What is the incidence of reactive arthritis (ReA) in the US?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Data on the incidence and prevalence of ReA are scarce, partly because of a lack of a disease definition and classification criteria; these factors complicate differentiation of ReA from other arthritides. [59] The frequency is estimated to be 3.5-5 cases per 100,000. The incidence reported in US Navy personnel over a 10-year period was 4 cases per 100,000 men per year. The prevalence of ReA may be relatively high among patients with AIDS, especially men who are seropositive for HLA-B27. ReA develops in almost 75% of HIV-positive men with HLA-B27.

An estimated 1-3% of all patients with a nonspecific urethritis develop an episode of arthritis. The incidence is 1-4% after enteric infection. This number jumps to 20-25% after bacterial enteritis in HLA-B27-positive individuals. [41] Prevalence of asymptomatic chlamydial infections, underdiagnosis, and underreporting may make the incidence even higher. [60] It has been noted that worse functional capacity and higher disease activity are observed in the lower socioeconomic classes. [61]

A population-based study assessed ReA after culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon. [62] The estimated incidence after culture-confirmed Campylobacter, Escherichia coli O157, Salmonella, Shigella, and Yersinia infections in Oregon was 0.6-3.1 cases per 100,000 population. ReA may occur in 1.5% of Shigella enterocolitis cases and 25% of HLA-B27–positive Shigella cases. After an outbreak of S enterica serovar Enteritidis, 29% had reactive arthritis. [31]


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