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Reactive Arthritis

  • Thomas Bardin
Chapter

Abstract

Reactive arthritis (ReA) is a form of spondyloarthropathy which associates with the HLA-B27 antigen and can be defined as a sterile inflammatory arthritis triggered by an infection generally due to a limited number of strict or facultative intracellular pathogens. The two main types of infection are sexually transmitted and intestinal. The clinical course typically includes an oligoarticular arthritis involving large joints of the lower limbs and various extra-articular features, including urethritis, conjunctivitis, and skin or mucosal features. Incomplete forms are frequent, and reactive arthritis may present as an isolated or undifferentiated arthritis. Diagnosis is challenging and relies on the demonstration of the causal infection. Chlamydia, the main cause of sexually acquired reactive arthritis, should be searched by molecular biology techniques in the first morning void of urine. Serology is much less useful for the diagnosis of Chlamydia- or intestinal infection-related reactive arthritis because serological tests lack specificity. The arthritis seems to be related to the presence of infectious components in the involved joints, but the standard bacteriological tests are negative. Clinical course is often prolonged, and the long-term outcome is darkened by frequent relapses and the possibility of development of a chronic arthritis or of ankylosing spondylitis. Poor outcomes are associated with the HLA-B27 carriage, and their frequency varies across the various triggering infections.

There is very little data about the microbiota of reactive arthritis patients.

Management relies on symptomatic medicines, sterilization of the portal of entry in Chlamydia-related arthritis, as well as evaluation for and treatment of other sexually transmittable infections. Long-term treatment by an association of antibiotics has been found helpful in one study of Chlamydia arthritis, whereas no evidence of the benefits of antibiotics has been reported in other types of reactive arthritis. Disease-modifying drugs, such as sulfasalazine or methotrexate, and TNFα blockers are used in chronic reactive arthritis.

Keywords

Reactive arthritis Spondyloarthritis Microbiota Chlamydia Chlamydia trachomatis Chlamydia pneumoniae Yersinia Salmonella Shigella Campylobacter Antibiotics Spondyloarthropathy HLAB27 

Abbreviations

ARA

American Rheumatism Association

DNA

Deoxyribonucleic acid

EB

Elementary body

HIV

Human immunodeficiency virus

HLA

Human leucocyte antigen

IL

Interleukin

INF-γ

Interferon gamma

RB

Reticular body

ReA

Reactive arthritis

RNA

Ribonucleic acid

SpA

Spondyloarthropathy

STI

Sextually transmitted infection

STReA

Sexually transmitted reactive arthritis

TH

T helper cell

TNF

Tumor necrosis factor

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Authors and Affiliations

  1. 1.INSERM U1132, Rheumatology DepartmentLariboisière Hospital Paris and University Paris DiderotParisFrance

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