Arthritis and genital infection in paraplegic patients.

In recent years there has been considerable discussion about the importance of chronic genitourinary infection as a cause of disease of the sacro-iliac joints. Mason, Murray, Oates, and Young (1958) demonstrated that there was a high incidence of chronic prostato-vesiculitis in patients with ankylosing spondylitis. Several observers have found an increased incidence of sacro-iliitis in patients with Reiter's disease (Ford, 1953; Stanworth and Sharp, 1956; Murray, Oates, and Young, 1958; Reynolds and Csonka, 1958; Wright, 1963). A suggestion was put forward that infection might spread by way of the venous system which links the prostate and seminal vesicles with the sacro-iliac joints (Batson, 1942; Grainger, 1959). The possibility that ankylosing spondylitis might be caused by chronic genito-urinary infection has been discussed by several observers (Romanus, 1953; Catterall, 1961). Further evidence in favour of this hypothesis has been brought forward and includes the view that a similar type of sacro-iliitis occurs in patients with paraplegia (Abel, 1950; Lodge, 1956). Mason and others (1958), in a review of the available facts, were of the opinion that chronic genitourinary inflammation was a possible cause of sacro-iliac disease and cited the high incidence of sacro-iliac abnormalities in men with paraplegia, the majority of whom might be expected to have chronic genito-urinary infection, in support of this idea. A leading article in the British Medical J7ournal (1960) put forward arguments along similar lines. There have only been a few detailed investigations into the bone and joint changes in paraplegic patients. The majority of the studies have been retrospective and little or no attempt has been made to correlate the clinical findings. Osteoporosis