Sporadic reactive arthritis in north India: lack of IgA response

Abstract

Objectives: In this hospital based study, we describe the clinical profile and prevalence of IgA antibodies against a panel of bacterial antigens in sera of patients with reactive arthritis (Rea). Methods: Thirty-one patients with Rea were included, 21 with preceding history of diarrhea (eRea) and 10 with symptoms suggestive of genitourinary infection (gRea). Fifty age and sex matched healthy controls from the same community were used as control. Whole bacterial lysate of Salmonella enteritidis, Shigella flexneri 2b, Yersinia enterocolitica 0.3 and Campylobacter jejuni and Escherachia coli were used as antigens. IgA antibodies to Chlamydia trachomatis were assayed using a commercial ELISA kit. Results: The median age at presentation was 28 years (11-52 yrs) and there was male predominance. The median duration of disease was 4 months (15 day – 16 yrs). Majority of patients on follow-up had either chronic (44%) or relapsing (28%) course Sera from 19 patients (11-eRea, 8-gRea) were analysed for antibacterial antibodies. Two patients with history of urethritis had elevated level of IgA antibodies against Chlamydia trachomatis. None of the 11 patients with eRea had raised levels of IgA antibodies against any of the bacterial antigens tested. Conclusion: The clinical profile of sporadic Rea is similar to other parts of the world but the organisms or strains responsible for triggering eRea may be different.