What is reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection. [6, 7] ReA has been associated with gastrointestinal (GI) infections with ShigellaSalmonellaCampylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis).

ReA was described by the German physician Hans Reiter in 1916, [8]  and for a time the disorder was known as Reiter syndrome. This eponym is no longer used, because of Reiter’s activities as a Nazi war criminal, and also because his was not the first description of ReA, and it mischaracterized the pathogenesis. [9, 10]

As currently understood, the term ReA encompasses the older concepts of complete and incomplete reactive arthritis and a clinical syndrome of arthritis with or without extra-articular features that develop within 1 month of infectious diarrhea or GU infection. The classic triad associated with this condition comprises noninfectious urethritis, arthritis, and conjunctivitis (though this triad is not found in all cases).

ReA is frequently associated with the human leukocyte antigen (HLA)–B27 (HLA-B27) haplotype and is classified in the category of seronegative spondyloarthropathies, which includes ankylosing spondylitispsoriatic arthritis, the arthropathy of associated inflammatory bowel disease, juvenile-onset ankylosing spondylitis, juvenile chronic arthritis, and undifferentiated spondyloarthritis. [11]

A study by Kaarela et al reported that ReA and ankylosing spondylitis appear to be identical. [12] When assessing long-term outcomes of reactive arthritis and ankylosing spondylitis to identify similarities in manifestations of disease, the investigators found a number of similarities. Among these was the determination that sacroiliitis, peripheral arthritis, and iritis developed most often in both chronic ReA and ankylosing spondylitis.

Most ReA patients are young men. Young children tend to have the postdysenteric form, whereas adolescents and young men are most likely to develop ReA after a genitourinary infection. Some authors, interpreting the mucocutaneous findings as pustular psoriasis and the seronegative arthritis as psoriatic arthritis, believe that ReA is best classified as a type of psoriasis. [13]

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