Reactive arthritis (Reiter’s syndrome)
a term for arthritis following an infection (e.g. rheumatic fever, Reiter’s syndrome)
Epidemiology:
- Relatively rare, with incidence rates varying between 0.6 to 27 per 100,000.
- 90% patients are male between 20-40 years
Aetiology:
- Symptoms manifest days to weeks post-infection, often after the resolution of initial infection symptoms.
- Infectious episode involving either the GI or GU tract
- GI: Shigella, salmonella, campylobacter, Yersinia
- GU: Chlamydia, Mycoplasma
- Acute pattern of clinical course:
- 1-4 weeks post-infection
- Lasts weeks to years (with 1/3 chronic)
- Often recurring
- Spinal involvement persists
Clinical features
- Often characterized by a triad. though not all patients present with this classic triad:
- arthritis
- urethritis
- conjunctivitis
- fever
- Peripheral arthritis, asymmetric pattern
- Axial arthritis
- enthesitis (inflammation where tendons insert into bone)- plantar fasciitis, Achilles tendonitis,
- dactylitis/sausage digits (swelling of an entire finger or toe) – characteristic of reactive and psoriatic arthritis
- conjunctivitis and iritis
- oral ulcers
- diarrhoea
- Keratoderma blennorrhagica (hyperkeratotic skin lesions on palms and soles)
- balanitis circinata (small, shallow, painless ulcers of glans penis) are diagnostic
Diagnosis:
- Clinical
- There is no specific test for diagnosing ReA.
- Lab findings – normocytic, normochromic anaemia and leukocytosis
- Cultures are sterile
Treatment:
- Appropriate antibiotics if there is infection
- Treatment is aimed at symptomatic relief and preventing or halting further joint damage
- NSAIDS, physical therapy, home exercise
- Local therapy – joint protection, intra-articular steroid injection, topical steroid for ocular involvement
- Systemic therapy – corticosteroids, sulfasalazine, methotrexate
Prognosis
- Generally self-limited, with symptoms resolving within 3 to 5 months.
- Approximately 30% to 50% of patients will go on to develop some form of chronic ReA.
Complications
- Potential for recurrent or chronic arthritis, sacroiliitis, urethral stricture, aortic root necrosis, cataracts, and cystoid macular edema