How are other types of arthritis differentiated from reactive arthritis (ReA)?

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

Gonorrhea and other types of infectious urethritis must be ruled out by means of microbiologic cultures of the urethral exudate. Gonococcal arthritis does not involve the spine. If reactive arthritis (ReA) occurs in a child as a result of a sexually transmitted disease, child protective service evaluation is mandatory.

Rheumatoid arthritis and psoriatic arthritis, as well as ankylosing spondylitis, must be differentiated from ReA. A disease flare of ankylosing spondylitis prompted by a minor diarrheal illness has been described as showing features of ReA. [81]

Septic arthritis and pyogenic arthritis also can mimic ReA. Septic arthritis must be ruled out if suspected before a diagnosis of ReA is made. Oligoarticular and asymmetrical involvement, together with the clinical course, may contribute to the diagnostic suspicion. Failure to treat septic arthritis appropriately in a timely manner could result in joint destruction.

Other seronegative arthritides can be present. The question of how to differentiate these conditions from ReA is academic because they share a common pathophysiologic pathway and similar treatment.

Rheumatic fever and serum sickness are characterized by a course that is more acute than that of ReA.


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