Reactive arthritis (ReA) is an inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. Patients with ReA may give a history of an antecedent infection 1 to 4 weeks before onset.
Presenting features include fever, peripheral and axial arthritis, enthesitis (inflammation where tendons insert into bone), dactylitis (swelling of an entire finger or toe), conjunctivitis and iritis, and skin lesions including circinate balanitis and keratoderma blennorrhagicum.
The peripheral arthritis in ReA is usually an asymmetrical oligoarticular arthritis affecting the large joints of the lower limb, although monoarticular and polyarticular arthritis can also occur.
There is no specific test for diagnosing ReA. Rather, a group of tests is used to confirm the suspicion in someone who has clinical symptoms suggestive of an inflammatory arthritis in the post-venereal or post-dysentery period.
Treatment is aimed at symptomatic relief and preventing or halting further joint damage. Typical agents include non-steroidal anti-inflammatory drugs, corticosteroids, and disease-modifying antirheumatic drugs.
Approximately 30% to 50% of patients will go on to develop some form of chronic ReA.
Reactive arthritis (ReA) is an inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. The classical triad of post-infectious arthritis, non-gonococcal urethritis, and conjunctivitis is frequently described but found only in a minority of cases and not required for diagnosis.
ReA belongs to the spondyloarthropathy family of inflammatory rheumatic diseases that also includes psoriatic arthritis, ankylosing spondylitis, arthritis related to inflammatory bowel disease, and undifferentiated spondyloarthropathy. These diseases share similar clinical, radiographic, and laboratory features, such as spinal inflammation and an association with HLA-B27.
History and exam
Key diagnostic factors
- presence of risk factors
- peripheral arthritis
- axial arthritis
Other diagnostic factors
- constitutional symptoms
- mucous membrane involvement
- skin rash
- circinate balanitis
- ocular manifestations
- cardiac manifestations
- male sex
- HLA-B27 genotype
- preceding chlamydial or gastrointestinal infection
- BCG immunotherapy
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- antinuclear antibody (ANA)
- rheumatoid factor
- urogenital and stool cultures
- plain x-rays
- arthrocentesis with synovial fluid analysis
Investigations to consider
- nucleic acid amplification tests
persisting or chronic reactive arthritis
- Ankylosing spondylitis (AS)
- Psoriatic arthritis
- Rheumatoid arthritis (RA)
- British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021
- ACR appropriateness criteria: chronic extremity joint pain - suspected inflammatory arthritis
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