Reactive arthritis in a population exposed to an extensive waterborne gastroenteritis outbreak after sewage contamination in Pirkanmaa, Finland

• Published in: Scandinavian journal of rheumatology Vol. 40; no. 5; pp. 358 - 362
• Main Authors: Uotila, T, Antonen, J, Laine, J, Kujansuu, E, Haapala, A-M, Lumio, J, Vuento, R, Oksa, H, Herrala, J, Kuusi, M, Mustonen, J, Korpela, M, for the Pirkanmaa Waterborne Outbreak Study Group
• Format: Journal Article
• Language: English
• Published: Colchester Informa Healthcare 01-01-2011; Taylor & Francis; Informa
• Subjects: Adolescent; Adult; Aged; Arthralgia - diagnosis; Arthralgia - epidemiology; Arthralgia - microbiology; Arthritis, Reactive - diagnosis; Arthritis, Reactive - epidemiology; Arthritis, Reactive - microbiology; Biological and medical sciences; Campylobacter Infections - epidemiology; Campylobacter Infections - microbiology; Campylobacter Infections - transmission; Diseases of the osteoarticular system; Diseases of the spine; Female; Finland - epidemiology; Gastroenteritis - diagnosis; Gastroenteritis - epidemiology; Gastroenteritis - microbiology; HLA-B27 Antigen - blood; Humans; Incidence; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Salmonella enteritidis - isolation & purification; Salmonella Infections - epidemiology; Salmonella Infections - microbiology; Salmonella Infections - transmission; Severity of Illness Index; Sewage - microbiology; Yersinia Infections - epidemiology; Yersinia Infections - microbiology; Yersinia Infections - transmission; Young Adult; Europe; Finland; Spondylarthropathy; Epidemic; Chronic; Gastroenteritis; Diseases of the osteoarticular system; Reactive arthritis; Rheumatology; Digestive diseases; Intestinal disease; Inflammatory joint disease; Contamination; Gastric disease
• ISSN: 0300-9742; 1502-7732
• DOI: 10.3109/03009742.2011.562533

Objectives: To assess the occurrence, clinical picture, and triggering infections of reactive arthritis (ReA) associated with a large waterborne gastroenteritis outbreak.
Methods: After an extensive sewage contamination of the water supply system, an estimated 8453 of the 30 016 inhabitants of the town of Nokia fell ill. General practitioners and occupational physicians were advised to refer any patients with suspicion of new ReA to rheumatological examination including faecal culture, human leucocyte antigen (HLA)-B27 and antibody tests for Campylobacter, Salmonella, and Yersinia.
Results: Forty-five patients (33 females, 12 males) aged 16-77 years (median 53) were referred. ReA was diagnosed in 21, postinfectious arthralgia in 13, and other musculoskeletal conditions in 11 patients. HLA-B27 was positive in five out of 44 patients (11%). Of the 21 patients with ReA, possible triggering infections were observed in seven (33%), Campylobacter in four, Yersinia in three, and Salmonella in one, who also had Campylobacter infection. ReA was mild in all but one patient who presented with persistent Salmonella enterica serotype enteritidis infection.
Conclusions: Taking into account the large population contaminated with potentially arthritogenic agents, the occurrence of ReA was rare and mild in character.