Cat-scratch disease-associated arthropathy.
OBJECTIVE
To characterize the articular manifestations of cat-scratch disease (CSD) and to evaluate the long-term clinical outcome of those manifestations.


METHODS
A community- and hospital-based surveillance study of CSD was conducted in Israel between 1991 and 2002. CSD was defined as present in a patient when a compatible clinical syndrome and a positive confirmatory finding of Bartonella henselae (by serology and/or polymerase chain reaction) were identified. CSD patients with arthropathy (arthritis/arthralgia) that limited or precluded usual activities of daily living constituted the study group. Patients were followed up until > or =6 weeks after resolution of symptoms, or if symptoms persisted, for >/=12 months. CSD patients without arthropathy served as controls.


RESULTS
Among 841 CSD patients, 24 (2.9%) had rheumatoid factor-negative arthropathy that was often severe and disabling. Both univariate and multivariate analyses identified female sex (67% of arthropathy patients versus 40% of controls; relative risk [RR] 2.5, P = 0.047), age older than 20 years (100% of arthropathy patients versus 43% of controls; RR 4.9, P = 0.001), and erythema nodosum (21% of arthropathy patients versus 2% of controls; RR 7.9, P = 0.001) as variables significantly associated with arthropathy. Knee, wrist, ankle, and elbow joints were most frequently affected. Ten patients (42%) had severe arthropathy in the weight-bearing joints, which substantially limited their ability to walk, and 4 of these patients were hospitalized. All of the patients had regional lymphadenopathy, 37.5% had nocturnal joint pain, and 25% had morning stiffness. Nineteen patients (79.2%) recovered after a median duration of 6 weeks (range 1-24 weeks), whereas 5 patients (20.8%) developed chronic disease persisting 16-53 months (median 30 months) after the onset of arthropathy.


CONCLUSIONS
This is the first comprehensive study of arthropathy in CSD. CSD-associated arthropathy is an uncommon syndrome affecting mostly young and middle-age women. It is often severe and disabling, and may take a chronic course.
Giladi
Michael
M
Pridan Laboratory for Molecular Biology of Infectious Diseases, Ichilov Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, Tel-Aviv 64239, Israel. mgiladi@zahav.net.il
Maman
Eran
E
Paran
Daphna
D
Bickels
Jacob
J
Comaneshter
Doron
D
Avidor
Boaz
B
Varon-Graidy
Merav
M
Ephros
Moshe
M
Wientroub
Shlomo
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D001170:Arthritis, Infectious / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D018416:Bartonella henselae / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity; D002372:Cat-Scratch Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family; D011159:Population Surveillance; D012217:Rheumatoid Factor / Q000032:analysis; D012306:Risk
D012217:Rheumatoid Factor