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| '''For patient information click [[Arthritis (patient information)|here]]''' | | __NOTOC__ |
| {{DiseaseDisorder infobox |
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| Name = {{PAGENAME}} |
| | '''For patient information click [[Reactive arthritis (patient information)|here]]''' |
| Image = SOA-arthritis.jpg|
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| Caption = Reactive arthritis of the knee following [[Gonorrhea]] infection.|
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| ICD10 = {{ICD10|M|02||m|00}} |
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| ICD9 = {{ICD9|711}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 29524 |
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| MedlinePlus = |
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| MeshName = Arthritis,+Reactive |
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| MeshNumber = C01.539.100.500 |
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| }}
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| {{Reactive arthritis}} | | {{Reactive arthritis}} |
| {{CMG}} | | {{CMG}};{{AE}} |
| ==Overview==
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| [[Reactive arthritis]] (ReA) is an [[autoimmune]] condition that develops in response to an infection in another part of your body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis. <ref>[http://www.mayoclinic.com/health/reactive-arthritis/DS00486 Mayoclinic - reactive-arthritis]</ref> [[Reactive arthritis]] has symptoms similar to [[arthritis]] or [[rheumatism]]. It is caused by another disease, and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection is typically missing in the chronic case.
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| [[Reactive arthritis]] is the combination of three seemingly unlinked [[symptoms]]—an [[inflammatory arthritis]] of large joints, inflammation of the eyes ([[conjunctivitis]] and [[uveitis]]), and [[urethritis]]. A useful mnemonic is "the patient can't see, can't pee and can't climb a tree". It is also known as '''arthritis urethritica''', '''venereal arthritis''' and '''polyarteritis enterica'''. It is a type of seronegative spondyloarthropathy.
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| Reactive arthritis is an [[rheumatoid factor|RF-seronegative]], [[HLA-B27]]-linked [[spondyloarthropathy]] (autoimmune damage to the [[cartilage]]s of [[joint]]s) often precipitated by genitourinary or gastrointestinal [[infection]]s.
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| It most commonly strikes individuals aged 20-40, it is more common in men than in women, and more common in white men than in black men. This is due to white individuals being more likely to have tissue type HLA-B27 than black individuals. People with [[HIV]] have an increased risk of developing reactive arthritis as well. [[Food poisoning]] is a common cause.
| | {{SK}} Reactive arthropathy; Reiter's syndrome; Fiessinger-Leroy disease |
| | ==[[Reactive arthritis overview|Overview]]== |
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| ==History== | | ==[[Reactive arthritis historical perspective|Historical Perspective]]== |
| Reactive arthritis was first described by Hans Reiter, a German military physician, who in 1916 described the disease in a World War I soldier who had recovered from a bout of [[diarrhea]]. The term ''Reiter's syndrome'' is being phased out, partly due to a move in the field of medicine to give descriptive names, rather than personal names, to conditions, and partly due to Dr. Reiter's experiments in Nazi concentration camps. Another reference states Reiter's syndrome is to be used when areas other than joints are affected. | |
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| ==Causes== | | ==[[Reactive arthritis classification|Classification]]== |
| It is set off by a preceding [[infection]], the most common of which would be a genital infection with ''[[Chlamydia trachomatis]]'' in the US. Other bacteria known to cause reactive arthritis which are more common worldwide are ''[[Neisseria gonorrhoeae]]'', ''[[Ureaplasma urealyticum]]'', ''[[Salmonella|Salmonella]]'' spp., ''[[Shigella|Shigella]]'' spp., ''[[Yersinia|Yersinia]]'' spp., and ''[[Campylobacter|Campylobacter]]'' spp.<ref>{{cite journal |author=Hill Gaston JS, Lillicrap MS |title=Arthritis associated with enteric infection |journal=Best practice & research. Clinical rheumatology |volume=17 |issue=2 |pages=219-39 |year=2003 |pmid=12787523 |doi=}}</ref> A bout of [[food poisoning]] or a [[gastrointestinal]] infection may also trigger the disease (those last four [[Genus|genera]] of bacteria mentioned are enteric bacteria). Reactive arthritis usually manifests about 1-3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that RA is caused either by an over-excited autoimmune response or by bacterial antigens which have somehow become deposited in the joints.
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| ==Signs and symptoms== | | ==[[Reactive arthritis pathophysiology|Pathophysiology]]== |
| [[Image:Feet-Reiters syndrome.jpg|thumb|left|200px|Diagnosis revealed that the rash on the bottom of this individual’s feet, known as ''keratoderma blennorrhagica'', was due to Reiter's syndrome' <small>Dr. MF Rein</small>.]] | |
| Symptoms generally appear within 1-3 weeks but can range from 4-35 days from the onset of the inciting episode of the disease.
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| The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination ([[dysuria]]) or an increased need to urinate ([[polyuria]] or [[frequency]]). Other urogenital problems may arise such as [[prostatitis]] in men, and [[cervicitis]], [[salpingitis]] and/or [[vulvovaginitis]] in women.
| | ==[[Reactive arthritis causes|Causes]]== |
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| The [[arthritis]] that follows usually affects the large joints such as the [[knee]]s causing [[Pain and nociception|pain]] and [[swelling]] with relative sparing of small joints such as the wrist and hand.
| | ==[[Differentiating reactive arthritis from other diseases|Differentiating Reactive arthritis from other Diseases]]== |
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| Eye involvement occurs in about 50% of men with urogenital reactive arthritis and about 75% of men with enteric reactive arthritis. [[Conjunctivitis]] and [[uveitis]] can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.
| | ==[[Reactive arthritis epidemiology and demographics|Epidemiology and Demographics]]== |
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| Roughly 20 to 40 percent of men with reactive arthritis develop penile lesions called [[balanitis circinata]] (circinate balanitis) on the end of the penis. A small percentage of men and women develop small hard nodules called [[keratoderma blennorrhagica]] on the soles of the feet, and less often on the palms of the hands or elsewhere. In addition, some people with Reactive Arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some people suffer serious gastrointestinal problems similar to those of Crohn's Disease.
| | ==[[Reactive arthritis risk factors|Risk Factors]]== |
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| About 10 percent of people with Reactive Arthritis, especially those with prolonged disease, will develop cardiac manifestations including [[aortic regurgitation]] and [[pericarditis]].
| | ==[[Reactive arthritis screening|Screening]]== |
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| ==Diagnosis== | | ==[[Reactive arthritis natural history|Natural History, Complications and Prognosis]]== |
| There are countless clinical symptoms, but the clinical picture is dominated by [[polyarthritis]]. There is [[Pain and nociception|pain]], swelling, redness, and heat in the [[joint]]s. [[MRI]]'s are effective for diagnosis.
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| The [[urethra]], [[cervix]] and [[throat]] may be swabbed in an attempt to [[microbiological culture|culture]] the causative organisms. Cultures may be carried out on [[urine]] and [[stool]] samples. [[Synovial fluid]] from an affected knee may be aspirated to look at the fluid under the microscope and for culture.
| | == Diagnosis == |
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| Also, a blood test for the gene [[HLA-B27]] may be given to determine if the patient has the gene. About 75 percent of all patients with Reiter's Syndrome have the gene.
| | [[Reactive arthritis history and symptoms| History and Symptoms]] | [[Reactive arthritis physical examination | Physical Examination]] | [[Reactive arthritis laboratory findings | Laboratory Findings]] | [[Reactive arthritis x ray|X Ray]] | [[Reactive arthritis CT|CT]] | [[Reactive arthritis MRI|MRI]] | [[Reactive arthritis ultrasound|Ultrasound]] | [[Reactive arthritis other imaging findings|Other Imaging Findings]] | [[Reactive arthritis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| | [[Reactive arthritis medical therapy|Medical Therapy]] | [[Reactive arthritis surgery|Surgery]] | [[Reactive arthritis primary prevention|Primary Prevention]] | [[Reactive arthritis secondary prevention|Secondary Prevention]] | [[Reactive arthritis cost-effectiveness of therapy|cost-effectiveness of therapy]] | [[Reactive arthritis future or investigational therapies|Future or investigational therapies]] |
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | :[[Reactive arthritis case study one|Case #1]] [[Category:Rheumatology]] |
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| ==External links==
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| * [http://www.merck.com/pubs/mmanual/section5/chapter51/51b.htm Merck Manual on Reactive Arthritis]
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| ===Images===
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| * [http://std-gov.org/std_picture/chlamydia_______.htm Picture - Conjunctivitis in reactive arthritis (Chlamydia)]
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| * [http://std-gov.org/std_picture/chlamydia________.htm Picture - Psoriasiform skin changes in reactive arthritis (Chlamydia)]
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| * [http://std-gov.org/std_picture/chlamydia_________.htm Picture - arm lesions in reactive arthritis (Chlamydia)]
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| * [http://std-gov.org/std_picture/chlamydia__________.htm Picture - hand lesions in reactive arthritis (Chlamydia)]
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| {{Diseases of the musculoskeletal system and connective tissue}}
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| [[Category:Arthritis]]
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| [[Category:Autoimmune diseases]]
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| [[Category:Conditions diagnosed by stool test]]
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| [[Category:Rheumatology]] | |
| [[Category:Syndromes]]
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| ----------------------------
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| [[de:Reaktive Arthritis]]
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| [[es:Síndrome de Reiter]]
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| [[fr:Syndrome oculo-uréthro-synovial]]
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| [[he:תסמונת רייטר]]
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| [[nl:Syndroom van Reiter]]
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| [[no:Reaktiv artritt]]
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| [[pt:Síndrome de Reiter]]
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| [[tr:Reaktif artrit]]
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| ----------------------------
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