title: Reactive arthritis at the Sydney Sexual Health Centre 1992-2012: declining despite increasing chlamydia diagnoses.
abstract: Reactive arthritis is an under-studied complication of genital Chlamydia trachomatis infection (chlamydia). We assessed trends and risk factors for reactive arthritis in a large urban sexual health clinic. Using a case-control design, data on reactive arthritis cases and controls at the Sydney Sexual Health Centre over the period 1992-2012 were extracted and multivariate analyses were performed. Trend analyses were performed on reactive arthritis diagnoses. Over the 1992-2012 study period, 85 reactive arthritis cases were diagnosed at Sydney Sexual Health Centre. The rate of reactive arthritis diagnoses decreased over time (23 in 1992-1996 to one in 2007-2011 and none in 2012), while chlamydia diagnoses increased (770 in 1992-1996 to 2257 in 2007-2011). In multivariate analysis, factors independently associated with a reactive arthritis diagnosis were: being male (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.04-10.32; p = 0.043) or born overseas (aOR 2.69; 95% CI 1.27-5.70; p = 0.010), while a past sexually transmitted infection other than chlamydia or non-gonococcal urethritis was protective (aOR 0.21; 95% CI 0.10-0.45; p < 0.001). Reactive arthritis was not associated with current or recent chlamydia infection (p = 0.184) but was marginally associated with past non-gonococcal urethritis (p = 0.080). This study found a decline in reactive arthritis diagnoses despite an increase in chlamydia diagnoses.
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia Faculty of Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Mason
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Women's and Children's Health, UNSW Australia, Sydney, NSW, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Wray
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Foster
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: M S
authors.initials: MS
authors.lastname: Jamil
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Guy
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: McNulty
authors.affiliation: Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW, Australia The Kirby Institute, UNSW Australia, Sydney, NSW, Australia bdonovan@kirby.unsw.edu.au.
authors.forename: B
authors.initials: B
authors.lastname: Donovan
mesh_terms: D000328:Adult; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014505:Urban Population; D055815:Young Adult
keywords: HIV; IRIS; Reactive arthritis; Reiter’s syndrome; SARA; chlamydia; immune reconstitution; sexually acquired reactive arthritis