Reactive arthritis (RA)
Reactive Arthritis (RA)
Reactive arthritis (RA) is an inflammatory arthritis that develops as a reaction to an infection in another part of the body, commonly the intestines, genitals, or urinary tract. It is sometimes referred to as Reiter’s syndrome when the classic triad of arthritis, conjunctivitis, and urethritis occurs, though not all patients present with all three symptoms simultaneously.
Causes
- Triggered by bacterial infections, most commonly:
- Chlamydia trachomatis (sexually transmitted)
- Enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, Escherichia coli, and Clostridioides difficile
- The triggering infection often resolves before arthritis symptoms appear.
- Genetic predisposition is linked to the HLA-B27 gene, increasing susceptibility.
Symptoms
- Joint symptoms:
- Pain, swelling, and stiffness primarily in large joints of the lower limbs (knees, ankles, feet)
- Enthesitis (inflammation where tendons/ligaments attach to bone), often causing heel pain
- Asymmetric oligoarthritis (affecting fewer than five joints)
- Possible involvement of sacroiliac joints and spine (spondylitis, sacroiliitis)
- Dactylitis (“sausage digits”) with swelling of fingers or toes
- Eye symptoms:
- Conjunctivitis (red, irritated eyes)
- Uveitis (painful inflammation inside the eye causing blurred vision)
- Urinary and genital symptoms:
- Urethritis in men (burning sensation when urinating, discharge)
- Cervicitis in women (inflammation of the cervix)
- Prostatitis in men
- Vulvovaginitis and salpingitis in women
- Skin manifestations:
- Keratoderma blennorrhagicum (scaly rash on palms and soles)
- Circinate balanitis (ring-shaped rash on the penis)
- Nail changes
- Other symptoms:
- Fatigue, fever, weight loss, mouth ulcers, abdominal pain, diarrhea
Symptoms typically begin 1 to 6 weeks after the initial infection and can last from 3 to 12 months, with some cases becoming chronic.
Diagnosis
- Based on clinical history of recent infection and characteristic symptoms.
- Physical examination focusing on joints, eyes, skin, and genitourinary system.
- Laboratory tests: inflammatory markers (ESR, CRP), HLA-B27 testing, and tests to detect triggering infections.
- Imaging (X-rays, MRI) to assess joint inflammation, especially sacroiliitis.
- Exclusion of other causes of arthritis.
Treatment
- Infection control: Antibiotics if active infection is present.
- Symptom management:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.
- Corticosteroids (oral or intra-articular) for severe inflammation.
- Disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine or methotrexate for persistent arthritis.
- Biologic agents (TNF inhibitors) in refractory cases.
- Supportive care: Physical therapy to maintain joint function.
- Most patients recover fully within months, but some develop chronic arthritis requiring long-term management.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Inflammatory arthritis triggered by infection, often post-genitourinary or gastrointestinal infection |
| Common Triggers | Chlamydia trachomatis, Salmonella, Shigella, Yersinia, Campylobacter, E. coli |
| Typical Symptoms | Asymmetric arthritis (knees, ankles, feet), enthesitis, conjunctivitis/uveitis, urethritis/cervicitis, skin rash |
| Genetic Factor | Strong association with HLA-B27 |
| Diagnosis | Clinical history, physical exam, labs (HLA-B27, infection screening), imaging |
| Treatment | NSAIDs, corticosteroids, antibiotics (if infection active), DMARDs, biologics |
| Prognosis | Usually self-limited within 3-12 months; some develop chronic arthritis |
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References
- Johns Hopkins Medicine: Reactive Arthritis
https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/reactive-arthritis - Mayo Clinic: Reactive Arthritis Symptoms & Causes
https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838 - Cleveland Clinic: Reactive Arthritis (Reiter’s Syndrome)
https://my.clevelandclinic.org/health/diseases/reactive-arthritis-reiters-syndrome - NHS: Reactive Arthritis
https://www.nhs.uk/conditions/reactive-arthritis/ - NIAMS: Reactive Arthritis
https://www.niams.nih.gov/health-topics/reactive-arthritis - Arthritis Foundation: Reactive Arthritis
https://www.arthritis.org/diseases/reactive-arthritis - Wikipedia: Reactive Arthritis
https://en.wikipedia.org/wiki/Reactive_arthritis
Reactive arthritis is an autoimmune inflammatory arthritis triggered by certain infections, presenting with joint, eye, and urinary symptoms. With appropriate treatment, most cases resolve within months, though some may become chronic.
