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Reactive arthritis associated with Clostridium difficile pseudomembranous colitis
1Division of Internal Medicine and Rheumatology Unit, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel.
Abstract:
Reactive arthritis is associated with several gastrointestinal pathogens, particularly Shigella, Salmonella, Campylobacter, and Yersinia. Another, less well recognized bowel infection leading to reactive arthritis is pseudomembranous colitis, caused by Clostridium difficile. An illustrative case is presented, and the clinical features and characteristics of all reported patients with this association are reviewed. The pathogenesis of the reactive arthritis seems to be related to an immunological response in joints and other tissues against bacterial antigens, which gain access to the systemic circulation through increased intestinal permeability. Therapy with nonspecific antiinflammatory drugs, anticlostridial agents, or a combination of the above is effective. Despite the possibility of persistent articular involvement after gastrointestinal symptoms have subsided, the long-term prognosis seems to be excellent.
Insights
Reactive arthritis can follow Clostridium difficile infection, a less common cause than Shigella or Salmonella. Early treatment with anti-inflammatory or anticlostridial drugs offers an excellent long-term prognosis for patients.
Area of Science:
- Gastroenterology
- Rheumatology
- Infectious Diseases
Background:
- Reactive arthritis is frequently linked to gastrointestinal pathogens like Shigella, Salmonella, Campylobacter, and Yersinia.
- Pseudomembranous colitis caused by Clostridium difficile is an underrecognized cause of reactive arthritis.
Observation:
- This review presents an illustrative case of reactive arthritis secondary to Clostridium difficile infection.
- Clinical features and characteristics of reported patients with this association are analyzed.
Findings:
- The pathogenesis involves an immunological response to bacterial antigens entering the bloodstream via increased intestinal permeability.
- Therapeutic strategies include non-specific anti-inflammatory drugs, anticlostridial agents, or combination therapy.
Implications:
- Effective treatment options exist for reactive arthritis associated with Clostridium difficile.
- While persistent joint issues are possible, the long-term prognosis for this condition is generally excellent.