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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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Incidence of reactive arthritis and nonspecific arthropathy/arthralgia in active US military personnel 1999 to 2007.
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Figure 2: Incidence of reactive arthritis and nonspecific arthropathy/arthralgia in active US military personnel 1999 to 2007.

Mentions: For both specific ReA and N.A.A, incidence rose with increasing age (Beta = 1.04, p = 0.002 and Beta = 55.68, p = 0.006, respectively). Distribution of cases by age category is shown in Figure 2. Nonspecific arthritis/arthralgia rates increased nearly 10-fold over the age spectrum, from 39.8 per 100,000 (95%CI 36.1-44.0) in the < 20 age group, to 349.7 per 100,000 (95%CI 339.5-360.2) in the > 40 age group. Similar increases were seen for specific ReA diagnoses, from 0.99 per 100,000 (95%CI 0.52-1.82) in the < 20 age group, to 7.09 per 100,000 (95% CI 5.70 - 8.72) in the > 40 age group.


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)

Incidence of reactive arthritis and nonspecific arthropathy/arthralgia in active US military personnel 1999 to 2007.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Incidence of reactive arthritis and nonspecific arthropathy/arthralgia in active US military personnel 1999 to 2007.
Mentions: For both specific ReA and N.A.A, incidence rose with increasing age (Beta = 1.04, p = 0.002 and Beta = 55.68, p = 0.006, respectively). Distribution of cases by age category is shown in Figure 2. Nonspecific arthritis/arthralgia rates increased nearly 10-fold over the age spectrum, from 39.8 per 100,000 (95%CI 36.1-44.0) in the < 20 age group, to 349.7 per 100,000 (95%CI 339.5-360.2) in the > 40 age group. Similar increases were seen for specific ReA diagnoses, from 0.99 per 100,000 (95%CI 0.52-1.82) in the < 20 age group, to 7.09 per 100,000 (95% CI 5.70 - 8.72) in the > 40 age group.

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