A clinical profile of reactive arthritis in a Peruvian series - A pilot study

Enteric pathogens are an endemic cause of acute diarrheal diseases among Pe ruvians. The frequency of HLA-B27 in the general population (0%-3%) is lowe r than that among Caucasians in the United States, Canada, and Europe (6%-1 4%). It was believed that both of these factors were likely to interact to modulate the clinical expression of reactive arthritis (ReA) or Reiter's Sy ndrome (RS). The objective of our study was to define the clinical characte ristics of ReA in a group of patients treated in a general hospital in Lima , Peru. Between December 1, 1976, and June 30, 1993, using a standardized protocol, we studied all patients who presented with peripheral arthritis that occur red within 1 month after urethritis and/or diarrhea. Additional inclusion a nd exclusion criteria were defined to rule out well-known causes of arthrit is. Patients with complete and incomplete RS of undetermined origin were al so included. Fifty-five patients (44 males, 11 females) met established criteria; the me an age at onset was 19 +/- 9.8 years (range 7-51). Fever was the most frequ ent manifestation (63.3%), followed by conjunctivitis/uveitis (61.8%), uret hritis/cervicitis (58.2%), diarrhea (45.5%), and balanitis (14.5%). Keratod erma blennorrhagica was absent. Compared with Caucasians, Peruvians were yo unger at the onset of disease, and their female/male ratio was higher. Addi tionally, the Peruvians experienced a higher frequency of fever and diarrhe a and a lower frequency of balanitis and genitourinary manifestations. Different lines of evidence, including poor public health facilities, the p atients' histories, demographics, and the extra-articular constellation of symptoms and signs, suggest that enteropathogenic microorganisms are at lea st as prevalent as sexually transmitted triggers of ReA in our series. Acco rdingly, clinicians treating patients with ReA in the Third World should ta ilor preventive measures and therapy to address the suspected infectious or igin. Furthermore, the lower frequency of certain extra-articular manifesta tions, such as keratoderma blenorrhagica, uveitis, and enthesopathy, as wel l as a better outcome may be a result of the low frequency of HLA-B27 posit ivity in this population.