Reactive arthritis

Reactive arthritis
Reactive arthritis of the knee
SpecialtyRheumatology

Reactive arthritis, previously known as Reiter's syndrome,[1] is a form of inflammatory arthritis[2] that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease.[3] By the time a person presents with symptoms, the "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The arthritis often is coupled with other characteristic symptoms; this was previously called Reiter's syndrome, Reiter's disease or Reiter's arthritis. The condition was renamed to reactive arthritis because of Hans Reiter's war crimes with the Nazi Party.

The manifestations of reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Arthritis occurring alone following sexual exposure or enteric infection is also known as reactive arthritis. Affected people may present with mucocutaneous lesions, as well as psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagicum. Enthesitis can involve the Achilles tendon resulting in heel pain.[4] Not all affected persons have all the manifestations.

The clinical pattern of reactive arthritis commonly consists of an inflammation of fewer than five joints which often includes the knee or sacroiliac joint. The arthritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or "migratory" (new joints become inflamed after the initially inflamed site has already improved).[5][6]

Reactive arthritis is an RF-seronegative, HLA-B27-linked arthritis[7] often precipitated by genitourinary or gastrointestinal infections. The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis);[8] however, it also can happen after group A streptococcal infections.[9][10]

It most commonly strikes individuals aged 20–40 years of age, is more common in men than in women, and more common in white than in black people. This is owing to the high frequency of the HLA-B27 gene in the white population.[11][12] It can occur in epidemic form. Patients with HIV have an increased risk of developing reactive arthritis as well.

Numerous cases during World Wars I and II focused attention on the triad of arthritis, urethritis, and conjunctivitis (often with additional mucocutaneous lesions), which at that time was also referred to as Fiessenger–Leroy–Reiter syndrome.[13]

  1. ^ Watson Buchanan, W; Kean, Walter F; Rainsford, K D; Kean, Colin A (February 2024). "Reactive arthritis: the convoluted history of Reiter's disease". Inflammopharmacology. 32 (1): 93–99. doi:10.1007/s10787-023-01336-4. PMID 37805646. Retrieved 31 August 2024.
  2. ^ American College of Rheumatology. "Reactive Arthritis". Retrieved 24 January 2017.
  3. ^ Mayo Staff (5 March 2011). "Reactive Arthritis (Reiter's Syndrome)". Mayo Clinic. Retrieved 16 May 2011.
  4. ^ H. Hunter Handsfield (2001). Color atlas and synopsis of sexually transmitted diseases, Volume 236. McGraw-Hill Professional. p. 148. ISBN 978-0-07-026033-7.
  5. ^ Primer on the Rheumatic Diseases, By John H. Klippel, page 218
  6. ^ Rheumatology in Practice, By J. A. Pereira da Silva, Anthony D. Woolf page 5.9
  7. ^ Ruddy, Shaun (2001). Kelley's Textbook of Rheumatology, 6th Ed. W. B. Saunders. pp. 1055–1064. ISBN 978-0-7216-9033-9.
  8. ^ Siala, Mariam; et al. (2008). "Analysis of bacterial DNA in synovial tissue of Tunisian patients with reactive and undifferentiated arthritis by broad-range PCR, cloning and sequencing". Arthritis Research & Therapy. 10 (2). BioMed Central: R40. doi:10.1186/ar2398. PMC 2453759. PMID 18412942.
  9. ^ Infectious Diseases Immunization Committee (1995). "Poststreptococcal arthritis". The Canadian Journal of Infectious Diseases. 6 (3): 133–135. doi:10.1155/1995/470341. PMC 3327910. PMID 22514384.
  10. ^ "Reactive Arthritis". www.rheumatology.org. Retrieved 18 September 2019.
  11. ^ Sampaio-Barros PD, Bortoluzzo AB, Conde RA, Costallat LT, Samara AM, Bértolo MB (June 2010). "Undifferentiated spondyloarthritis: a longterm followup". The Journal of Rheumatology. 37 (6): 1195–1199. doi:10.3899/jrheum.090625. PMID 20436080. S2CID 45438826.
  12. ^ Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, Kristjansson K, Gudbjornsson B (May 2010). "Prevalence and clinical characteristics of ankylosing spondylitis in Iceland – a nationwide study". Clinical and Experimental Rheumatology. 28 (3): 333–40. PMID 20406616.
  13. ^ Harrison's Rheumatology, Second Edition [Anthony Fauci, Carol Langford], Ch.9 THE SPONDYLOARTHRITIDES, Reactive Arthritis, page.134