had been asymptomatic during the

outbreak, and in 17.6 and 21.6% of those who had moderate and severe

symptoms of acute gastroenteritis, respectively (P-value for trend = 0.009).

Compared with the asymptomatic participants, those with moderate and severe

symptoms of gastroenteritis had an adjusted relative risk of arthritis of

1.19 [95% confidence interval (CI) 0.99-1.43] and 1.33 (95% CI 1.07-1.66),

respectively. No association was observed between gastroenteritis and the

subsequent risk of prescription medication for arthritis (P = 0.49).

Conclusions. Acute bacterial gastroenteritis necessitating medical attention

was associated with a higher risk of arthritic symptoms, but not arthritic

medications, up to 4 yrs afterwards. The nature and chronicity of these

arthritic symptoms requires further study.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kem339v1?papetoc

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