[Reactive arthritis in enteral infections]

Certain gastrointestinal tract infections can trigger reactive arthritis. The best known triggering agents are yersinia, salmonella, shigella, campylobacter jejuni, and possibly clostridium difficile. The clinical findings show a subacute onset of mono- or oligoarthritis, less often of asymmetric polyarthritis with predominance of the lower limbs. The clinical picture is somewhat modified by the genetic constitution (HLA type) of the patient. HLA-B27-positive patients appear to have more severe symptoms, extraarticular features and incomplete or complete Reiter's syndrome than HLA-B27-negative patients. Diagnosis of postenteritic reactive arthritis is based on bacteriological stool analysis and/or examination of serumantibodies to the corresponding agents. Reactive arthritis is usually self-limiting and therefore treatment of the disease has to be mainly symptomatic. Only more severe chronic or destroying arthritis is thought to be treated locally (i.e. by synoviorthesis) or by immunoregulatory drugs.