© 1995 British Society for Rheumatology
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REACTIVE ARTHRITIS: UROGENTTAL SWAB CULTURE IS THE ONLY USEFUL DIAGNOSTIC METHOD FOR THE DETECTION OF THE ARTHRITOGENIC INFECTION IN EXTRA-ARTICULARLY ASYMPTOMATIC PATIENTS WITH UNDIFFERENTIATED OLIGOARTHRITIS
Department of Internal Medicine III, Division of Rheumatology, University of Vienna Vienna, Austria
*Department of Microbiology, University of Vienna Vienna, Austria
Department of Dermatology, University of Vienna Vienna, Austria
Correspondence to:
Correspondence to: W. Graninger, Postfach 37, A-1097 Vienna, Austria.
Reactive arthritis (ReA) is a scronegative oligoarthritis triggered by a preceding extra-articular infection. While evidence of a microbial infection is mandatory for establishing the diagnosis of ReA, the sensitivity of bacteriological and serological tests has not been determined in patients without symptoms of infection. In a retrospective study, we evaluated the usefulness of urogenital swab cultures, serology and stool culture to identify infections in 234 patients with undifferentiated oligoarthritis. One hundred and forty-four patients complaining about joint pain who had no sign or history of inflammatory arthritis served as controls. Urogenital swab cultures showed a microbial infection in 44% of the patients with oligoarthritis (15% Chlamydia, 14% Mycoplasma, 28% Ureaplasma), whereas in the control group only 26% had a positive result (4% Chlamydia, 7% Mycoplasma, 21% Ureaplasma) (P < 0.001). A Chlamydia IgG-antibody titre 
1:256 was found in 22% of the patients in the oligoarthritis group and in 9% of the controls (P < 0.01). However, for only half of Chlamydia IgG-positive patients could a Chlamydia infection be confirmed by urogenital swab culture. Twenty-one per cent of patients with oligoarthritis vs 23% of the controls had positive antibody titres for Salmonella (not significant), 15% vs 5% for Yersinia (P < 0.05) and 17% vs 3% for Borrelia IgG (P < 0.01). In two patients, stool cultures were positive for Campylobacter. Urogenital swab culture is a sensitive diagnostic method to identify the triggering infection in ReA. A single determination of antibodies against Chlamydia trachomatis is of limited value because of the high prevalence of positive results in the control group.
KEY WORDS: Reactive arthritis, Oligoarthritis, Urogenital swab culture, Serology, Stool culture, Chlamydia infection
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