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

Curry, Jennifer A.; Riddle, Mark S.; Gormley, Robert; Tribble, David R.; Porter, Chad K.

doi:10.1186/1471-2334-10-266

Cited by 25 publications

(25 citation statements)

References 39 publications

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“…Previous studies using the Defense Medical Surveillance System have identifi ed a higher risk of infl ammatory bowel disease ( 14 ), Guillain-Barr é syndrome ( 15 ), and reactive arthritis ( 16 ) with antecedent episodes of IGE among active duty military benefi ciaries. Th e purpose of this study is to describe the epidemiology of FGDs among this same population, as well as to evaluate the risk of select functional gastrointestinal sequelae aft er an antecedent episode of IGE in a generally healthy population with unrestricted health care access.…”

Section: Resultsmentioning

confidence: 99%

The Incidence and Gastrointestinal Infectious Risk of Functional Gastrointestinal Disorders in a Healthy US Adult Population

Porter

Gormley

Tribble

et al. 2011

American Journal of Gastroenterology

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103

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Section: Resultsmentioning

confidence: 99%

The Incidence and Gastrointestinal Infectious Risk of Functional Gastrointestinal Disorders in a Healthy US Adult Population

Porter

Gormley

Tribble

et al. 2011

American Journal of Gastroenterology

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103

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“…Many mild cases of reactive arthritis are certainly unrecognized and may not present to medical attention ( 1 ). In this case, the duration of time between diarrhea, or at least when it was first recognized and treated, and arthritis symptoms was 23 days.…”

Section: Discussionmentioning

confidence: 99%

A case of reactive arthritis due to Clostridium difficile colitis

Essenmacher

Khurram

Bismack

2016

Journal of Community Hospital Internal Medicine Perspectives

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Reactive arthritis is an acute, aseptic, inflammatory arthropathy following an infectious process but removed from the site of primary infection. It is often attributed to genitourinary and enteric pathogens, such as Chlamydia, Salmonella, Shigella, Campylobacter, and Yersinia, in susceptible individuals. An uncommon and less recognized cause of this disease is preceding colonic infection with Clostridium difficile, an organism associated with pseudomembranous colitis and diarrhea in hospitalized patients and those recently exposed to antibiotics. Recognition of this association may be complicated by non-specific presentation of diarrhea, the interval between gastrointestinal and arthritic symptoms, and the wide differential in mono- and oligoarthritis. We present the case of a 61-year-old, hospitalized patient recently treated for C. difficile colitis who developed sudden, non-traumatic, right knee pain and swelling. Physical examination and radiographs disclosed joint effusion, and sterile aspiration produced cloudy fluid with predominant neutrophils and no growth on cultures. Diagnostic accuracy is enhanced by contemporaneous laboratory investigations excluding other entities such as gout and rheumatoid arthritis and other infections that typically precede reactive arthritis. Contribution of Clostridium infection to reactive arthritis is an obscure association frequently difficult to prove, but this organism is warranted inclusion in the differential of reactive arthritis.

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“…First, an important limitation is that CD diagnoses were based on a medical encounter database, and while we believe our strategy for determining case status is robust based on prior experience with other complex diseases (12, 43–45) it is not possible to review individual medical records to confirm. Additional studies are needed (and being planned) that use clinical procedure codes associated with upper endoscopy and histology, as well as serological evidence from linked Department of Defense serum repository specimens.…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Risk of Celiac Disease in a Healthy US Adult Population

Riddle¹,

Murray²,

Porter³

2012

American Journal of Gastroenterology

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OBJECTIVES Celiac disease (CD) is an increasingly common disease that may affect as many as 1% of the North American population. Recent population-based data suggest a substantial increase in the prevalence of CD over the last several decades. Several factors are hypothesized as possible disease triggers including intercurrent illnesses, such as gastroenteritis, surgeries, and trauma. We used the active duty US military, a unique healthy worker population with essentially complete medical diagnostic coding, as an opportunity to describe trends in CD and deployment-related risk factors. METHODS Using electronic medical encounter data (1999–2008) on active duty US military (over 13.7 million person-years), a matched, nested case–control study describing the epidemiology and risk determinants of CD (based on ≥2 ICD-9 medical encounters) was conducted. Incidence and duration of CD-related medical care were estimated, and conditional logistic regression was utilized to evaluate CD risk following infectious gastroenteritis (IGE) occurring within 3 years before CD diagnosis while controlling for other risk factors. RESULTS A total of 455 incident cases of CD were identified and age, gender, and time matched to 1,820 controls. The incidence of CD increased five-fold from 1.3 per 100,000 in 1999 to 6.5 per 100,000 in 2008, with the highest rates of increase among those over 34 years of age (average annual increase of 0.8 cases per 100,000). A total of 172 IGE episodes, predominately of “viral etiology” (60.5%), were documented. In multivariate models, a significant association between IGE and CD was found (Odds ratio (OR): 2.06, 95% confidence interval (CI) 1.43, 2.97). Risk generally increased with temporal proximity to, and non-viral etiology of, exposure. Other notable risk factors for CD in multivariate models were Caucasian race (OR: 3.1, P < 0.001), non-Army service (OR: 1.5, P = 0.001), and greater than a high-school education (OR: 1.3, P = 0.05). CONCLUSIONS Incidence of CD diagnosis in the US military is increasing, particularly among those in the fourth and fifth decades of life and appears higher than other population-based estimates. An association between antecedent IGE and risk of CD was noted, but the potential for exposure misclassification cannot be ruled out and further study is needed to link pathogen-specific exposure to incident CD anti-gluten antibody development or symptom onset.

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

Cited by 25 publications

References 39 publications

The Incidence and Gastrointestinal Infectious Risk of Functional Gastrointestinal Disorders in a Healthy US Adult Population

The Incidence and Gastrointestinal Infectious Risk of Functional Gastrointestinal Disorders in a Healthy US Adult Population

A case of reactive arthritis due to Clostridium difficile colitis

The Incidence and Risk of Celiac Disease in a Healthy US Adult Population

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