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Reactive arthritis 

Reactive arthritis

Chapter:
Reactive arthritis
Author(s):

J.S. Hill Gaston

DOI:
10.1093/med/9780199204854.003.1908_update_002

August 28, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Pathogenesis—new findings in genetics of ankylosing spondylitis have implications for reactive arthritis.

Updated on 28 Nov 2012. The previous version of this content can be found here.
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date: 28 April 2017

Reactive arthritis is a subset of postinfectious arthritis in which infection, usually of the gastrointestinal or genitourinary tracts, leads to inflammatory arthritis. Following infection, organisms or their components find their way to joints, where they provoke inflammatory immune responses. Whether the responses cross-react with self antigens is unclear; arthritis may be maintained by persistent infection. The disease commonly has specific extra-articular features not seen in other forms of postinfectious arthritis, and is genetically and pathologically a form of spondyloarthritis (see Chapter 19.6).

Clinical presentation—an acute oligoarthritis of weight-bearing joints is a common finding in secondary care, whereas community cases show mild polyarthritis. In addition to synovitis, enthesopathy is common, and extra-articular features include conjunctivitis, keratoderma, balanitis, and mouth ulcers. Urethritis can be reactive and does not necessarily indicate genitourinary infection.

Diagnosis—this depends on a careful history to determine whether there has been preceding infection, followed by examination for enthesopathy and extra-articular features in addition to joint involvement. Definitive proof requires demonstration of recent infection by a triggering organism, using serological, culture, and nucleic acid amplification techniques. In some cases, when the nature of the triggering infection cannot be established, patients may be classified as having undifferentiated spondyloarthritis (see Chapter 19.6).

Management—treatment is with symptomatic measures—nonsteroidal anti-inflammatory drugs, intra-articular steroids, and physiotherapy suffice in most cases. Severe, relapsing, or persistent disease may require methotrexate or sulfasalazine, and occasionally biologic drugs such as TNF inhibitors. Little evidence supports prolonged treatment with antibiotics, although chlamydial infection requires conventional short-term treatment.

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