The nature of urogenital involvements in female uro-arthritis, with special reference to chlamydial infection.

To study the nature of urogenital involvements in female uro-arthritis 73 consecutive patients with arthritis concomitant with any type of urogenital involvement were examined. The controls were 281 females interviewed only and an additional 83 also gynaecologically examined. A history of cervicitis, salpingitis, dysuria and pyelocystitis/-nephritis occurred significantly more often in patients than in controls. Clinical gynaecological examination revealed cervicitis in 26,8% (19/71) of the patients and 15.7% (13/83) of the controls (p less than 0.05). Aseptic pyuria was definitely more frequent in patients (19/73) than in controls (0/63). The isolation of Chlamydia trachomatis was positive in 14.7% (10/68) of the patients and 3.7% (3/81) of the controls (p less than 0.025). Serological evidence (titre greater than or equal to 64) for chlamydial infection was obtained in 53.4% (39/73) of the patients and 18.2% (14/77) of the controls (p less than 0.00025). The results indicate the importance of urogenital history and findings in females with rheumatic attacks. The most prominent and persistent urogenital involvements were cervicitis, salpingitis, pyuria and dysuria. Chlamydial infection appears in any case to be responsible for part of these involvements (42/73).

Urogenital involvements in female sexual partners of males with Reiter's syndrome.

The occurrence of urogenital involvements in female sexual partners of males with Reiter's syndrome (RS) or suspicion of RS (SRS) was studied. The possible etiological role of Chlamydia trachomatis (Ct) was demonstrated by isolation and by immunofluorescence (IF) serology. Evidence of chlamydial infection (positive isolation and/or IF titre greater than or equal to 64) was found in 35 out of 56 (62,5%) males with RS and in 9 out of 16 (56,3%) males with SRS. 43 female sexual partners of these men were studied. Evidence of present or past chlamydial infection was demonstrated in 23 of these 43 females (53,5%). This was a significantly higher frequency than that evidenced among controls studied, 14/77 verified serologically and 3/81 by isolation, p less than 0.0025 and p less than 0.005, respectively. A history of dysuria occurred in 10 out of 43 female sexual partners and in only 20 out of 364 interviewed randomly selected controls (p less than 0.00025). Abnormal urinary findings were also more frequent among the sexual partners than among the controls (p less than 0.025). The results emphasize the role of Ct as a triggering factor in RS and stress the importance of urogenital investigations among couples with RS.

Musculoskeletal involvements in female sexual partners of males with Reiter's syndrome.

To examine the occurrence of signs and symptoms of Reiter's syndrome (RS) in female sexual partners of males with RS we have investigated 43 female consorts of 42 males, originating from 72 consecutive patients suffering from RS or suspicion of RS (SRS). Anamnestic mono-, oligo- or polyarthritis occurred in 14 of the 43 females (32,6%) as compared to 28 out of 311 randomly selected interviewed controls (9,0%). Five of the 43 females had RS and 7 had SRS, (27,9%). However, the diagnosis could have been possible with only anamnestic information in 6 (14%) as compared to 7 out of 311 controls (2,3%). Taking into consideration the 30 males whose sexual partners were not investigated, the theoretically counted values still differ significantly from those of the controls (p less than 0.01). A history of urogenital and, on the other hand, nasopharyngeal or pulmonary infections involvements preceded equally frequently the first or further joint attacks. Evidence of chlamydial infection was found in 53,5% (32/43) of the partners while Yersinia antibodies measured by ELISA occurred with the same frequency as among healthy blood donors. We would like to stress the importance of various infectious involvements, especially sexually transmitted diseases, as etiological agents in joint attacks in females who are sexual partners of males with RS.

Reiter's syndrome in male sexual partners of females with Reiter's syndrome or suspicion of it.

With sexually transmitted rheumatic diseases in mind we investigated 37 male sexual partners of females with Reiter's syndrome (RS) or suspicion of RS (SRS). Controls were 219 randomly selected interviewed males. A history of urogenital involvements was found in 19/37 (51,4%) as compared to 65/219 (29,7%). Anamnestic nonspecific urethritis, dysuria, gonorrhoea, condylomata acuminata and prostatitis occurred more frequently in the 37 males than in the controls (p less than 0.05 - p less than 0.025). Six out of 37 as compared to 5 of 219 had a history of balanitis (p less than 0.0025). Anamnestic synovitis was found in 8/37 (21,6%) and in 9/219 (4,1%) (p less than 0.001) RS or SRS was diagnosed in 6/37 (16,2%). Taking into consideration the consecutive females with RS or SRS, whose sexual partners were not investigated, the theoretical counting still shows clear differences in the anamnestic occurrence of synovitis and balanitis between the 37 males and the controls (p less than 0.0125 - p less than 0.05). The results emphasize the important role of sexually acquired and maintained RS in rheumatology.

Sebaceous glands in the buccal mucosa in patients with rheumatic disorders.

When seeking oral lesions in patients with rheumatic disorders (RD), the most frequent discernible finding in the buccal mucosa seems to be sebaceous glands (SG). The purpose of the present study was to examine whether or not SG are associated with RD, especially Reiter's syndrome (RS). Observation of SG in the buccal mucosa took place by thorough inspection of 50 males and 80 females suffering from RD. Controls were 237 males and 231 females from an oto-rhino-laryngologic clientèle. Further rheumatological examination was made of 12 males and 7 females from the control group who showed positive SG findings. Biopsies from SG were performed for 9 patients suffering from RS. SG were observed in 24 males (48%) and 35 females (43.8%) among patients with RD and in 19 males (8%) and 8 females (3.7%) in the control group (p less than 0.001). Rheumatological examination of the above-mentioned 12 males and 7 females revealed either a history and/or objective signs of RD, most often RS, in 7 males (58.3%) and 6 females (85.7%). The histological pattern of SG was different from that of the mucocutaneous lesions of RS. The results speak in favour of a close association of oral SG and RD, with a certain emphasis in the direction of RS. SG seem to be an important additional non-specific clinical sign in the protean picture of rheumatic disorders.

Urogenital involvements and musculoskeletal complaints in women. An interview study and clinical investigation with special reference to chlamydial infections.

To study the correlation of urogenital involvements and musculoskeletal complaints in females, 311 randomly selected women, aged 15 to 54, were interviewed. In addition, clinical gynecological examination including isolation and serology of Chlamydia trachomatis (Ct) was performed for 30 consecutive volunteers. A history of musculoskeletal complaints occurred in 218 (70.1%) and a history of urogenital involvements in 244 (78.5%) of the 311 women. The number of urogenital involvements in 218 females with musculoskeletal complaints was 453, a significantly higher frequency than the 120 urogenital involvements in 93 females without musculoskeletal complaints. The most important urogenital involvements appeared to be cervicitis, dysuria, Trichomonas vaginalis infections and pyelocystitis/-nephritis. Regarding the musculoskeletal complaints, histories of unexplained dorsalgia and anamnestic joint pains in the extremities occurred more often in the females with a history of urogenital involvements than in those without such a history. There were anamnestic urogenital involvements in 28 (93.3%) of the 30 volunteers. The clinical investigation revealed gynecological disease in only 16 (53.3%). Isolation of Ct was negative in 29 and contaminated in one. Chlamydial immunofluorescence serology was positive (titre greater than 64) in 5 (16.7%). The results of this study speak for the importance of infections in the genito-urinary tract as a possible triggering factor in rheumatic disorders in females. This conception is supported by the correlation of the musculoskeletal complaints especially with past histories of urogenital involvement. No such correlation was found with recent histories of urinary tract involvements, nor with the actual pathological findings of those gynecologically examined.

Chlamydial infection in a family.

In a family comprising parents and two daughters, Chlamydia trachomatis (CT) was observed to be the infective agent causing urethritis in the father and conjunctivitis in the newborn. CT was probably a trigger factor in Reiter's syndrome (RS) in the mother, who suffered from arthritis, microscopic pyuria and hematuria, cervicitis and ocular manifestations. The elder daughter's mucocutaneous manifestations, probably keratodermia blennorrhagica, broke out simultaneously with chlamydial infections in the other members of the family. Later she developed joint pains, conjunctivitis and vulvitis. The elder daughter and the father are HLA-B27 negative, whereas the mother is HLA-B27 positive. With this study we would like to emphasize the importance of observing the microbial environment in the family in the etiology of rheumatic disease. Simultaneous treatment of infections in family members might benefit the clinical course of rheumatic disease.

Reiter's syndrome in the population. An Interview Study.

To obtain data on the incidence of Reiter's syndrome (RS) as well as on possible simultaneously appearing signs and symptoms of RS in sexual couples we have made interview reports of randomly selected 530 persons: 219 males and 311 females, aged 15 to 54. None had RS. Six males (2.7%) and seven females (2.3%) had a history of probable RS (PRS). Almost all (5/6) female sexual partners of the men with PRS and more than half (4/7) male sexual partners of the women with PRS had a history of urogenital involvement. Twenty-seven men and 54 women said they did not have any sexual partners at that time. Forty (21.5%) of the female sexual partners of the remaining 186 men and likewise 11 male sexual partners (4,4%) of the 250 women had a history of urogenital involvements. Thus the relative risk of urogenital involvement is increased 3.9-fold in females and 13-fold in males who are sexual partners of persons with a history of PRS. Likewise in couples where one of the consorts has a history of PRS the simultaneous occurrence of urogenital involvement in both partners as well as the simultaneous occurrence of joint involvement in one and urogenital involvement in the other consort were registered significantly more frequently than in couples where neither of the consorts has a history of PRS. Sexual partners of persons with PRS even show a tendency to have joint and back pains more frequently than sexual partners of persons lacking a history of PRS. These results emphasize the role of infections in the genito-urinary tracts of sexual couples as a possible channel and reservoir of microbes which may cause, or contribute to, the initiation of and/or repeated attacks of RS. Sexually acquired and maintained rheumatic diseases may be one of the major problems in rheumatology.

Chlamydial isolations and serology in Reiter's syndrome.

To assess the possible etiological link between genital infection due to Chlamydia trachomatis (CT) and Reiter's syndrome (RS) 24 men and 2 women with typical RS and 5 women with signs suggestive of RS (SRS) were examined. CT was isolated by irradiated McCoy cell culture technique and chlamydial indirect immunofluorescence serology was applied. Chlamydial isolation from the urethra was positive in 5 patients as well as from synovial fluid of the knee in one man. The serology was positive (titre greater than or equal to 64) in 17 (55%) of the 31 patients, including all 7 women. HLA-B27 antigen was detected in only 15 of 27 patients (55%). All except one of the 12 patients negative for HLA-B27 antigen had positive chlamydial serology. Among the patients were two married couples, both negative for B27 antigen and positive for chlamydial serology. The case report of the one couple, in which the wife had positive urethral chlamydial isolation, is given. Sexually acquired RS might easily be overlooked in women and be misdiagnosed as seronegative arthritis. The classification for RS associated with CT infection is discussed. The simultaneous treatment of the infection in sexual partners is emphasized.