Reactive arthritis, diagnosis and treatment

Abstract

The diagnosis of reactive arthritis (ReA) is easy in typical cases with a history of an infection within 3 weeks in combination with an asymmetric mono- or oligoarthritis with or without extra-articular manifestations. Subclinical microbial infections, a possible co-existing inflammatory bowel disease and the fact that in 25% of the cases the microbial agent remains unidentified, make the diagnosis more troublesome. The course of disease is usually self-remittent within 6 months but a less good long-term prognosis is pre-determined by two factors—namely, the presence of HLA-B27 and the recurrence of triggering infections. The finding of microbial fragments in the joint cavity have led to new treatment strategies especially in Chlamydia-triggered ReA. It must, however, be remembered that the antibiotics mostly used (namely, tetracyclines) also possess immunoregulatory and anticollagenolytic potential. In chronic destructive cases, antirheumatic treatment, similar to that used in rheumatoid arthritis, is recommended.