Reactive arthritis associated with campylobacter enteritis.

Sm, Eastmond and his colleagues' really should not compare chalk with cheese. They studied patients infected in a single explosive outbreak of campylobacter enteritis, all presumably due to the same strain of Campylobacter jejuni. We studied cases occurring sporadically, diagnosed but not necessarily infected, within the Harrow Heath District, and probably caused by numerous different Campylobacter subtypes. There are other differences between the 2 studies, such as the likely rates of hospitalisation in a rural area south of Aberdeen and in urban Harrow, and the results reviewing the histories and examinations of hospitalised patients compared with perusal of general practice records. In any case, differences in the frequency of inflammatory joint disease following bowel infection are a feature of the extensive literature and need not lead to suggestions of bias. The main purpose of our communication was to emphasise the need to culture faeces of all cases of possible reactive arthritis. In the year following our study Campylobacter species were found in the faeces of 4 new cases of reactive arthritis. One was a trainee hotel manager about to start three months' practical work in the hotel kitchen, and he continued to excrete campylobacter for 2 months. Two patients and their partners were given some reassurances that the previous firm diagnosis of sexually acquired reactive arthritis could not be substantiated.