The Don Julio’s mexican restaurant in Corinth, Mississippi has been linked to at least 59 confirmed Salmonella illnesses, and likely many more unconfirmed illnesses. If the existing medical literature on the subject is accurate, the Don Julio’s Salmonella outbreak will cause many of those victims–between 6 and 30%, according to some studies–to develop a condition called reactive arthritis.
Reactive Arthritis refers to a group of arthritic diseases that includes a subset formally known as “Reiter’s Syndrome” The old term Reiter’s syndrome has fallen into disfavor. In recent medical literature Reiter’s Syndrome is simply referred to as Reactive Arthritis which may or may not be accompanied by extraintestinal manifestations.
Reactive Arthritis is the name used to describe an uncommon, but potentially debilitating group of symptoms that follows a gastrointestinal, genitourinary, or viral infection. The most common gastrointestinal bacteria involved are Salmonella, Campylobacter, Yersinia, Shigella, E. coli, and Vibrio. The most common genitourinary causes are sexually transmitted diseases such as Chlamydia and Gonorrhea. The most common viral causes are the common flu, HIV, and Parvovirus.
The specific triad of arthritis, conjunctivitis, and urethritis was known as Reiter’s Syndrome. In many patients however only one or two of these symptoms many be present, such as arthritis and urethritis or arthritis and conjunctivitis. (Hill Gaston & Lillicrap, 2003). A reactive arthritis may develop after a person eats food that has been tainted with the pathogenic bacteria. Many patients will get severe bloating, abdominal pain, and watery diarrhea. However in some patients, the initial infection may be milder and not easily recognized, but the reactive arthritis may still occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis) or several joints (oligoarthritis), preferentially affecting those of the lower extremities. The most common joints affected are the knees and ankles. The pattern of joint involvement is usually asymmetric. Inflammation can also be commonly seen at an enthesis (a places where ligaments and tendons attach to bone), especially the front of the knee or the back of the ankle where the Achilles attaches to the calcaneal bone. This is referred to as an enthesopathy. It causes local swelling and pain with walking or exercise.
Salmonella has been the most frequently studied bacteria associated with reactive arthritis. Overall, studies have found rates of Salmonella-associated reactive arthritis to vary between 6 and 30% (Hill Gaston, & Lillicrap, 2003). The frequency of post-infectious Reiter’s syndrome specifically, however, has not been well described. In a Washington State study of an outbreak of food-borne Salmonella gastroenteritis, 29% of patients developed arthritis, but only 3% developed the triad of symptoms associated with Reiter’s syndrome (Dworkin, et al., 2001). In addition, individuals of Caucasian descent may be more likely than those of Asian descent to develop reactive arthritis (McColl, et al., 2000), and children may be less susceptible than adults to reactive arthritis following infection with Salmonella (Rudwaleit, et al., 2001).