Skip to Main Content

ESSENTIALS OF DIAGNOSIS

  • Inflammatory arthritis, developing within days to weeks of gastrointestinal or genitourinary infection, considered to be a form of spondyloarthritis.

  • Pattern of arthritis is an asymmetric mono- or oligoarthritis tending to affect the lower extremities, associated with enthesitis and dactylitis.

  • May have extra-articular findings, including ocular inflammation and skin manifestations, particularly keratoderma blennorrhagicum and circinate balanitis.

  • Many patients have resolution by 6 months, but can result in a chronic arthritis.

  • First-line treatment is nonsteroidal anti-inflammatory drugs (NSAIDs), followed by glucocorticoids and nonbiologic disease-modifying antirheumatic drugs (DMARDs).

  • Antibiotic therapy is not of clear benefit once infection has resolved, but antibiotics may have a role in Chlamydia-induced arthritis.

GENERAL CONSIDERATIONS

Reactive arthritis (ReA) is a form of inflammatory arthritis that develops days to weeks following an infection, typically involving the gastrointestinal or genitourinary sites. The etiologic agent is most often a bacterial infection, but other types of pathogens can also lead to ReA. Although infection is thought to trigger the disease, organisms are generally not recovered from affected joints, and identification of the specific antecedent infection is not always possible. There are no widely accepted classification or diagnostic criteria for ReA, but proposed criteria require a clinical diagnosis of either a mono- or oligoarthritis following a microbiologically confirmed enteric or genitourinary infection (Kingsley and Sieper, 1996). ReA is generally considered to be a form of spondyloarthritis, a group of disorders that tend to affect the axial skeleton and periarticular structures as well as peripheral joints. Other spondyloarthritides include ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated spondyloarthritis.

The term “reactive arthritis,” once known as Reiter syndrome, was used in the past to refer to the classic constellation of peripheral arthritis, conjunctivitis, and urethritis or cervicitis. However, it is now recognized that only a subset of patients with ReA present with the full triad of symptoms. ReA is generally characterized by a mono- to oligoarticular arthritis, often of the lower extremities. ReA can also be associated with axial skeleton involvement (particularly the lumbar spine and sacroiliac joints), enthesitis, dactylitis, and extra-articular manifestations that are typical of other forms of spondyloarthritis. The symptoms are often acute and self-limited, resolving within weeks to months, but some patients develop a chronic inflammatory arthritis (symptoms lasting longer than 6 months).

ReA predominantly affects young adults (usual range 20–40 years old) more frequently than children. Both men and women are affected, but ReA resulting from genitourinary infections occurs more commonly in men. Most cases are sporadic, but clusters of ReA cases following outbreaks of foodborne illness have been reported. ReA is the least common of the spondyloarthritis variants, particularly in the United States. Reported incidence and prevalence is variable (reported global incidence between 0.6 and 27 per 100,000), depending on geographic location, methodology for identifying preceding infection, and definition of ReA used (Courcoul et al, 2018). The incidence of ReA after ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.