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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 spondyloarthropathies, 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.

Long-term (3 to 6 months) antibiotics may help Chlamydia-induced ReA but does not affect the course of ReA associated with enteric pathogens.

Over 50% of patients have a self-limited course lasting 2 to 6 months, 30% have recurrent episodes, and 10% to 20% have a chronic course requiring immunosuppressive therapy.

Reiter’s syndrome:

As originally described in 1916, Reiter’s syndrome is the clinical triad of conjunctivitis, nongonococcal urethritis, and arthritis following an infectious dysentery. Reiter’s syndrome, a term no longer used, is now considered to be a form of ReA because two thirds of patients do not have all three features of this triad.

Iinfectious 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