The evolving story of Chlamydia-induced reactive arthritis

There have been tremendous recent insights into our understanding of the epidemiology, pathophysiology, and treatment of Chlamydia-induced reactive arthritis (CiReA). Some of these advances embellish our previous understanding of CiReA, whereas others suggest that a change in the paradigm is required.

Epidemiological data suggest that we are underdiagnosing CiReA and emerging data suggest that asymptomatic chlamydial infections might be a common cause. Although the clinical manifestations of CiReA are indistinct from the postenteric variety, there appear to be important differences in the pathophysiology of these clinically congruent entities. The hallmark difference pertains to synovial-based viable chlamydial organisms, although in an aberrant state, known as chlamydial persistence. Specific chlamydial serovars appear to be causative of CiReA. Emerging potential therapies include antitumor necrosis factor treatment and combination antibiotics. However, the data with the former are particularly scant and there are theoretical concerns with their use in this setting. Recent data regarding prolonged combination antibiotics are particularly encouraging.

A history of a chlamydial infection may prove to be a poor guide for the diagnosis of CiReA and prolonged combined antimicrobial therapy could be an effective treatment strategy.