Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It encompasses what was formerly called Reiter's syndrome*, a term which described a classic triad of urethritis, conjunctivitis and arthritis following a dysenteric illness during the Second World War.

'Can't see, pee or climb a tree'

Later studies identified patients who developed symptoms following a sexually transmitted infection (post-STI, now sometimes referred to as sexually acquired reactive arthritis, SARA).

Reactive arthritis is defined as an arthritis that develops following an infection where the organism cannot be recovered from the joint (≠ septic arthritis).

It can occur:

• 2° inflammatory bowel disease (equal sex incidence) or enteritis (d/t Salmonella, Shigella, Yersinia, Campylobacter, C. difficile)
• 2° Genitourinary infection (far greater in men) - nongonococcal urethritis 2° chlamydia, ureaplasma

Features

• time course
  • typically develops within 4 weeks of initial infection - symptoms generally last around 4-6 months
  • around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease
• arthritis is typically an asymmetrical oligoarthritis of lower limbs
  • Axial involvement including sacroiliitis, may occur in about 20% of cases.
• dactylitis
• symptoms of urethritis
• eye
  • conjunctivitis (seen in 10-30%)
  • anterior uveitis
• skin
  • circinate balanitis (painless vesicles on the coronal margin of the prepuce)
  • keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles, may mimic pustular psoriasis)

seronegative (RF negative) spondyloarthropathy

associated with HLA-B27

Management