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Reactive arthritis or post-infectious arthritis?

Timo Hannu1, Robert Inman, Kaisa Granfors

  • 1Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. timo.hannu@ttl.fi

Best Practice & Research. Clinical Rheumatology
|June 17, 2006
PubMed
Summary

Reactive arthritis is an inflammatory joint condition following infection, often asymptomatic. While antibiotics treat underlying infections, they don't cure established arthritis, with many patients experiencing recurrent episodes or chronic spondyloarthritis.

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Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Reactive arthritis, first described in 1969, is sterile inflammatory arthritis following remote infections, typically gastrointestinal or urogenital.
  • Evidence of microbial components in joints blurs the line between reactive and post-infectious arthritis.
  • No universally agreed diagnostic criteria exist, relying heavily on clinical presentation.

Purpose of the Study:

  • To define reactive arthritis and its diagnostic challenges.
  • To explore diagnostic methods for triggering infections.
  • To discuss treatment efficacy and long-term outcomes.

Main Methods:

  • Clinical diagnosis based on acute oligoarticular arthritis developing 2-4 weeks post-infection.
  • Identification of triggering infections via cultures (stool, urogenital) or ligase chain reaction for Chlamydia trachomatis.

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  • Serological tests for previous infection, though lacking standardization.

    • Main Results:

    • Triggering infections can be asymptomatic in 25% of patients.
    • Cultures and PCR are most effective for early diagnosis; serology is used later.
    • Antibiotic treatment is effective for Chlamydia but not for established arthritis.
    • Long-term outcomes show recurrence in 25-50% and chronic spondyloarthritis in 25%.

    Conclusions:

    • Reactive arthritis diagnosis is primarily clinical, supported by identifying the preceding infection.
    • While treating the infection is crucial, antibiotics do not cure established reactive arthritis.
    • Prognosis varies, with a significant portion developing recurrent arthritis or chronic spondyloarthritis.