This is an inflammatory condition that occurs after exposure to certain gastrointestinal and genitourinary infections, particularly Chlamydia species, Campylobacter jejuni, Salmonella enteritidis, Shigella, and Yersinia.
Patients may give a history of an antecedent genitourinary or dysenteric infection 1 to 4 weeks before the onset of arthritis.
Presenting features include systemic symptoms such as 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 reactive arthritis (ReA) is usually an asymmetric 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 postvenereal or postdysentery period.
Treatment is aimed at symptomatic relief and preventing or halting further joint damage. Typical agents include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs).
Approximately 30% to 50% of patients will go on to develop some form of chronic ReA.
Keratoderma blenorrhagia in a patient with reactive arthritis
Image provided by the CDC Public Health Image Library
- peripheral arthritis
- axial arthritis
- constitutional symptoms
- mucous membrane involvement
- skin rash
- circinate balanitis
- ocular manifestations
- cardiac manifestations
1st Tests To Order
- C-reactive protein (CRP)
- rheumatoid factor
- urogenital and stool cultures
- plain radiographs
- arthrocentesis with synovial fluid analysis
Other Tests to Consider
- nucleic amplification tests
- nonsteroidal anti-inflammatory drugs (NSAIDs)
persisting or chronic reactive arthritis
- disease-modifying antirheumatic drugs