Patients with reactive arthritis (ReA) may give a history of an antecedent genitourinary or dysenteric 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
John D. Carter, MD
Professor of Medicine
Division of Rheumatology
University of South Florida College of Medicine
JDC is on the speakers bureau for Abbvie and Amgen. JDC is a co-author of several references cited in this topic.
Dr John D. Carter would like to gratefully acknowledge Dr Jason P. Guthrie, a previous contributor to this topic. JPG declares that he has no competing interests.
J.S.H. Gaston, MA, PhD, BM, BCh, FRCP, FMedSci
Professor of Rheumatology
University of Cambridge
JSHG declares that he has no competing interests.
Luis R. Espinoza, MD
Professor and Chief
Section of Rheumatology
Department of Internal Medicine
LSU Health Sciences Center
LRE is a co-author of several references cited in this topic. Unfortunately, we have since been made aware that Dr Luis R. Espinoza is deceased.
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