ASYMPTOMATIC PYURIA IN WOMEN WITH SPONDYLOARTHRITIS

Background: The spondyloarthropathies are a group of inflammatory arthritic conditions, in which reactive arthritis has been included and may be secondary to urethritis, cervicitis or gastrointestinal infection caused by specific pathogens. Chlamydia trachomatis infections are most often asymptomatic in the general population. Patients with spondyloarthritis sometimes present asymptomatic pyuria and leukocyte esterase. Objectives: To investigate whether women with spondyloarthritis, pyuria and a negative urine culture have a urogenital infectious process triggering the disease or an inflammatory process secondary to the spondyloarthritis. Methods: We investigate in a cross-sectional descriptive study, urinary free symptoms women with a clinical diagnosis of spondyloarthritis according to ASAS-2010 classification criteria presenting with leukocyturia and a positive leukocyte esterase were evaluated in the Urogynecology service in our hospital to perform a cystoscopy and colposcopy with samples for culture and cytology (cervical and urethral). Results: We studied 38 patients with a mean age of 49 (±12) with a clinical diagnosis of undifferentiated spondyloarthritis in 19, psoriatic arthritis in 10, ankylosing spondylitis in 6 and inflammatory bowel disease on 3. Twenty-six patients were colposcopy evaluated and in only one patient a florid vaginosis was found. Cervical cultures were positive for Chlamydia Trachomatis in 6 patients, E. Coli in 6, Staphylococcus spp y Bacillus in 3 each, Gardnerrella vaginalis, Klebsiella and Pseudomona in 1 patient each. Urethral cultures were positive for Chlamydia trachomatis in 12 patients, E. coli in 8, Lactobacilli, Psesudomana, Staphylococcus 4 patients each and Enterococci in 3 patients. The most common cystoscopic findings were increased vasculature in 19 patients, metaplasia in 13, trabeculae in 10, superficial hemorrahage in 5 and urethral stricture in 3. In three patients increased vasculature, petechiae and hemorrhagic points were reported simultaneously. Conclusions: Patients with spondyloarthritis and asymptomatic positive leukocyte esterase can present Chlamydia trachomatis in culture of urethra and/or cervix. Patients who do not have positive culture presented cystoscopic inflammatory changes, which suggests an inflammatory process independent of bacteria. References: 1. Carter J.D., Hudson A.P. Reactive Arthritis: Clinical aspects and medical management. Rheum Dis Clin N Am 35(2009) p21-44 2. Carter J.D. Reactive Arthritis: defined etiologies, emerging, pathophysiology, and unresolved treatment. Infect Dis Clin N Am 20(2006) p827-847 3. Lange U., Berliner M., Ludwig M., Shiefer H.G. and Et all. Ankylosing sponyilitis and infections of the female urogenital tract. Rheumatol Int 17(1998) p181-184 4. Mohammad-Bagher O. and Eley A.R., Is the role of Chlamydia Trachomatis underestimated in patients with suspected Reactive Arthritis?. International Journal Of Rheumatic Disease 13(2010) Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.5678Citation: Annals of the Rheumatic Diseases, volume 73, supplement 2, year 2014, page 1038Session: Spondyloarthritis - clinical aspects (other than treatment) (Abstracts accepted for publication )