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The epidemiology of infectious gastroenteritis related reactive arthritis in U.S. military personnel: a case-control study.

Curry JA, Riddle MS, Gormley RP, Tribble DR, Porter CK - BMC Infect. Dis. (2010)

Bottom Line: The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S. military population.Specific IGE exposures were documented in 1.4% of subjects.The burden of ReA and strong association with antecedent IGE warrants continued IGE prevention efforts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

ABSTRACT

Background: Reactive arthritis (ReA) is a recognized sequela of infectious gastroenteritis (IGE). However, the population-based incidence of IGE-related ReA is poorly defined, and the risk of disease has not previously been characterized in a military population. The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S. military population.

Methods: Using active duty US military medical encounter data from the Defense Medical Surveillance System, we conducted a matched case-control study to assess the risk of ReA following IGE. Both specific and nonspecific case definitions were utilized to address ICD-9 coding limitations; these included specific ReA (Reiter's Disease or postdysenteric arthritis) and nonspecific arthritis/arthralgia (N.A.A) (which included several related arthropathy and arthralgia diagnoses). Incidence was estimated using events and the total number of active duty personnel for each year.

Results: 506 cases of specific ReA were identified in active duty personnel between 1999 and 2007. Another 16,365 cases of N.A.A. were identified. Overall incidence was 4.1 (95% CI: 3.7, 4.5) and 132.0 (95% CI, 130.0-134.0) per 100,000 for specific ReA and N.A.A, respectively. Compared to the youngest age category, the incidence of both outcomes increased 7-fold with a concurrent increase in symptom duration for cases over the age of 40. Specific IGE exposures were documented in 1.4% of subjects. After adjusting for potential confounders, there was a significant association between IGE and ReA (specific reactive arthritis OR: 4.42, 95% CI: 2.24, 8.73; N.A.A OR: 1.76, 95% CI: 1.49, 2.07).

Conclusions: Reactive arthritis may be more common in military populations than previously described. The burden of ReA and strong association with antecedent IGE warrants continued IGE prevention efforts.

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ReA incidence rate (95%CI) by age, category, and diagnosis.
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Figure 1: ReA incidence rate (95%CI) by age, category, and diagnosis.

Mentions: Between 1999 and 2007 a total of 506 subjects met the specific ReA case definition, including 482 with Reiter's disease (RD) and 32 with postdysenteric arthritis (PA). Eight cases met both the RD and PA case definitions. An additional 16,365 cases met the nonspecific arthritis/arthalgia (N.A.A) case definition. Incidence rates for specific ReA and N.A.A were 4.1 (95% CI: 3.7, 4.5) and 132.0 (95% CI: 130.0, 134.0) per 100,000, respectively. A rising incidence over time of N.A.A was observed (p < 0.0001), while incidence rates for specific ReA remained stable (Figure 1).


The epidemiology of infectious gastroenteritis related reactive arthritis in U.S. military personnel: a case-control study.

Curry JA, Riddle MS, Gormley RP, Tribble DR, Porter CK - BMC Infect. Dis. (2010)

ReA incidence rate (95%CI) by age, category, and diagnosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944352&req=5

Figure 1: ReA incidence rate (95%CI) by age, category, and diagnosis.
Mentions: Between 1999 and 2007 a total of 506 subjects met the specific ReA case definition, including 482 with Reiter's disease (RD) and 32 with postdysenteric arthritis (PA). Eight cases met both the RD and PA case definitions. An additional 16,365 cases met the nonspecific arthritis/arthalgia (N.A.A) case definition. Incidence rates for specific ReA and N.A.A were 4.1 (95% CI: 3.7, 4.5) and 132.0 (95% CI: 130.0, 134.0) per 100,000, respectively. A rising incidence over time of N.A.A was observed (p < 0.0001), while incidence rates for specific ReA remained stable (Figure 1).

Bottom Line: The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S. military population.Specific IGE exposures were documented in 1.4% of subjects.The burden of ReA and strong association with antecedent IGE warrants continued IGE prevention efforts.

View Article: PubMed Central - HTML - PubMed

Affiliation: Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

ABSTRACT

Background: Reactive arthritis (ReA) is a recognized sequela of infectious gastroenteritis (IGE). However, the population-based incidence of IGE-related ReA is poorly defined, and the risk of disease has not previously been characterized in a military population. The intent of this study was to provide estimates of the incidence and morbidity associated with IGE-related ReA in the U.S. military population.

Methods: Using active duty US military medical encounter data from the Defense Medical Surveillance System, we conducted a matched case-control study to assess the risk of ReA following IGE. Both specific and nonspecific case definitions were utilized to address ICD-9 coding limitations; these included specific ReA (Reiter's Disease or postdysenteric arthritis) and nonspecific arthritis/arthralgia (N.A.A) (which included several related arthropathy and arthralgia diagnoses). Incidence was estimated using events and the total number of active duty personnel for each year.

Results: 506 cases of specific ReA were identified in active duty personnel between 1999 and 2007. Another 16,365 cases of N.A.A. were identified. Overall incidence was 4.1 (95% CI: 3.7, 4.5) and 132.0 (95% CI, 130.0-134.0) per 100,000 for specific ReA and N.A.A, respectively. Compared to the youngest age category, the incidence of both outcomes increased 7-fold with a concurrent increase in symptom duration for cases over the age of 40. Specific IGE exposures were documented in 1.4% of subjects. After adjusting for potential confounders, there was a significant association between IGE and ReA (specific reactive arthritis OR: 4.42, 95% CI: 2.24, 8.73; N.A.A OR: 1.76, 95% CI: 1.49, 2.07).

Conclusions: Reactive arthritis may be more common in military populations than previously described. The burden of ReA and strong association with antecedent IGE warrants continued IGE prevention efforts.

Show MeSH
Related in: MedlinePlus