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M Leirisalorepo - One of the best experts on this subject based on the ideXlab platform.
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Reactive Arthritis following salmonella infection a population based study
Scandinavian Journal of Rheumatology, 2013Co-Authors: R Tuompo, Timo Hannu, L Mattila, Anja Siitonen, M LeirisalorepoAbstract:Objectives: To study the incidence and clinical picture of Salmonella-associated Reactive Arthritis (ReA), as well as other Reactive musculoskeletal symptoms and the arthritogenicity of various Salmonella enterica ssp. enterica serotypes in the population.Method: We sent a questionnaire on enteric and extraintestinal (especially musculoskeletal) symptoms to 999 consecutive subjects with a Salmonella-positive stool culture. Analysis of self-reported musculoskeletal symptoms was supplemented with a clinical examination of subjects with recent symptoms.Results: Of the 999 Salmonella-positive subjects, 496 (50%) returned the questionnaire. Of these, 4.4% (22/496) had ReA and 13.7% (68/496) had other Reactive musculoskeletal symptoms [tendinitis, enthesopathy, or bursitis (ReTe)]. Among the ReA patients, all adults, Salmonella Enteritidis was the most common causative serotype. The clinical picture of patients with ReA was mostly monoarticular or oligoarticular. Human leucocyte antigen (HLA)-B27 was positive i...
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Reactive Arthritis or post infectious Arthritis
Best Practice & Research: Clinical Rheumatology, 2006Co-Authors: Kaisa Granfors, Robert D Inman, Timo Hannu, M LeirisalorepoAbstract:The term 'Reactive Arthritis' was first used in 1969 to describe the development of sterile inflammatory Arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. The demonstration of antigenic material (e.g. Salmonella and Yersinia lipopolysaccharide), DNA and RNA, and, in occasional cases, evidence of metabolically active Chlamydia spp. in the joints has blurred the boundary between Reactive and post-infectious forms of Arthritis. No validated and generally agreed diagnostic criteria exist, but the diagnosis of Reactive Arthritis is mainly clinical based on acute oligoarticular Arthritis of larger joints that develops within 2-4 weeks of the preceding infection. In about 25% of patients, the infection can be asymptomatic. Diagnosis of the triggering infection is very helpful for the diagnosis of Reactive Arthritis. This is mainly achieved by isolating the triggering infection (stools, urogenital tract) by cultures (stool cultures for enteric microbes) or ligase reaction (Chlamydia trachomatis). However, after the onset of Arthritis, this is less likely to be possible. Therefore, the diagnosis must rely on various serological tests to demonstrate evidence of previous infection, but, these serological tests are unfortunately not standardized. Treatment with antibiotics to cure Chlamydia infection is important, but the use of either short or prolonged courses of antibiotics in established Arthritis has not been found to be effective for the cure of Arthritis. The long-term outcome of Reactive Arthritis is usually good; however, about 25-50% of patients, depending on the triggering infections and possible new infections, subsequently develop acute Arthritis. About 25% of patients proceed to chronic spondyloArthritis of varying activity.
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three month treatment of Reactive Arthritis with azithromycin a eular double blind placebo controlled study
Annals of the Rheumatic Diseases, 2004Co-Authors: T K Kvien, M Leirisalorepo, J S H Gaston, T Bardin, I Butrimiene, Ben A C Dijkmans, P Solakov, M Altwegg, P Mowinckel, Pa PlanAbstract:Objective: To determine the efficacy of weekly treatment with oral azithromycin for 13 weeks on the severity and resolution of Reactive Arthritis (ReA). Methods: 186 patients from 12 countries were enrolled in a randomised, double blind, placebo controlled trial. Inclusion criteria were inflammatory Arthritis of ⩽6 swollen joints, and disease duration of ⩽2 months. All patients received a single azithromycin dose (1 g) as conventional treatment for possible Chlamydia infection, and were then randomly allocated to receive weekly azithromycin or placebo. Clinical assessments were made at 4 week intervals for 24 weeks. Results: 152 patients were analysable (34 failed entry criteria), with a mean (SD) age of 33.8 (9.4) and duration of symptoms 30.7 (17.5) days. Mean C Reactive protein (CRP) was 48 mg/l, and ∼50% of those typed were HLA-B27+, suggesting that the inclusion criteria successfully recruited patients with acute ReA. Treatment and placebo groups were well matched for baseline characteristics. There were no statistical differences for changes in any end point (swollen and tender joint count, joint pain, back pain, heel pain, physician and patient global assessments, and CRP) between the active treatment and placebo groups, analysed on an intention to treat basis or according to protocol completion. The time to resolution of Arthritis and other symptoms or signs by life table analyses was also not significantly different. Adverse events were generally mild, but were more commonly reported in the azithromycin group. Conclusions: This large trial has demonstrated that prolonged treatment with azithromycin is ineffective in ReA.
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Reactive Arthritis after an outbreak of yersinia pseudotuberculosis serotype o 3 infection
Annals of the Rheumatic Diseases, 2003Co-Authors: Timo Hannu, Anja Siitonen, Leena Mattila, J P Nuorti, P Ruutu, J Mikkola, M LeirisalorepoAbstract:Objective: To determine the occurrence and clinical characteristics of Reactive Arthritis (ReA) after an outbreak of Yersinia pseudotuberculosis serotype O:3 infection. Methods: From 15 October to 6 November 1998, a widespread outbreak of Y pseudotuberculosis serotype O:3 occurred in Finland. A questionnaire on musculoskeletal symptoms was mailed to 38 patients with infection confirmed by culture. All patients who reported joint symptoms were interviewed by phone and their medical records of outpatient visits or hospital admission because of recent joint symptoms were reviewed. Results: Thirty three of 38 (87%) patients returned the questionnaire. Reactive musculoskeletal symptoms were reported by 5/33 (15%): four patients (12%) fulfilled the criteria for ReA and one additional patient had Reactive enthesopathy. The patients with ReA were adults (age range 40–47 years), whereas the patient with Reactive enthesopathy was a 14 year old boy. In all patients with ReA, the Arthritis was polyarticular. In addition to peripheral Arthritis, other musculoskeletal symptoms included sacroiliitis (one patient), pain in Achilles tendon (one patient), and heel pain (two patients). HLA-B27 was positive in all the three patients tested. In three of four patients with ReA, the duration of acute Arthritis was over six months. Conclusion: Y pseudotuberculosis serotype O:3 infection is frequently associated with ReA and the clinical picture is severe.
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campylobacter triggered Reactive Arthritis a population based study
Rheumatology, 2002Co-Authors: Timo Hannu, L Mattila, H Rautelin, P Pelkonen, P Lahdenne, Anja Siitonen, M LeirisalorepoAbstract:Objective. To study the incidence and clinical picture of Campylobacter-associated Reactive Arthritis (ReA) and other Reactive musculoskeletal symptoms in the population. Methods. A questionnaire on enteric and extraintestinal, including specifically musculoskeletal, symptoms was sent to 870 consecutive patients with Campylobacter-positive stool culture and 1440 matched controls. Analysis of self-reported musculoskeletal symptoms with clinical examination was performed. Results. Forty-five of the patients (7%) had ReA and eight (1%) had Reactive tendinitis, enthesopathy or bursitis. No child had ReA. The Arthritis was oligo- or polyarticular, and, in most cases, mild. HLA-B27 was positive in 14% of ReA patients. Of the 45 ReA patients, 37 had C. jejuni and 8 had C. coli infection. No controls had ReA. Conclusion. ReA is common following Campylobacter infection, with an annual incidence of 4.3 per 100 000. At the population level, acute ReA is mild, more frequent in adults, and not associated with HLA-B27. Besides C. jejuni, C. coli can trigger ReA.
Grant W Cannon - One of the best experts on this subject based on the ideXlab platform.
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comparison of sulfasalazine and placebo in the treatment of Reactive Arthritis reiter s syndrome a department of veterans affairs cooperative study
Arthritis & Rheumatism, 1996Co-Authors: Daniel O Clegg, Domenic J Reda, M Weisman, John J Cush, F Vasey, Ralph H Schumacher, Elly Budimanmak, Dominic J Balestra, Warren D Blackburn, Grant W CannonAbstract:Objective To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective in the treatment of Reactive Arthritis (ReA) that has been unresponsive to nonsteroidal antiinflammatory drug (NSAID) therapy. Methods One hundred thirty-four patients with ReA who had failed to respond to NSAIDs were recruited from 19 clinics, randomized (double-blind) to receive either SSZ or placebo, and followed up for 36 weeks. The definition of treatment response was based on joint pain/tenderness and swelling scores and physician and patient global assessments. Results Longitudinal analysis revealed improvement in the patients taking SSZ compared with those taking placebo, which appeared at 4 weeks and continued through the trial (P = 0.02). At the end of treatment, response rates were 62.3% for SSZ treatment compared with 47.7% for placebo treatment. The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P Conclusion SSZ at a dosage of 2,000 mg/day is well tolerated and effective in patients with chronically active ReA.
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comparison of sulfasalazine and placebo in the treatment of Reactive Arthritis reiter s syndrome a department of veterans affairs cooperative study
Arthritis & Rheumatism, 1996Co-Authors: Daniel O Clegg, Frank B Vasey, Domenic J Reda, John J Cush, Ralph H Schumacher, Elly Budimanmak, Dominic J Balestra, Warren D Blackburn, Michael H Weisman, Grant W CannonAbstract:Objective. To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective in the treatment of Reactive Arthritis (ReA) that has been unresponsive to nonsteroidal antiinflammatory drug (NSAID) therapy. Methods. One hundred thirty-four patients with ReA who had failed to respond to NSAIDs were recruited from 19 clinics, randomized (double-blind) to receive either SSZ or placebo, and followed up for 36 weeks. The definition of treatment response was based on joint pain/tenderness and swelling scores and physician and patient global assessments. Results. Longitudinal analysis revealed improvement in the patients taking SSZ compared with those taking placebo, which appeared at 4 weeks and continued through the trial (P = 0.02). At the end of treatment, response rates were 62.3% for SSZ treatment compared with 47.7% for placebo treatment. The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints. Conclusion. SSZ at a dosage of 2,000 mg/day is well tolerated and effective in patients with chronically active ReA.
Timo Hannu - One of the best experts on this subject based on the ideXlab platform.
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Yersinia enterocolitica biotype 1A: a possible new trigger of Reactive Arthritis
Rheumatology International, 2017Co-Authors: Riitta Tuompo, Timo Hannu, Anja Siitonen, Elisa Huovinen, Leila Sihvonen, Marjatta Leirisalo-repoAbstract:Yersinia enterocolitica ( YE ) biotype 1A is generally considered non-pathogenic, and the role of it in causing Reactive musculoskeletal complications is unclear. We evaluated the capability of YE biotype 1A to induce Reactive Arthritis (ReA) and other Reactive musculoskeletal symptoms. Analysis of self-reported musculoskeletal symptoms was supplemented with a telephone interview (with a permission to acquire copies of patient files from a local physician or hospital) and/or clinical examination of subjects with recent musculoskeletal symptoms after a positive stool culture for YE . The diagnoses of ReA and Reactive tendinitis and enthesitis (ReTe) were defined as “definite” when based on clinical examination and/or on interview by phone and “probable” when based solely on the questionnaire. Of 120 subjects, who reported musculoskeletal symptoms, 100 were included in the final analysis. Among these 100 patients, 68% had YE biotype 1A, 16% YE bio/serotype 4, and 1% biotype 2 infection; the remaining 15% had different YE -like strains or a non-biotypable strain. Of the 21 patients with ReA and of the 14 patients with ReTe, the diagnosis was definite in 9 and 7 patients and probable in 12 and 7 patients, respectively. The clinical picture of ReA caused by YE biotype 1A was similar with other bio/serotypes of YE . The definite ReA due to YE biotype 1A occurred in middle-aged adults (5 men, 4 women) with the most frequently affected joints being the knees and ankles. We suggest that YE biotype 1A should be taken into account as a new trigger of ReA.
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Reactive Arthritis following salmonella infection a population based study
Scandinavian Journal of Rheumatology, 2013Co-Authors: R Tuompo, Timo Hannu, L Mattila, Anja Siitonen, M LeirisalorepoAbstract:Objectives: To study the incidence and clinical picture of Salmonella-associated Reactive Arthritis (ReA), as well as other Reactive musculoskeletal symptoms and the arthritogenicity of various Salmonella enterica ssp. enterica serotypes in the population.Method: We sent a questionnaire on enteric and extraintestinal (especially musculoskeletal) symptoms to 999 consecutive subjects with a Salmonella-positive stool culture. Analysis of self-reported musculoskeletal symptoms was supplemented with a clinical examination of subjects with recent symptoms.Results: Of the 999 Salmonella-positive subjects, 496 (50%) returned the questionnaire. Of these, 4.4% (22/496) had ReA and 13.7% (68/496) had other Reactive musculoskeletal symptoms [tendinitis, enthesopathy, or bursitis (ReTe)]. Among the ReA patients, all adults, Salmonella Enteritidis was the most common causative serotype. The clinical picture of patients with ReA was mostly monoarticular or oligoarticular. Human leucocyte antigen (HLA)-B27 was positive i...
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Reactive Arthritis or post infectious Arthritis
Best Practice & Research: Clinical Rheumatology, 2006Co-Authors: Kaisa Granfors, Robert D Inman, Timo Hannu, M LeirisalorepoAbstract:The term 'Reactive Arthritis' was first used in 1969 to describe the development of sterile inflammatory Arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. The demonstration of antigenic material (e.g. Salmonella and Yersinia lipopolysaccharide), DNA and RNA, and, in occasional cases, evidence of metabolically active Chlamydia spp. in the joints has blurred the boundary between Reactive and post-infectious forms of Arthritis. No validated and generally agreed diagnostic criteria exist, but the diagnosis of Reactive Arthritis is mainly clinical based on acute oligoarticular Arthritis of larger joints that develops within 2-4 weeks of the preceding infection. In about 25% of patients, the infection can be asymptomatic. Diagnosis of the triggering infection is very helpful for the diagnosis of Reactive Arthritis. This is mainly achieved by isolating the triggering infection (stools, urogenital tract) by cultures (stool cultures for enteric microbes) or ligase reaction (Chlamydia trachomatis). However, after the onset of Arthritis, this is less likely to be possible. Therefore, the diagnosis must rely on various serological tests to demonstrate evidence of previous infection, but, these serological tests are unfortunately not standardized. Treatment with antibiotics to cure Chlamydia infection is important, but the use of either short or prolonged courses of antibiotics in established Arthritis has not been found to be effective for the cure of Arthritis. The long-term outcome of Reactive Arthritis is usually good; however, about 25-50% of patients, depending on the triggering infections and possible new infections, subsequently develop acute Arthritis. About 25% of patients proceed to chronic spondyloArthritis of varying activity.
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Reactive Arthritis after an outbreak of yersinia pseudotuberculosis serotype o 3 infection
Annals of the Rheumatic Diseases, 2003Co-Authors: Timo Hannu, Anja Siitonen, Leena Mattila, J P Nuorti, P Ruutu, J Mikkola, M LeirisalorepoAbstract:Objective: To determine the occurrence and clinical characteristics of Reactive Arthritis (ReA) after an outbreak of Yersinia pseudotuberculosis serotype O:3 infection. Methods: From 15 October to 6 November 1998, a widespread outbreak of Y pseudotuberculosis serotype O:3 occurred in Finland. A questionnaire on musculoskeletal symptoms was mailed to 38 patients with infection confirmed by culture. All patients who reported joint symptoms were interviewed by phone and their medical records of outpatient visits or hospital admission because of recent joint symptoms were reviewed. Results: Thirty three of 38 (87%) patients returned the questionnaire. Reactive musculoskeletal symptoms were reported by 5/33 (15%): four patients (12%) fulfilled the criteria for ReA and one additional patient had Reactive enthesopathy. The patients with ReA were adults (age range 40–47 years), whereas the patient with Reactive enthesopathy was a 14 year old boy. In all patients with ReA, the Arthritis was polyarticular. In addition to peripheral Arthritis, other musculoskeletal symptoms included sacroiliitis (one patient), pain in Achilles tendon (one patient), and heel pain (two patients). HLA-B27 was positive in all the three patients tested. In three of four patients with ReA, the duration of acute Arthritis was over six months. Conclusion: Y pseudotuberculosis serotype O:3 infection is frequently associated with ReA and the clinical picture is severe.
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campylobacter triggered Reactive Arthritis a population based study
Rheumatology, 2002Co-Authors: Timo Hannu, L Mattila, H Rautelin, P Pelkonen, P Lahdenne, Anja Siitonen, M LeirisalorepoAbstract:Objective. To study the incidence and clinical picture of Campylobacter-associated Reactive Arthritis (ReA) and other Reactive musculoskeletal symptoms in the population. Methods. A questionnaire on enteric and extraintestinal, including specifically musculoskeletal, symptoms was sent to 870 consecutive patients with Campylobacter-positive stool culture and 1440 matched controls. Analysis of self-reported musculoskeletal symptoms with clinical examination was performed. Results. Forty-five of the patients (7%) had ReA and eight (1%) had Reactive tendinitis, enthesopathy or bursitis. No child had ReA. The Arthritis was oligo- or polyarticular, and, in most cases, mild. HLA-B27 was positive in 14% of ReA patients. Of the 45 ReA patients, 37 had C. jejuni and 8 had C. coli infection. No controls had ReA. Conclusion. ReA is common following Campylobacter infection, with an annual incidence of 4.3 per 100 000. At the population level, acute ReA is mild, more frequent in adults, and not associated with HLA-B27. Besides C. jejuni, C. coli can trigger ReA.
Cem Gabay - One of the best experts on this subject based on the ideXlab platform.
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lower level of synovial fluid interferon gamma in hla b27 positive than in hla b27 negative patients with chlamydia trachomatis Reactive Arthritis
Rheumatology, 2003Co-Authors: Sylvette Bas, Tore K Kvien, N Buchs, T Fulpius, Cem GabayAbstract:OBJECTIVES To compare the synovial fluid (SF) concentrations of various cytokines in rheumatoid Arthritis (RA) and in Reactive Arthritis, and to look for a correlation between cytokine levels and the presence of HLA-B27 antigen in Reactive Arthritis patients. METHODS Concentrations of interleukin (IL) 10, IL-12, IL-18, interferon gamma (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were determined by commercially available enzyme-linked immunosorbent assays (ELISA) in the SF from 48 patients with Reactive Arthritis, 33 with RA and 13 with osteoArthritis (non-inflammatory controls). RESULTS The SF concentrations of IL-10 were significantly lower in patients with Reactive Arthritis (median 2.3 pg/ml) than in RA patients (median 14.6 pg/ml). The SF levels of IFN-gamma were not significantly different but the ratios of IFN-gamma to IL-10 were significantly higher in patients with Reactive Arthritis (median 9.2) than in RA patients (median 0.83). When the subset of patients with Chlamydia trachomatis Reactive Arthritis was considered, the SF concentration of IFN-gamma was significantly lower in HLA-B27-positive (median 2.9 pg/ml) than in HLA-B27-negative patients (median 42.4 pg/ml). After 2 yr of follow-up, two HLA-B27-positive patients, who had low SF levels of IFN-gamma, had a chronic course of Arthritis, whereas after 1 yr all HLA-B27-negative patients had complete resolution of Arthritis. CONCLUSIONS The lower IFN-gamma concentrations in HLA-B27-positive patients with C. trachomatis Reactive Arthritis could be related to the tendency of these patients to have more severe or chronic Arthritis.
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lower level of synovial fluid interferon γ in hla b27 positive than in hla b27 negative patients with chlamydia trachomatis Reactive Arthritis
Rheumatology, 2003Co-Authors: Sylvette Bas, Tore K Kvien, N Buchs, T Fulpius, Cem GabayAbstract:Objectives. To compare the synovial fluid (SF) concentrations of various cytokines in rheumatoid Arthritis (RA) and in Reactive Arthritis, and to look for a correlation between cytokine levels and the presence of HLA-B27 antigen in Reactive Arthritis patients. Methods. Concentrations of interleukin (IL) 10, IL-12, IL-18, interferon y (IFN-y) and tumour necrosis factor a (TNF-a) were determined by commercially available enzyme-linked immunosorbent assays (ELISA) in the SF from 48 patients with Reactive Arthritis, 33 with RA and 13 with osteoArthritis (non-inflammatory controls). Results. The SF concentrations of IL-10 were significantly lower in patients with Reactive Arthritis (median 2.3 pg/ml) than in RA patients (median 14.6 pg/ml). The SF levels of IFN-y were not significantly different but the ratios of IFN-y to IL-10 were significantly higher in patients with Reactive Arthritis (median 9.2) than in RA patients (median 0.83). When the subset of patients with Chlamydia trachomatis Reactive Arthritis was considered, the SF concentration of IFN-y was significantly lower in HLA-B27-positive (median 2.9 pg/ml) than in HLA-B27-negative patients (median 42.4 pg/ml). After 2 yr of follow-up, two HLA-B27-positive patients, who had low SF levels of IFN-y, had a chronic course of Arthritis, whereas after 1 yr all HLA-B27-negative patients had complete resolution of Arthritis. Conclusions. The lower IFN-y concentrations in HLA-B27-positive patients with C. trachomatis Reactive Arthritis could be related to the tendency of these patients to have more severe or chronic Arthritis.
Heikki Repo - One of the best experts on this subject based on the ideXlab platform.
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Double-blind, placebo-controlled study of three-month treatment with lymecycline in Reactive Arthritis, with special reference to Chlamydia Arthritis.
Arthritis & Rheumatism, 1991Co-Authors: Anneli Lauhio, Marjatta Leirisalo-repo, Juhani Lähdevirta, Pekka Saikku, Heikki RepoAbstract:We conducted a double-blind, placebo-controlled, randomized study of 3-month treatment with lymecycline, a form of tetracycline, in Reactive Arthritis (ReA). Lymecycline therapy significantly decreased the duration of the illness in patients with Chlamydia trachomatis-triggered ReA, but not in other ReA patients. In 2 ReA patients, C trachomatis was found in the throat, an uncommon locale for this organism. Our results suggest that it is important to verify the triggering microbe and that it is beneficial to treat Chlamydia Arthritis patients with a prolonged course of tetracycline.
