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Rheumatology65 papers

Reactive arthritis

Last edited: 4/14/2026

Overview

Reactive arthritis is an inflammatory arthritis triggered by infections, often involving the genitourinary or gastrointestinal tracts, leading to symptoms such as arthritis, conjunctivitis, and urethritis. It can affect individuals of all ages, with variations in presentation and severity 172.

Diagnosis

  • Key Diagnostic Criteria: Asymmetric oligoarthritis, urethritis/cervicitis, conjunctivitis 718.
  • Recommended Tests:
    • - Serological tests for triggering pathogens (e.g., Chlamydia, Salmonella, Yersinia) 11838. - HLA-B27 testing, particularly in patients with prolonged symptoms or atypical presentations 1444.
  • Imaging: Ultrasound may reveal synovitis or tenosynovitis 625.
  • Differential Diagnosis: Consider other forms of inflammatory arthritis, including ankylosing spondylitis and psoriatic arthritis 1724.

    • Management

  • First-Line Treatments:
    • - Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 124. - Early treatment of underlying infection with appropriate antibiotics (e.g., doxycycline for Chlamydia) 11538.
  • Adjunctive Treatments:
    • - Corticosteroids for severe cases or resistant symptoms 124. - Disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine or methotrexate in refractory cases 124.

    Special Populations

  • Pediatrics: Reactive arthritis can occur in children, often following infections like Cryptosporidium or Yersinia 227.
  • Elderly: Specific considerations for comorbidities and drug interactions; management similar to adults but tailored to individual health status 15.
  • Comorbidities: Patients with HLA-B27 may have more severe or chronic presentations requiring closer monitoring 1444.

    • Key Recommendations

  • Identify and Treat Underlying Infection: Early diagnosis and treatment of the triggering infection are crucial for managing reactive arthritis (Evidence: Strong 115).
  • Use NSAIDs for Symptom Control: NSAIDs should be initiated early to manage pain and inflammation effectively (Evidence: Moderate 124).
  • Consider HLA-B27 Testing: Particularly useful in patients with prolonged symptoms or atypical presentations to guide management (Evidence: Moderate 1444).
  • Monitor for Complications: Regular follow-up to detect and manage complications such as uveitis or carditis (Evidence: Expert opinion 2131).
  • Tailored Management in Special Populations: Adjust treatment plans considering age, comorbidities, and specific triggers (Evidence: Expert opinion 2275).

    • References

    1 Carlin E, Marzo-Ortega H, Flew S. British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. International journal of STD & AIDS 2021. link 2 Tugelbayeva А, Ivanova R, Goremykina М, Rymbayeva Т, Toktabayeva B. REACTIVE ARTHRITIS IN CHILDREN (REVIEW). Georgian medical news 2021. link 3 Hayes KM, Hayes RJP, Turk MA, Pope JE. Evolving patterns of reactive arthritis. Clinical rheumatology 2019. link 4 Sumiyoshi R, Koga T, Tsuji S, Endo Y, Takatani A, Shimizu T et al.. Chlamydia-induced reactive arthritis diagnosed during gout flares: A case report and cumulative effect of inflammatory cytokines on chronic arthritis. Medicine 2019. link 5 Brinster A, Guillot X, Prati C, Wendling D. Evolution over thirty years of the profile of inpatients with reactive arthritis in a tertiary rheumatology unit. Reumatologia clinica 2018. link 6 Muşetescu AE, Florea M, ForŢofoiu MC, Bumbea AM, Tudorancea AD, Criveanu C et al.. Streptococcal tonsillitis related reactive arthritis - clinical, ultrasound imaging and immunohistochemical study. Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 2017. link 7 Carlin E, Flew S. Sexually acquired reactive arthritis. Clinical medicine (London, England) 2016. link 8 Mason E, Foster R, Wray L, McNulty A, Donovan B. Reactive arthritis following a Microsporidia infection. International journal of STD & AIDS 2016. link 9 Spaska G. Heart left ventricle's diastolic function features in patients with reactive arthritis. Likars'ka sprava 2013. link 10 Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet's disease. From the description of 198 cases found in the literature. Clinical rheumatology 2013. link 11 Kumar Digge V, Meena S, Khan SA, Mittal R. Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter syndrome. Chinese journal of traumatology = Zhonghua chuang shang za zhi 2012. link 12 Kobayashi S, Ichikawa G. Reactive arthritis induced by tonsillitis: a type of 'focal infection'. Advances in oto-rhino-laryngology 2011. link 13 Madge SN, James C, Selva D. Bilateral dacryoadenitis: a new addition to the spectrum of reactive arthritis?. Ophthalmic plastic and reconstructive surgery 2009. link 14 Yates JA, Stetz LC. Reiter's syndrome (reactive arthritis) and travelers' diarrhea. Journal of travel medicine 2006. link 15 Rihl M, Köhler L, Klos A, Zeidler H. Persistent infection of Chlamydia in reactive arthritis. Annals of the rheumatic diseases 2006. link 16 Mesci E. Coexistence of osteopoikilosis with reactive arthritis: a case report. Rheumatology international 2006. link 17 Kohnke SJ. Reactive arthritis. A clinical approach. Orthopedic nursing 2004. link 18 Schneider JM, Matthews JH, Graham BS. Reiter's syndrome. Cutis 2003. link 19 Panush RS, Paraschiv D, Dorff RE. The tainted legacy of Hans Reiter. Seminars in arthritis and rheumatism 2003. link 20 Wallace DJ, Weisman MH. The physician Hans Reiter as prisoner of war in Nuremberg: a contextual review of his interrogations (1945-1947). Seminars in arthritis and rheumatism 2003. link 21 Kobayashi S, Tamura N, Ikeda M, Sakuraba K, Matsumoto T, Hashimoto H. Uveitis in adult patients with poststreptococcal reactive arthritis: the first two cases reported associated with uveitis. Clinical rheumatology 2002. link 22 Tupchong M, Simor A, Dewar C. Beaver fever--a rare cause of reactive arthritis. The Journal of rheumatology 1999. link 23 Bryant GA. Reiter's syndrome. Orthopedic nursing 1998. link 24 Toivanen A, Toivanen P. Reactive arthritis. Current opinion in rheumatology 1996. link 25 Kobayashi S, Tamura N, Akimoto T, Ichikawa G, Xi G, Takasaki Y et al.. Reactive arthritis induced by tonsillitis. Acta oto-laryngologica. Supplementum 1996. link 26 Kirchner JT. Reiter's syndrome. A possibility in patients with reactive arthritis. Postgraduate medicine 1995. link 27 Cron RQ, Sherry DD. Reiter's syndrome associated with cryptosporidial gastroenteritis. The Journal of rheumatology 1995. link 28 Verschuren F, Hainaut P, Delhaye L, Rodzynek JJ. Poststreptococcal reactive arthritis: a form of acute rheumatic fever in adulthood. Acta clinica Belgica 1995. link 29 Rothschild B. Reactive arthritis and Reiter's syndrome. Comprehensive therapy 1994. link 30 Thomas DG, Roberton DM. Reiter's syndrome in an adolescent girl. Acta paediatrica (Oslo, Norway : 1992) 1994. link 31 Huppertz HI, Sandhage K. Reactive arthritis due to Salmonella enteritidis complicated by carditis. Acta paediatrica (Oslo, Norway : 1992) 1994. link 32 Gran JT, Hjetland R, Andreassen AH. Pneumonia, myocarditis and reactive arthritis due to Chlamydia pneumoniae. Scandinavian journal of rheumatology 1993. link 33 Tamura N, Kobayashi S, Hashimoto H, Hirose S. Reactive arthritis induced by Vibrio parahaemolyticus. The Journal of rheumatology 1993. link 34 Tuncer T, Arman MI, Akyokus A, Bütün B, Unal S. HLA B27 and clinical features in Reiter's syndrome. Clinical rheumatology 1992. link 35 Luqmani RA, Dawes PT. Yersinia arthritis with erythema nodosum. Postgraduate medical journal 1986. link 36 Sehgal VN, Koranne RV, Shyam Prasad AL. Unusual manifestations of Reiter's disease in a child. Dermatologica 1985. link 37 Golding DN, Robertson MH. Reactive arthritis due to Salmonella schwarzengrund in a patient with asymptomatic spondylitis. British journal of rheumatology 1985. link 38 Goh BT, Morgan-Capner P, Lim KS. Isolation of Chlamydia trachomatis from prostatic fluid in association with inflammatory joint or eye disease. The British journal of venereal diseases 1983. link 39 Seedat YK, Duminiet H. Reiter's syndrome in black patient. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1982. link 40 Pönkä A, Martio J, Kosunen TU. Reiter's syndrome in association with enteritis due to Campylobacter fetus ssp. jejuni. Annals of the rheumatic diseases 1981. link 41 Weiss JJ, Thompson GR, Good A. Reiter's disease after Salmonella typhimurium enteritis. The Journal of rheumatology 1980. link 42 Good AE. Reiter's disease: modern concepts. Cutis 1979. link 43 Pajarre R, Kero M. Nail changes as the first manifestation of the HLA-B27 inheritance. A case report. Dermatologica 1977. link 44 . Reiter's syndrome. California medicine 1966. link

    Original source

    1. [1]
      British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. — Carlin E, Marzo-Ortega H, Flew S International journal of STD & AIDS (2021)
    2. [2]
      REACTIVE ARTHRITIS IN CHILDREN (REVIEW). — Tugelbayeva А, Ivanova R, Goremykina М, Rymbayeva Т, Toktabayeva B Georgian medical news (2021)
    3. [3]
      Evolving patterns of reactive arthritis. — Hayes KM, Hayes RJP, Turk MA, Pope JE Clinical rheumatology (2019)
    4. [4]
      Chlamydia-induced reactive arthritis diagnosed during gout flares: A case report and cumulative effect of inflammatory cytokines on chronic arthritis. — Sumiyoshi R, Koga T, Tsuji S, Endo Y, Takatani A, Shimizu T et al. Medicine (2019)
    5. [5]
      Evolution over thirty years of the profile of inpatients with reactive arthritis in a tertiary rheumatology unit. — Brinster A, Guillot X, Prati C, Wendling D Reumatologia clinica (2018)
    6. [6]
      Streptococcal tonsillitis related reactive arthritis - clinical, ultrasound imaging and immunohistochemical study. — Muşetescu AE, Florea M, ForŢofoiu MC, Bumbea AM, Tudorancea AD, Criveanu C et al. Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie (2017)
    7. [7]
      Sexually acquired reactive arthritis. — Carlin E, Flew S Clinical medicine (London, England) (2016)
    8. [8]
      Reactive arthritis following a Microsporidia infection. — Mason E, Foster R, Wray L, McNulty A, Donovan B International journal of STD & AIDS (2016)
    9. [9]
      Heart left ventricle's diastolic function features in patients with reactive arthritis. — Spaska G Likars'ka sprava (2013)
    10. [10]
      Clinical features of Poncet's disease. From the description of 198 cases found in the literature. — Rueda JC, Crepy MF, Mantilla RD Clinical rheumatology (2013)
    11. [11]
      Spontaneous atraumatic dislocation of sternoclavicular joint in Reiter syndrome. — Kumar Digge V, Meena S, Khan SA, Mittal R Chinese journal of traumatology = Zhonghua chuang shang za zhi (2012)
    12. [12]
      Reactive arthritis induced by tonsillitis: a type of 'focal infection'. — Kobayashi S, Ichikawa G Advances in oto-rhino-laryngology (2011)
    13. [13]
      Bilateral dacryoadenitis: a new addition to the spectrum of reactive arthritis? — Madge SN, James C, Selva D Ophthalmic plastic and reconstructive surgery (2009)
    14. [14]
      Reiter's syndrome (reactive arthritis) and travelers' diarrhea. — Yates JA, Stetz LC Journal of travel medicine (2006)
    15. [15]
      Persistent infection of Chlamydia in reactive arthritis. — Rihl M, Köhler L, Klos A, Zeidler H Annals of the rheumatic diseases (2006)
    16. [16]
      Coexistence of osteopoikilosis with reactive arthritis: a case report. — Mesci E Rheumatology international (2006)
    17. [17]
      Reactive arthritis. A clinical approach. — Kohnke SJ Orthopedic nursing (2004)
    18. [18]
      Reiter's syndrome. — Schneider JM, Matthews JH, Graham BS Cutis (2003)
    19. [19]
      The tainted legacy of Hans Reiter. — Panush RS, Paraschiv D, Dorff RE Seminars in arthritis and rheumatism (2003)
    20. [20]
      The physician Hans Reiter as prisoner of war in Nuremberg: a contextual review of his interrogations (1945-1947). — Wallace DJ, Weisman MH Seminars in arthritis and rheumatism (2003)
    21. [21]
      Uveitis in adult patients with poststreptococcal reactive arthritis: the first two cases reported associated with uveitis. — Kobayashi S, Tamura N, Ikeda M, Sakuraba K, Matsumoto T, Hashimoto H Clinical rheumatology (2002)
    22. [22]
      Beaver fever--a rare cause of reactive arthritis. — Tupchong M, Simor A, Dewar C The Journal of rheumatology (1999)
    23. [23]
      Reiter's syndrome. — Bryant GA Orthopedic nursing (1998)
    24. [24]
      Reactive arthritis. — Toivanen A, Toivanen P Current opinion in rheumatology (1996)
    25. [25]
      Reactive arthritis induced by tonsillitis. — Kobayashi S, Tamura N, Akimoto T, Ichikawa G, Xi G, Takasaki Y et al. Acta oto-laryngologica. Supplementum (1996)
    26. [26]
      Reiter's syndrome. A possibility in patients with reactive arthritis. — Kirchner JT Postgraduate medicine (1995)
    27. [27]
      Reiter's syndrome associated with cryptosporidial gastroenteritis. — Cron RQ, Sherry DD The Journal of rheumatology (1995)
    28. [28]
      Poststreptococcal reactive arthritis: a form of acute rheumatic fever in adulthood. — Verschuren F, Hainaut P, Delhaye L, Rodzynek JJ Acta clinica Belgica (1995)
    29. [29]
      Reactive arthritis and Reiter's syndrome. — Rothschild B Comprehensive therapy (1994)
    30. [30]
      Reiter's syndrome in an adolescent girl. — Thomas DG, Roberton DM Acta paediatrica (Oslo, Norway : 1992) (1994)
    31. [31]
      Reactive arthritis due to Salmonella enteritidis complicated by carditis. — Huppertz HI, Sandhage K Acta paediatrica (Oslo, Norway : 1992) (1994)
    32. [32]
      Pneumonia, myocarditis and reactive arthritis due to Chlamydia pneumoniae. — Gran JT, Hjetland R, Andreassen AH Scandinavian journal of rheumatology (1993)
    33. [33]
      Reactive arthritis induced by Vibrio parahaemolyticus. — Tamura N, Kobayashi S, Hashimoto H, Hirose S The Journal of rheumatology (1993)
    34. [34]
      HLA B27 and clinical features in Reiter's syndrome. — Tuncer T, Arman MI, Akyokus A, Bütün B, Unal S Clinical rheumatology (1992)
    35. [35]
      Yersinia arthritis with erythema nodosum. — Luqmani RA, Dawes PT Postgraduate medical journal (1986)
    36. [36]
      Unusual manifestations of Reiter's disease in a child. — Sehgal VN, Koranne RV, Shyam Prasad AL Dermatologica (1985)
    37. [37]
      Reactive arthritis due to Salmonella schwarzengrund in a patient with asymptomatic spondylitis. — Golding DN, Robertson MH British journal of rheumatology (1985)
    38. [38]
      Isolation of Chlamydia trachomatis from prostatic fluid in association with inflammatory joint or eye disease. — Goh BT, Morgan-Capner P, Lim KS The British journal of venereal diseases (1983)
    39. [39]
      Reiter's syndrome in black patient. A case report. — Seedat YK, Duminiet H South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (1982)
    40. [40]
      Reiter's syndrome in association with enteritis due to Campylobacter fetus ssp. jejuni. — Pönkä A, Martio J, Kosunen TU Annals of the rheumatic diseases (1981)
    41. [41]
      Reiter's disease after Salmonella typhimurium enteritis. — Weiss JJ, Thompson GR, Good A The Journal of rheumatology (1980)
    42. [42]
      Reiter's disease: modern concepts. — Good AE Cutis (1979)
    43. [43]
      Nail changes as the first manifestation of the HLA-B27 inheritance. A case report. — Pajarre R, Kero M Dermatologica (1977)
    44. [44]
      Reiter's syndrome. California medicine (1966)
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