Reactive arthritis

Reactive arthritis is non-infectious inflammation of the joints that develops in response to an infectious disease located outside the joint within a few days/weeks. We classify it among the group of spondyloarthritis, therefore also reactive arthritis has common manifestations, which are typical for this group of diseases:


 * binding to positivity HLA-B27
 * more frequent eye damage (uveitis, conjunctivitis)
 * more frequent enthesitis
 * skin and mucous membrane damage (aphthae, erythema nodosum,...)
 * changes in the axial skeleton are only a late consequence
 * increased sedimentation and CRP

Etiology and Pathogenesis
Genetic factors play a role (96 % pac. HLA-B27 pozitivních) + infections of the gastrointestinal tract: (salmonella, shigella, yersinie, Campylobacter jejuni), urogenital infection: (Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum) and infections of the respiratory system. Sometimes without a previous detectable infection.

General manifestations
Twitching, fatigue, temperature.

Musculoskeletal manifestations

 * Asymmetric mono-/oligoartritis (max. 4 joints) with predilection localization of the supporting joints; affected joints reddish + warmer;
 * enthesopathy, which can lead to movement provision interfusion of the tendon insertion on a bone (Achilles tendon, plantar fasciitis)

Cutaneous manifestations
Keratoderma blenorrhagicum (peeling skin of the palms or soles similar to psoriasis like patches) and balanitis.

UGT symptoms
Sterile urethritis - Reiter's syndrome - ( arthritis, urethritis , conjunctivitis, etc.); ocular findings may progress to episcleritis, corneal ulcers and hl. anterior uveitis.

Diagnosis

 * Oligoarthritis of the supporting joints affecting younger individuals following an infection in UGT / GIT
 * lab. higher: unspecified markers of inflammation in the acute phase high (FW, CRP, mucoproteins, ELFO proteins), serology (detection of antibodies against microorganisms), higher. effusion (different from septic arthritis);
 * X-ray: mostly negative, sometimes in the chronic phase of the disease sacroiliitis;
 * complete Reiter's syndrome: arthritis + urethritis + conjunctivitis (complete triad is rather rare);
 * incomplete Reiter's syndrome: arthritis + 1 more symptom; there may also be enthesitis, skin and mucosal ulceration, periostitis.

Differential diagnosis

 * Arthritis uratica;
 * Rheumatoid arthritis;
 * Infectious purulent arthritis.

Therapy
Individual, based on NSA, for heavier forms glucocorticoids (initial dose 30–50 mg with a gradual decrease; for recurrent joint effusions intra articularly); ATB (for isolating infectious agents / sometimes also with positive serology); basal medicamentations (in chronic course with higher activity; sulfasalazin 2–3 g, MTX 10–20 mg/week).

Prognosis
Mostly good, but in a some patients the transition leads to chronicity. (imminent m. Bechtěrev).

Related articles

 * Chlamydial infections of the genitals
 * Psoriatic arthritis
 * Ankylosing spondylarthritis