2Reactive arthritis
Section snippets
Incidence
Most cases of ReA arise sporadically. Single-source epidemics, in which patients with joint symptoms during and/or after the infection have been traced with questionnaires and/or with clinical investigations, have been reported in association with different gastrointestinal microbes (Table 3, Table 4). In these studies, estimates of the incidence of ReA and frequency with which it occurs following an episode of infection depend, in large part, on how ReA is defined and on the epidemiologic
Clinical picture
There is usually an interval of 1–2 weeks from the start of infection to the onset of musculoskeletal symptoms; in Chlamydia infection, the interval can extend up to 4 weeks. The triggering infection can also be asymptomatic, which can hamper the diagnosis. The ReA patients are usually young adults, with a mean age of nearly 30–40 years. The disease is uncommon in children [32], [40], [41]. Male and female patients have similar risk for the development of ReA induced by gastrointestinal
Investigation
In addition to the typical clinical picture, the diagnosis of ReA relies on the diagnosis of the triggering infection. During the acute phase of enteric infections, isolation is usually possible from the stools. However, by the time arthritic complications appear, the patient may have already recovered from the gastroenteritis and the microbe may no longer be detectable in the faeces. Therefore, the laboratory diagnosis of ReA is often dependent on the detection of specific antibodies in the
Is it necessary to test for HLA-B27?
Nearly 90% of patients with ankylosing spondylitis (AS) carry antigen HLA-B27. Several early studies investigating this connection in ReA patients reported a high frequency (nearly 60–80%) also with this antigen. These figures were founded on hospital-based series, including the most severe cases [47]. In outbreak studies or in epidemiological surveys at population level, only a slight or no increased frequency of HLA-B27 has been reported [20].
In 2002, Sieper et al. published calculations of
Treatment – experience and evidence
First, the treatment of ReA with respect to treatment of the triggering infection and treatment of acute arthritis is discussed. Then, effect of antimicrobial therapy on acute arthritis will be discussed, followed by considering effects of disease modifying antirheumatic drugs (DMARDs) and biologicals. Finally, some novel insights are addressed.
What is the long-term outcome?
The average duration of acute ReA is 3–5 months. Clinically, the duration of arthritis for >6 months is regarded as a sign of development of chronicity.
We summarised the long-term outcome of enteric ReA in this journal in 2006 [7]. Since then, no new clinical studies dealing with this issue have been published. Two older studies have assessed the long-term prognosis of Salmonella-triggered ReA [51], [61]. In an American study with 5 years’ follow-up, one-third of the patients had fully
Acknowledgements
Professor Marjatta Leirisalo-Repo is acknowledged for critically reading the manuscript.
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