Overview
Sexually acquired reactive arthritis (SARA) is a form of reactive arthritis that develops following a genitourinary infection, typically caused by sexually transmitted pathogens 1. It is characterized by peripheral arthritis, often affecting the lower limbs, and can be accompanied by other symptoms such as urethritis, conjunctivitis, and skin lesions 1.Diagnosis
Diagnosis is primarily clinical, based on the presence of peripheral arthritis (especially oligoarthritis of lower limbs) in a patient with a history of genitourinary infection 1.
Urethral or cervical swabs for nucleic acid amplification testing (NAAT) for Chlamydia trachomatis* should be performed in all patients with suspected SARA 1.
Consider testing for other sexually transmitted infections (STIs) and enteric pathogens if indicated by clinical presentation 1.
HLA-B27 testing may be considered but is not diagnostic 1.Management
Treatment focuses on managing symptoms and treating the underlying infection if still present 1.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of symptomatic treatment 1.
Intra-articular corticosteroid injections can be used for severe joint inflammation 1.
Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or methotrexate may be considered for persistent or severe disease 1.
Antibiotic treatment is generally not indicated for established SARA unless there is evidence of ongoing infection 1.Key Recommendations
Perform urethral or cervical swabs for Chlamydia trachomatis NAAT in all patients with suspected sexually acquired reactive arthritis 1. (Evidence: Strong)
NSAIDs are the first-line treatment for symptomatic relief of arthritis in sexually acquired reactive arthritis 1. (Evidence: Strong)
Consider DMARDs like sulfasalazine or methotrexate for patients with persistent or severe symptoms of sexually acquired reactive arthritis 1. (Evidence: Moderate)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