From the Research
Reactive arthritis is a disease caused by an extra-articular infection that manifests as a sterile joint inflammation, typically developing in response to an infection elsewhere in the body, usually in the genitourinary or gastrointestinal tract, as noted in the most recent study 1.
Definition and Characteristics
Reactive arthritis is characterized by joint pain and swelling, often accompanied by inflammation of the eyes and urogenital tract, and usually begins within 1-4 weeks after the triggering infection. The primary extra-articular infection in classical reactive arthritis is of bacterial origin and usually affects either the urogenital, gastrointestinal, or respiratory tract, with Chlamydia and enterobacteria being among the most common pathogens causing reactive arthritis 1.
Diagnosis and Treatment
The diagnosis is made on the basis of a typical clinical picture, evidence of a previous or persistent infection, and the exclusion of other causes of arthritis. Treatment includes physical measures, the use of anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) or glucocorticoids, and in the case of persistent arthritis, immunomodulating substances such as sulfasalazine or methotrexate may be used 1.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen or ibuprofen are the first-line treatment for joint pain and inflammation.
- Corticosteroids, such as prednisone, may be prescribed in more severe cases.
- Disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine or methotrexate may be used for persistent symptoms.
- Antibiotics are typically only prescribed if there's evidence of an ongoing infection.
Prognosis and Management
The prognosis for reactive arthritis is generally good, with most cases resolving within 3-12 months, as noted in 2 and 3. However, some patients may experience chronic or recurrent symptoms. Regular follow-up with a rheumatologist is important for monitoring disease activity and adjusting treatment as needed. Understanding that reactive arthritis is an immune-mediated response to infection helps explain its self-limiting nature in most cases and the focus on symptomatic treatment rather than targeting a specific pathogen in chronic cases 4.