Relationship between disease activity and infection in patients with spondyloarthropathies

Abstract

Methods: A cross sectional study of 95 non-selected patients with SpA (62 men; mean age 26.4 years), who were examined for signs and symptoms of infection and their association with disease activity. 52 had ankylosing spondylitis (AS), 32 undifferentiated SpA (uSpA), 6 chronic reactive arthritis (ReA), and 5 psoriatic arthritis (PsA). Categorical data were analysed by χ² or Fisher's tests.

Results: 53 (56%) patients had infections: 41 (43%) upper respiratory tract (URT), 34 (36%) enteric, and 20 (21%) genitourinary infections. More infections occurred in HLA-B27 positive patients as a whole (39 v 5; p = 0.003) and in uSpA (12 v 2; p = 0.005). In AS and uSpA, infections occurred in ∼50%. 30/39 (77%) patients with active disease (group A) and 23/56 (41%) (group B) (p = 0.001) had infection. There were more enteric infections in group A (47%; p<0.001) and more URT infections in group B (52%; p = NS). 22/30 (73%) patients attributed disease activity to infection.

Conclusion: Enteric, and less commonly, URT infections in Mexican patients with SpA, particularly those who were HLA-B27 positive, seem to have a role in the active phase of AS and uSpA.

Full Text

The Full Text of this article is available as a PDF (100.5 KB).

Figure 1.

 Overall prevalence of infections according to diagnoses and relative prevalence according to the type of infection. Apart from the groups with ReA and PsA (which contained few patients), the overall prevalence of infection in the SpA, particularly AS and uSpA was around 50%. Whereas intestinal infections predominated in AS, those of the URT occurred more commonly in the other groups.

Figure 2.

 Overall prevalence of infections in 77 HLA-B27 positive (HLA-B27+) or HLA-B27 negative (HLA-B27–) subjects. More infections occurred in HLA-B27+ patients, particularly in the group of SpA as a whole (p = 0.003 in comparison with the prevalence of infections in HLA-B27– subjects) and the subgroup of uSpA (p = 0.005 v B27– subjects with infection).

Figure 3.

 Overall prevalence of infections in active (group A) and inactive (group B) SpA and relative prevalence according to the type of infection. The prevalence of all types of infections and particularly those of the gut were significantly higher in patients with active SpA (p = 0.001 and p<0.001, respectively). Although differences between groups did not reach statistical significance, the prevalence of URT and urinary tract infections was higher in patients with inactive disease.