Reactive arthritis

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.[1]Parker CT, Thomas D. Reiter's syndrome and reactive arthritis. J Am Osteopath Assoc. 2000;100:101-104. http://www.ncbi.nlm.nih.gov/pubmed/10732393?tool=bestpractice.com

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.