What is reactive arthritis?

Reactive arthritis (formerly known as Reiter’s Syndrome) is a type of joint inflammation that occurs after certain types of infections (usually gastrointestinal or sexually transmitted infections), even though the germ that caused the infection is not found in the joint itself.

Causes

Most cases of reactive arthritis are associated with two types of bacterial infections:

intestinal infections caused by Salmonella, Shigella, Campylobacter, Yersinia, Escherichia coli, and Clostridioides difficile
genital infections caused by Chlamydia trachomatis

In addition to the underlying infection, it is believed that a genetic predisposition is necessary for the development of the disease.

Symptoms

The main symptom of reactive arthritis is pain and swelling in certain joints, particularly the knees, ankles, and feet. Less commonly, the cervical and lumbar spine or the sacroiliac joint may be affected, which can manifest as lower back pain or buttock pain.

As with other spondyloarthropathies, it is common to observe inflammation of tendons and entheses (the site where tendons and ligaments attach to bone), as well as diffuse swelling of a finger (dactylitis).

The most frequent extra-articular manifestations include:

eye inflammation (conjunctivitis or uveitis)
genitourinary symptoms (pain during urination, urethritis, or cystitis)
oral lesions, including mouth ulcers
skin manifestations, such as: peeling of the palms and soles (called keratoderma blennorrhagicum), nail changes similar to those seen in psoriasis, genital lesions (e.g., circinate balanitis)
very rarely, cardiac manifestations, particularly involving the heart valves

Diagnosis

There are no specific tests for diagnosing reactive arthritis. The diagnosis is made clinically.

Prevention

Prevention of sexually transmitted and gastrointestinal infections.

Treatment

Most patients experience a limited course of the disease, with good response to non-steroidal anti-inflammatory drugs (NSAIDs). Resistant cases may benefit from the use of corticosteroids for a short period of time. In rare cases of chronic or recurrent disease, other medications may be necessary, such as: Sulfasalazine, methotrexate and Biologic drugs targeting TNF-alpha (anti-TNF agents)

By the Einstein Editorial Board