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Infections preceding early arthritis in southern Sweden: a prospective population-based study
Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
Rheumatism Foundation Hospital, Heinola, Finland.
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2003 (English)In: The Journal of Rheumatology, ISSN 0315-162X, Vol. 30, no 3, 459-464 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To detect evidence of infections preceding early arthritis in Southern Sweden and to compare the clinical outcome of remission during a 6-month followup for patients with and without signs of prior infection.

METHODS: Adult patients with arthritis of less than 3 months' duration were referred from primary health care centers to rheumatologists. All patients were systematically screened for infections caused by Salmonella typhimurium and Salmonella enteritidis, Yersinia enterocolitica, Campylobacter jejuni, Borrelia burgdorferi, Chlamydia trachomatis, Chlamydia pneumoniae, and parvovirus B19.

RESULTS: Seventy-one patients were included in this study. Twenty-seven (38%) patients had reactive arthritis (ReA), 17 (24%) undifferentiated arthritis, 15 (21%) rheumatoid arthritis (RA), 4 (6%) psoriatic arthritis, and the rest (11%) other diagnoses. Of all the patients, 45% had evidence of a recent infection preceding the arthritis, as indicated by laboratory tests and/or disease history. C. jejuni dominated the ReA group. The occurrence of recent C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections was low. Overall, 58% of the patients went into remission during the 6-month followup. Of the patients with a preceding infection, 69% went into remission as compared to 38% of the patients without a preceding infection (p = 0.011). Thirty-three percent of the patients with RA were in remission after 6 months.

CONCLUSION: In this population-based cohort, 45% of the patients presenting with a new-onset arthritis had had a prior infection. Campylobacter ReA dominated the ReA group. There were only a few cases preceded by infections by C. trachomatis, B. burgdorferi, C. pneumoniae, and parvovirus B19 infections. Remission during the first 6 months was especially frequent in the group of patients with a prior infection, but the remission rate was relatively high even for arthritis without prior infection.

Place, publisher, year, edition, pages
2003. Vol. 30, no 3, 459-464 p.
Keyword [en]
Incidence, Chlamydia, Reactive arthritis, Campylobacter, Parvovirus B19
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13710OAI: oai:DiVA.org:liu-13710DiVA: diva2:21191
Available from: 2003-12-16 Created: 2003-12-16 Last updated: 2015-08-31
In thesis
1. A population-based study on early arthritis in southern Sweden: Incidence, preceding infections, diagnostic markers and economic burden
Open this publication in new window or tab >>A population-based study on early arthritis in southern Sweden: Incidence, preceding infections, diagnostic markers and economic burden
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The total annual incidence of arthritis in this prospective cross-sectional study on adults was 115/100 000. The annual incidence of rheumatoid arthritis (RA) was 24/100 000, 29/100 000 for women, and 18/100 000 for men. For reactive arthritis (ReA) the annual incidence was slightly higher, 28/100 000, and for undifferentiated arthritis 41/100 000. The annual incidence of Lyme disease and sarcoid arthritis was low. The annual incidence of arthritis in this study compares well with findings in earlier reports from both registers and case review studies. Almost 50% of the patients in the series of 71 patients with arthritis of less than 3 months’ duration had a preceding infection. Campylobacter jejuni ReA dominated the enteric ReA group. We found only a few patients with preceding Chl. trachomatis, Chl. pneumoniae, Borrelia burgdorferi or parvovirus B19 infections. The arthritis patients with a preceding infection went into remission more often than the patients without a preceding infection. The disease specificity of anti-CCP antibodies for RA was high, 96%, confirming earlier results. Anti-CCP antibodies differentiated RA from other arthritides. Several patients in the different diagnosis groups had raised serum COMP levels, indicating cartilage involvement very early in the disease, even in mild and self-limiting disease with good prognosis. The economic burden of early joint inflammation was found to be considerable already during the first few months of the arthritis irrespective of diagnosis. Surprisingly, patients with ReA generated almost as high costs as patients with RA during thefirst few months of the disease, even though most of the ReA patients had a relatively mild disease. Sick leave accounted for about 50% of the costs. The distribution of costs in the different patient groups was skewed. The median cost per patient for the group of patients with RA was US$4385, for ReA US$4085, for other types of specified arthritis US$3361, and for undifferentiated arthritis US$1482. This underlines the necessity of quick referral and therapy, not only to decrease the inflammation and prevent functional impairment, but also to decrease the costs of early arthritis.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2003. 100 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 824
Keyword
Arthritis diagnosis, arthritis economics, Biological markers blood, Extracellular matrix proteins blood, Cost of illness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5225 (URN)91-7373-506-X (ISBN)
Public defence
2003-11-21, Elsa Brändströmsalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
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Available from: 2003-12-16 Created: 2003-12-16 Last updated: 2015-08-31Bibliographically approved

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Söderlin, MariaSkogh, Thomas

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