Fast food arthritis--a clinico-pathologic study of post-Salmonella reactive arthritis.
OBJECTIVE
To study the clinical presentation, immunogenetics, and serum immune response to lipopolysaccharide (LPS) in a cohort of patients with post-Salmonella reactive arthritis (ReA).


METHODS
A validate ReA screening questionnaire (Quest 2) was mailed to 919 individuals reporting symptoms of gastroenteritis to the health department after eating at a single restaurant. Three hundred twenty-one persons returned questionnaires; 170 reported symptoms outside the gastrointestinal tract; 23 of those 170 reporting persistent joint symptoms were seen 4 to 16 weeks after the outbreak and 5 of the 23 were seen in followup 12 to 20 weeks later. Clinical features, HLA Class I typing, serum soluble CD8 levels, and serum antibodies to gram negative LPS by ELISA were determined.


RESULTS
Joint complaints were reported more frequently by individuals with a longer duration of diarrhea. Upper extremity joints were frequently involved, and 66% reported one or more extraarticular symptoms of Reiter's syndrome. Three of 5 typed individuals were HLA-B27 positive, including 3 of the 4 most severely involved. Serum soluble CD8 levels correlated poorly with disease activity measured either clinically or by C-reactive protein. Antibodies to Klebsiella and Shigella LPS rose over time, while antibodies to Salmonella LPS fell.


CONCLUSIONS
The clinical picture of post-Salmonella ReA is less stereotyped than often assumed, although severity correlated with HLA-B27 status. The association of joint symptoms with duration of diarrhea and the kinetics of the anti-LPS antibody response support the hypothesis that abnormal gut permeability plays a role in the pathogenesis of post-Salmonella ReA.
Samuel
M P
MP
Department of Medicine, SUNY Health Science Center at Syracuse, USA.
Zwillich
S H
SH
Thomson
G T
GT
Alfa
M
M
Orr
K B
KB
Brittain
D C
DC
Miller
J R
JR
Phillips
P E
PE
D000907:Antibodies, Bacterial / Q000032:analysis; D016918:Arthritis, Reactive / Q000276:immunology / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000032:analysis; D016827:CD8 Antigens / Q000032:analysis; D015331:Cohort Studies; D004196:Disease Outbreaks; D004755:Enterobacteriaceae / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D015235:HLA-B Antigens / Q000032:analysis; D006801:Humans; D007125:Immunogenetics; D008070:Lipopolysaccharides / Q000494:pharmacology; D000091402:Prohibitins; D012480:Salmonella Infections / Q000453:epidemiology; D012995:Solubility; D011795:Surveys and Questionnaires
D000907:Antibodies, Bacterial; D016827:CD8 Antigens; D015235:HLA-B Antigens; D008070:Lipopolysaccharides; C000717331:PHB2 protein, human; D000091402:Prohibitins; D002097:C-Reactive Protein