Reactive arthritis in Adult
See also in: Anogenital,Nail and Distal DigitAlerts and Notices
Synopsis
ReA was initially described after infections with specific bacteria: Chlamydia trachomatis, Shigella, Salmonella, Yersinia, and Campylobacter. However, recent studies have implicated Clostridioides difficile, Giardia, and other atypical infections as triggers for ReA. As in other spondyloarthropathies, ReA is associated with HLA-B27. While the joint fluid in ReA is sterile, bacterial antigens in the synovium (as opposed organisms) are thought to induce an immune response.
Onset is most commonly noted between 20-40 years of age and in those of Caucasian descent. Males and females are equally affected where arthritis follows a gastrointestinal infection, but males are more affected where the condition has been triggered by C trachomatis.
Only a minority of patients present with the "classic" triad of arthritis, urethritis (or cervicitis), and conjunctivitis. ReA usually presents as an acutely painful oligoarthritis (fewer than 5 joints), usually of the lower extremities. Patients can also complain of stiffness and pain of the lower back. Enthesitis (inflamed tendon and ligament insertion points) is especially common, and dactylitis (sausage digits) can also be seen. Conjunctivitis is typically bilateral and mucopurulent.
Mucocutaneous findings include balanitis circinata, circinate vulvitis, keratoderma blenorrhagicum, and oral ulcers.
Patients occasionally have systemic features, including fever, weight loss, and fatigue. Rarely there may be cardiac conduction abnormalities, aortic insufficiency, pericarditis, pleuritis, or nephropathy.
For most patients, ReA is a self-limited disease, and they recover completely within 2-6 months. A chronic arthritis may persist in a minority, usually in association with HLA-B27 phenotype. Other patients can develop recurrent episodes of ReA after encountering the same organism.
Cutaneous involvement has been reported to be more frequent and severe in patients with ReA and HIV/AIDS.
Codes
ICD10CM:M02.30 – Reiter's disease, unspecified site
SNOMEDCT:
67224007 – Reactive arthritis
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Differential Diagnosis & Pitfalls
Joint presentation:- Lofgren syndrome (acute sarcoidosis presenting with bilateral ankle arthritis, erythema nodosum, and bilateral hilar adenopathy)
- Post-streptococcal reactive arthritis
- Acute rheumatic fever
- Gonococcal arthritis (see gonococcemia)
- Psoriatic arthritis
- Inflammatory bowel disease-associated arthritis (see bowel-bypass syndrome, Crohn disease, and ulcerative colitis)
- Rheumatoid arthritis
- Septic arthritis
- Viral-associated arthritis
- Gout
- Calcium pyrophosphate deposition disease (pseudogout)
- Behçet syndrome
- Systemic lupus erythematosus
- Vasculitis
- Trauma
- Lyme arthritis
- Psoriasis with psoriatic arthritis
- Palmoplantar keratoderma
- Candidal balanitis
- Herpes simplex virus (HSV)
- Primary syphilis
- Amebiasis
- Lymphogranuloma venereum
- Granuloma inguinale (donovanosis)
- Chancroid
- Lichen sclerosus
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Last Reviewed:02/20/2019
Last Updated:10/16/2022
Last Updated:10/16/2022
Patient Information for Reactive arthritis in Adult
Overview
Reactive arthritis (formerly called Reiter syndrome) is a type of arthritis triggered by infection. The infection causes an autoimmune reaction of arthritic joint pain, stiffness, and inflammation. The joints often affected are your knees, ankles, and joints in your upper extremities. The arthritis may also occur along the spine and lower back. A small number of patients also have inflammation in the urethra, eyes, and skin.Reactive arthritis is a rare condition that usually goes away on its own in as few as 2-6 months. Less commonly, it can persist beyond 6 months (referred to as chronic reactive arthritis). It can also recur. Foodborne illnesses and sexually transmitted chlamydial infections are both common precursors to reactive arthritis.
Who’s At Risk
Reactive arthritis most commonly affects young adults (aged 20-40). Women and men develop reactive arthritis to foodborne infections at about the same rate, but men have a higher chance of developing reactive arthritis due to sexually transmitted bacteria. A family history of reactive arthritis also increases the likelihood of developing reactive arthritis.The following bacteria have been known to cause reactive arthritis:
- Chlamydia
- Salmonella
- Yersinia
- Campylobacter
- Shigella
- Clostridioides difficile
- Giardia
Signs & Symptoms
The symptoms of reactive arthritis typically begin 1-4 weeks after the initial infection. They may include:- Joint pain and swelling
- Eye inflammation or pink eye
- Increased frequency and discomfort during urination
- Swollen toes and fingers (sausage digits)
- Fever, fatigue, and weight loss
- Changes in fingernails and toenails (ridging, peeling, discoloration)
- Some people have changes in bowel movements, such as diarrhea or constipation
Self-Care Guidelines
These measures can be taken to reduce your risk of developing an infection that could lead to reactive arthritis:- Store food at its proper temperature and cook it properly
- Use condoms to lower your risk of sexually transmitted infections
These measures can be taken to manage symptoms:
- Talk to your doctor about following an anti-inflammatory diet
- Exercise regularly, preferably with activities easy on the joints (swimming, walking, bicycling)
- Do stretching exercises to maintain joint movement and range of motion
When to Seek Medical Care
Contact your health care provider if you have joint pain or swelling for longer than a week.Treatments
If your reactive arthritis is caused by a bacterial infection that is still active, your health care provider may prescribe an antibiotic.To relieve the symptoms of arthritis, the health care provider may recommend:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve inflammation, such as ibuprofen
- Corticosteroid injections into joints to reduce inflammation
- Some types of rheumatoid arthritis drugs help to reduce pain
- Physical therapy to increase strength of joints, joint flexibility, and range of motion
Reactive arthritis in Adult
See also in: Anogenital,Nail and Distal Digit