Yersinia-induced arthritis and Reiter's syndrome.

In 1975 a study was initiated in Vancouver to determine the prevalence of yersinia-induced arthritis. British Columbia has a population of 21 million. About 1 million reside in Greater Vancouver, in which are located 10 rheumatologists who co-operated in the study. Sera from all patients whose acute or subacute arthritis was of unexplained origin were examined for agglutinins against the six most commonly encountered yersinial serotypes. Four cases of 'yersinia-related' arthritis were diagnosed by serological evidence from a group of 28 cases of 'acute undiagnosed arthritis'. None of the four cases had erythema nodosum and none had the clinical manifestations of RS. In addition, the testing of stored RS sera showed no yersinial agglutinins. The findings of this study have been reported.'16 In the year after the above study a continued attempt was made to uncover further cases of yersinial arthritis. Serum samples from patients with arthritis in whom there was a suggestion of an antecedent intestinal infection, or of preceding abdominal symptoms, were forwarded to Dr. S. Toma, Director of the National Reference Service for Yersinia, at the Ontario Ministry of Health Laboratories, Toronto. The case selection was not precisely defined. A statistical evaluation is therefore not possible, but perhaps 20 such cases could be considered as 'postintestinal arthritis'. In fact, only one of these patients was diagnosed as yersinial arthritis, and he had the clinical manifestations of RS. The patient was 28-year-old Chinese man who ate in a restaurant on 10 October 1977. The next day he complained of fever and diarrhoea. About five days later he noted dysuria and a urethral discharge but no ocular or mucocutaneous symptoms. He absolutely denied any recent sexual contacts. The day after the onset of dysuria he complained of pain and swelling of the right elbow and later the right knee, right ankle, and right first carpometacarpal joint. The arthritis gradually subsided over the succeeding three months. He had a Y. enterocolitica type 0:3 serum antibody level of 1:400. He was HLA-B27 positive.