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Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up

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Abstract

The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3–6 months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2 years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2 years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2 years in nearly half of the patients.

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Funding

This work was funded by the Guatemala-Penn Partners Program and the NIH Fogarty International Center grant D43TW008317. AO was supported by NIH K23 AR063764 and the Rheumatology Research Foundation. JUS was supported by NIH K23 AR064318.

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Authors and Affiliations

  1. Guatemalan Association against Rheumatic Diseases (AGAR), Guatemala City, Guatemala

    Helga Raquel Garcia Ferrer, Isa Iraheta & Abraham Garcia Kutzbach

  2. Universidad Francisco Marroquin, Guatemala City, Guatemala

    Helga Raquel Garcia Ferrer & Abraham Garcia Kutzbach

  3. Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Alexander Azan, Joan Von Feldt & Alexis Ogdie

  4. LSU Health Science Center, New Orleans, LA, USA

    Luis R. Espinoza

  5. New York University School of Medicine, New York, NY, USA

    Julia Manasson & Jose U. Scher

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  1. Helga Raquel Garcia Ferrer
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  4. Joan Von Feldt
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Correspondence to Alexis Ogdie.

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Conflicts of interest

AO has consulted for Novartis and Pfizer and has received grant support from Pfizer and Novartis. JUS has consulted for Novartis, Janssen, and UCB. AGK served as a principal investigator for studies funded by MS&D, Novartis, Pfzier, and Lilly. The remaining authors do not report a conflict of interest.

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Helga Raquel Garcia Ferrer and Alexander Azan are co-first authors.

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Garcia Ferrer, H.R., Azan, A., Iraheta, I. et al. Potential risk factors for reactive arthritis and persistence of symptoms at 2 years: a case-control study with longitudinal follow-up. Clin Rheumatol 37, 415–422 (2018). https://doi.org/10.1007/s10067-017-3911-3

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  • DOI: https://doi.org/10.1007/s10067-017-3911-3

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