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Reactive arthritis – infectious and immunologic disease

Reactive arthritis (ReA) is a nonpurulent arthritis occuring as an immunologically mediated inflammatory response to an infection localized elsewhere in the body in a certain time period. The disease is usually triggered by a urogenital and intestinal infection. Many authors define Reither syndrome, which includes urethritis, arthritis and conjunctivitis, as ReA. Reactive arthritis occurs most commonly at the age from 16 to 35 yars. HLA B27 antigen is found in 60-80% of persons with postenteric ReA and in 40-60% of persons with postvenereal, Chlamydia trachomatis triggered ReA. The diagnosis of ReA is made relatively easy in HLA B27 positive young persons with monoarthritis or asymmetric oligoarhritis and urogenital or enteral infection occuring within one month period. Enteritis occurs in about half of the patients, at the beginning of the diease in the area of one or both heels or feet. Significant ReA symptoms include mucocutaneous lesions: urethritis, cystitis, vaginitis, cervicitis, prostatitis, acute enterocolitis, conjunctivitis, iritis, erythema nodosum, blennorrhagic keratoderma on palms and sole, balanitis circinata and stomatitis. In some cases, early affection of the heart, aorta and muscular hypotrophy occur. The course and prognosis of ReA is determined by HLA B27 gene and triggering infection. Therefore, it is of great importance to treat the triggering infection and prevent recurring infections by pathogen eradication and nonexposing of patient to new sources of infection. In patients with acute and chronic course of disease, nonsteroidal antirheumatic drugs, physical therapy and intraarticular infiltration of corticosteroids are used. In chronic ReA, the following can be applied: sulfasalazine, methotrexate, gold compounds, chloroquine, azathioprine and cyclosporine, and only rarely synovectomy and orthopedic aids. A team of rheumatologists, infectious disease specialists, immunologists and dermatologists should treat the patient with ReA for at least two years.

reactive arthritis (ReA)

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