• Clinical science

Reactive arthritis (Reiter syndrome)

Summary

Reactive arthritis, (formerly known as Reiter's syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondyloarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously.

Epidemiology

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[1]

Clinical features

The classic triad of reactive arthritis (formerly called Reiter's syndrome) consists of urethritis, conjunctivitis, and arthritis, but it is only present in about a third of cases!

Can't see, can't pee, can't climb a tree!

References:[1][2]

Diagnostics

References:[1][2][3][4]

Differential diagnoses

Differential diagnoses of infection-associated arthritis
Condition: Septic arthritis Lyme disease Reactive arthritis

At-risk groups

  • People commonly involved in outdoor activities (e.g., hunters, farmers, hikers), especially in summer months

Onset and course

  • Acute course with rapid onset of symptoms
  • Progressive onset that can become chronic
  • Acute onset
  • Typically resolves within 6 months, although 20–30% become chronic
  • Often self-limiting

Clinical features

  • Three stages:

Pattern of disease

  • Primarily monoarthritis, oligoarthritis is possible
  • Migratory asymmetrical polyarthropathy
    • Intermittent or persistent arthritis
    • Generally in large joints (especially knee or elbow)
  • Mono- or oligoarthritis
  • Predominately lower extremities (especially knee)
  • Migratory character if associated with gonococcal infection

References:[5][6][2][7][8][4]

The differential diagnoses listed here are not exhaustive.

Treatment

There is no curative treatment. The goal of treatment is to primarily control symptoms as the disease is usually self-limiting.

References:[2][4]

Prognosis

  • Resolves spontaneously within a year (80% of cases)
  • High rate of recurrence (15–50% of cases)

References:[4]

  • 1. Barth WF, Segal K. Reactive arthritis (Reiter's syndrome). http://www.aafp.org/afp/1999/0801/p499.html. Updated August 1, 1999. Accessed March 16, 2017.
  • 2. Yu DT. Reactive Arthritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/reactive-arthritis. Last updated July 21, 2016. Accessed March 16, 2017.
  • 3. Hill Gaston JS, Lillicrap MS. Arthritis associated with enteric infection. http://europepmc.org/abstract/MED/12787523. Updated April 1, 2003. Accessed March 16, 2017.
  • 4. Lozada CJ. Reactive Arthritis. In: Diamond HS. Reactive Arthritis. New York, NY: WebMD. http://emedicine.medscape.com/article/331347. Updated November 21, 2016. Accessed March 16, 2017.
  • 5. Brusch JL. Septic Arthritis. In: Stuart Bronze M. Septic Arthritis. New York, NY: WebMD. http://emedicine.medscape.com/article/236299. Updated October 21, 2016. Accessed March 1, 2017.
  • 6. Hu L. Clinical Manifestations of Lyme Disease in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-lyme-disease-in-adults. Last updated August 17, 2016. Accessed March 13, 2017.
  • 7. Smith BG, Cruz AI, Milewski MD, Shapiro ED. Lyme disease and the orthopaedic implications of Lyme arthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656475/. Updated February 1, 2011. Accessed March 16, 2017.
  • 8. Richie AM, Francis ML. Diagnostic approach to polyarticular joint pain. http://www.aafp.org/afp/2003/0915/p1151.html. Updated September 15, 2003. Accessed March 16, 2017.
  • Herold G. Internal Medicine. Cologne, Germany: Herold G; 2014.
  • Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education; 2015.
  • Tidy C. Aeactive Arthritis. http://patient.info/doctor/reactive-arthritis-pro. Updated February 24, 2015. Accessed March 16, 2017.
  • [No authors listed]. Syphilitic arthritis. JAMA. 1973; 224(5 Suppl): p. 755. pmid: 4739751.
  • Ruan XC, Lim JH, Tey HL. Acute Inflammatory Polyarthritis: A Rare Presentation of Secondary Syphilis. Ann Acad Med Singapore. 2017; 46(2): pp. 72–73. pmid: 28263344.
  • Li R, Hatcher JD. Gonococcal Arthritis. StatPearls. 2019. pmid: 29261865.
  • Ghanem KG. Chapter 46: Disseminated Gonococcal Infection. In: Imboden JB, Hellmann DB, Stone JH, eds. Current Diagnosis & Treatment in Rheumatology, Third Edition. Third Edition, ed. New York: McGraw-Hill Education / Medical; 2013.
last updated 06/29/2020
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