Summary about Disease
Yersinia pseudotuberculosis arthritis is a reactive arthritis that occurs as a complication following infection with the bacterium Yersinia pseudotuberculosis. Reactive arthritis is a type of arthritis triggered by an infection in another part of the body. While *Y. pseudotuberculosis* primarily causes gastrointestinal illness, in some individuals, it can trigger an autoimmune response affecting the joints, leading to arthritis.
Symptoms
Symptoms typically appear after the initial Y. pseudotuberculosis infection (usually gastroenteritis) has subsided. Common symptoms include:
Joint pain and swelling, typically in the large joints of the lower extremities (knees, ankles, hips)
Stiffness, particularly in the morning
Tenderness in the affected joints
Limited range of motion in the affected joints
Eye inflammation (uveitis, conjunctivitis) can occur
Skin lesions (erythema nodosum) may develop
Urethritis (inflammation of the urethra) may occur, though less common than in other forms of reactive arthritis.
Causes
The arthritis is caused by an autoimmune reaction triggered by a prior Yersinia pseudotuberculosis* infection, usually gastroenteritis.
The exact mechanism is not fully understood, but it is believed that bacterial antigens trigger an immune response that cross-reacts with joint tissues.
Certain genetic factors, such as HLA-B27, increase the risk of developing reactive arthritis following Yersinia infection. However, most people with *Yersinia* infection do not develop arthritis.
Medicine Used
Treatment focuses on managing the symptoms of arthritis and, if needed, eradicating any lingering Yersinia infection. Medicines used may include:
Antibiotics: If Y. pseudotuberculosis infection is still present (rare at the time arthritis develops), antibiotics like doxycycline, tetracycline, trimethoprim-sulfamethoxazole, or fluoroquinolones may be used. However, antibiotics are generally not effective for the arthritis itself, as it is an autoimmune reaction.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen, or other NSAIDs are used to reduce pain and inflammation.
Corticosteroids: Prednisone or other corticosteroids may be used for more severe cases of arthritis to reduce inflammation. Can be given orally or injected into the joint.
Disease-modifying antirheumatic drugs (DMARDs): In chronic cases, DMARDs like sulfasalazine or methotrexate may be used to suppress the immune system and reduce inflammation.
Biologic Agents: In severe or refractory cases, TNF inhibitors or other biologic agents might be considered.
Is Communicable
The Yersinia pseudotuberculosis* infection itself is communicable, primarily through contaminated food or water.
However, the reactive arthritis that follows is not directly communicable. It is an autoimmune response within an individual. You cannot "catch" arthritis from someone who has reactive arthritis.
Precautions
To prevent Yersinia pseudotuberculosis infection, which can lead to reactive arthritis:
Practice good hygiene: Wash hands thoroughly and frequently, especially before eating and after using the restroom.
Food safety: Cook food thoroughly, especially pork, which is a common source of Yersinia. Avoid consuming raw or undercooked pork.
Water safety: Drink clean, safe water.
Avoid cross-contamination: Use separate cutting boards and utensils for raw and cooked foods.
If you develop symptoms of Yersinia infection (gastroenteritis), seek medical attention promptly.
How long does an outbreak last?
The initial Yersinia pseudotuberculosis* infection (gastroenteritis) typically lasts from a few days to several weeks.
The reactive arthritis that follows usually develops weeks after the initial infection.
The duration of the arthritis varies. In many cases, it is self-limiting and resolves within a few months to a year. However, in some individuals, it can become chronic and persist for years.
How is it diagnosed?
Diagnosis involves:
Clinical evaluation: Assessment of symptoms, medical history (including recent gastrointestinal illness), and physical examination of the joints.
Laboratory tests:
Stool culture or PCR to detect Yersinia pseudotuberculosis (usually done early in the course of the initial infection).
Blood tests: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to assess inflammation. Complete Blood Count (CBC)
Testing for HLA-B27 (a genetic marker that increases risk)
Synovial fluid analysis: If fluid can be aspirated from an affected joint, it can be analyzed to rule out other causes of arthritis (e.g., septic arthritis).
Imaging studies: X-rays or other imaging studies (MRI, ultrasound) may be used to assess joint damage or inflammation.
Timeline of Symptoms
1. Initial Infection: Ingestion of Yersinia pseudotuberculosis through contaminated food or water. 2. Gastroenteritis: Typically develops within a few days to a week of infection. Symptoms include abdominal pain, diarrhea, fever, and vomiting. Lasts days to weeks. 3. Latent Period: After the gastroenteritis resolves, there is a latent period of usually 1-4 weeks or longer. 4. Arthritis Onset: Joint pain and inflammation develop weeks or months after the initial infection. Symptoms typically involve the large joints of the lower extremities (knees, ankles, hips). 5. Other Symptoms: Eye inflammation (uveitis, conjunctivitis) and/or skin lesions (erythema nodosum) may appear around the same time as the arthritis or shortly after.
Important Considerations
Reactive arthritis due to Yersinia pseudotuberculosis* is relatively uncommon.
Early diagnosis and treatment of the initial Yersinia infection may reduce the risk of developing reactive arthritis.
The arthritis is an autoimmune response, so treatment focuses on managing inflammation and pain.
While many cases of reactive arthritis resolve within months, some individuals may develop chronic arthritis requiring long-term management.
Individuals with HLA-B27 are at increased risk for reactive arthritis following Yersinia infection, and also chronic arthritis.
Consult with a rheumatologist for proper diagnosis and management of Yersinia-related reactive arthritis.