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Reactive arthritis (ReA)

Reactive arthritis (ReA) is a sterile, inflammatory arthritis that is typically preceded by a gastrointestinal or genitourinary infection occurring 1 to 4 weeks previously. Similar to other spondyloarthritis, patients with ReA are more likely to be human leukocyte antigen-B27 (HLA-B27) positive, which portends a worse prognosis and more joint and extraarticular manifestations.

Infectious agents “causing” ReA:

Urogenital

Chlamydia trachomatis, Ureaplasma urealyticum

Enterogenic

Salmonella typhimurium, Salmonella enteritidis, Salmonella Heidelberg, Salmonella choleraesuis


Shigella flexneri, Shigella dysenteriae, Shigella sonnei


Yersinia enterocolitica, Yersinia pseudotuberculosis


Campylobacter jejuni

Others

Clostridium difficile


Chlamydia pneumoniae


Vibrio parahaemolyticus


Borrelia burgdorferi


Neisseria gonorrhoeae


Streptococcus (post-Streptococcal ReA)


Hepatitis C


Giardia lamblia


Mycoplasma

Note: In 40% of ReA patients an infectious agent cannot be identified. Urine PCR for Chlamydia and stool cultures may be helpful in patients with urethritis or diarrhea, respectively. Serologic tests for Chlamydia, Salmonella, and Yersinia can be done depending on the suspected inciting agent.


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Web:

RareDiseases (NORD)

American College of Rheumatology

BMJ BestPractice

Spondylitis Association of America

MedicineNet

MayoClinic

Medscape