THE POSSIBLE ROLE OF SHIGELLA IN SPORADIC ENTERIC REACTIVE ARTHRITIS

Reactive arthritis (ReA) occurs after a urogenital infectionusually with Chlamydia trachomatis or an enteritis due to Yer-sinia,Salmonella, Campylobacter or Shigella, Shigella, except duringepidemics, is not considered to be a frequent cause of entericreactive arthritis. However this might be due to the lack ofa reliable antibody test, which makes diagnosis difficult. Wecompared synovial and peripheral blood lymphocyte proliferationto various bacterial antigens in 19 consecutive patients withReA or undifferentiated oligoarthritis. In five patients Shigellawas identified as the causative microbe by a specific synoviallymphocyte proliferation. All five patients had a history ofsymptomatic diarrhoea and had negative stool cultures by thetime arthritis developed. Four of the five were HLA B 27 positive.We conclude that Shigella may be underestimated as a cause ofnon-epidemic ReA. KEY WORDS: Reactive arthritis, Shigella, Antigen specific lymphocytes, Synovial fluid