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Reactive arthritis

Last updated: August 22, 2021

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Reactive arthritis, (formerly known as Reiter syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondyloarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously.

Epidemiological data refers to the US, unless otherwise specified.

She Cherishes Cooking Yummy Salmon: Shigella, Chlamydia, Campylobacter, Yersinia, and Salmonella are the most common causes for reactive arthritis.

The classic triad of reactive arthritis consists of urethritis, conjunctivitis, and arthritis, but it manifests in only about a third of affected individuals.

Can't see (conjunctivitis), can't pee (urethritis), can't climb a tree (arthritis).

Reactive arthritis is a clinical diagnosis that may be supported by diagnostic steps, but there is no confirmatory test. [1][5]

Most common infection-associated differentials

Differential diagnoses of infection-associated arthritis [4][6][7]
Condition Reactive arthritis Septic arthritis Lyme disease [8] Syphilitic arthritis
Nongonococcal Gonococcal (disseminated gonococcal infection)
Bacterial pathogen
Risk factors
  • Frequent outdoor activities (e.g., hunters, farmers, hikers)
Onset
  • Acute
  • Acute
  • Variable [10]
  • Progressive
  • Progressive
Clinical features
Distribution pattern
  • Polyarthritis
    • Asymmetrical
    • Migratory
    • Lower body (especially knee)
Treatment

Other

The differential diagnoses listed here are not exhaustive.

There is no curative treatment. The goal of treatment is to primarily control symptoms as the disease is usually selflimiting. Extraintestinal manifestations should be treated as necessary.

  • Resolves spontaneously within a year
  • High rate of recurrence
  1. Hu L. Clinical Manifestations of Lyme Disease in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-lyme-disease-in-adults.Last updated: August 17, 2016. Accessed: March 13, 2017.
  2. Yu DT. Reactive Arthritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/reactive-arthritis.Last updated: July 21, 2016. Accessed: March 16, 2017.
  3. Diagnostic approach to polyarticular joint pain. http://www.aafp.org/afp/2003/0915/p1151.html. Updated: September 15, 2003. Accessed: March 16, 2017.
  4. Lyme disease and the orthopaedic implications of Lyme arthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656475/. Updated: February 1, 2011. Accessed: March 16, 2017.
  5. Ruan XC, Lim JH, Tey HL. Acute Inflammatory Polyarthritis: A Rare Presentation of Secondary Syphilis.. Ann Acad Med Singapore. 2017; 46 (2): p.72-73.
  6. Ghanem KG. Chapter 46: Disseminated Gonococcal Infection. In: Imboden JB, Hellmann DB, Stone JH, eds. Current Diagnosis & Treatment in Rheumatology, Third Edition. Third Edition, ed. McGraw-Hill Education / Medical ; 2013.
  7. Li R, Hatcher JD. Gonococcal Arthritis. StatPearls. 2019 .
  8. Reactive arthritis (Reiter's syndrome). http://www.aafp.org/afp/1999/0801/p499.html. Updated: August 1, 1999. Accessed: March 16, 2017.
  9. Maman E, Bickels J, Ephros M, et al. Musculoskeletal Manifestations of Cat Scratch Disease. Clinical Infectious Diseases. 2007; 45 (12): p.1535-1540. doi: 10.1086/523587 . | Open in Read by QxMD
  10. Apoorva Cheeti; Rebanta K. Chakraborty; Kamleshun Ramphul.. Reactive Arthritis (Reiter Syndrome). StatPearls. 2020 .
  11. Arthritis associated with enteric infection. http://europepmc.org/abstract/MED/12787523. Updated: April 1, 2003. Accessed: March 16, 2017.