CLINICAL-FEATURES AND HLA ASSOCIATIONS OF REACTIVE ARTHRITIS ASSOCIATED WITH NON-GONOCOCCAL URETHRITIS

Abstract

Patients (57) with arthritis associated with non-gonococcal genital infection were studied. Synovitis characteristically affected 1 or a few joints, especially the knee, ankle or metatarsophalangeal joints and was accompanied by tenosynovitis and enthesopathies, each in about 1/3 of the patients. Of the patients studied, 1/4 had ocular, cutaneous or mucous membrane lesions (Reiter''s syndrome). Although 6 patients developed a chronic or relapsing course, average duration of the acute episode in the majority was 3-5 mo. Available evidence strongly suggests that infection following sexual intercourse, usually but not always with a new partner, was instrumental in the initiation of the disease. The term sexually acquired reactive arthritis (SARA) was suggested to emphasize the mode of acquisition of the disease. Similar syndromes are seen associated with gut infection. Usage of the term Reiter''s syndrome is correctly applied to only those cases which exhibited the characteristic triad of urethritis, arthritis and conjunctivitis with or without other cutaneous and mucous membrane lesions. Thirty-six of the 54 patients who were HLA typed (67%) possessed the antigen HLA-B27. Of 30 who presented directly to a rheumatology unit 25 (83%) were HLA-B27 positive. The other 24 patients initially attended a venereology clinic and only 11 (46%) of these bore the antigen. This appears to reflect disease severity. HLA-B27 positive patients had a significantly longer duration of disease symptoms and a higher frequency of extra-articular manifestations, than those lacking this antigen.