eMedicine Specialties > Rheumatology > Spondyloarthropathies

Reactive Arthritis: Follow-up

Author: Carlos J Lozada, MD, Director of Rheumatology Fellowship Program, Associate Professor, Department of Medicine, Division of Rheumatology and Immunology, Jackson Memorial Medical Center, University of Miami School of Medicine
Coauthor(s): Maria F Carpintero, MD, Fellow, Department of Rheumatology, University of Miami, Jackson Memorial Medical Center, Miami Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Jan 5, 2010

Follow-up

Further Inpatient Care

Hospitalization of a patient with uncomplicated reactive arthritis is not indicated.

Deterrence/Prevention

Even when a causal microorganism is isolated, antibiotic therapy does not change the course of the disease.

Patient Education

For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Psoriatic Arthritis.

Miscellaneous

Medicolegal Pitfalls

  • Septic arthritis must be ruled out if suspected before a diagnosis of reactive arthritis is made. Failure to appropriately treat septic arthritis in a timely manner could result in joint destruction. Medicolegal liability could result from this oversight.
  • HIV/AIDS should be considered before instituting immunosuppressive therapy in severe cases of reactive arthritis.
 


More on Reactive Arthritis

Overview: Reactive Arthritis
Differential Diagnoses & Workup: Reactive Arthritis
Treatment & Medication: Reactive Arthritis
Follow-up: Reactive Arthritis
References
[ CLOSE WINDOW ]

References

  1. Reiter H. Ueber cine bisher unbekannte spirochaeten-infektion (spirochaetosis arthritica). Dtsche Med Wschr. 1916;42:1535-6.

  2. Lu DW, Katz KA. Declining use of the eponym "Reiter's syndrome" in the medical literature, 1998-2003. J Am Acad Dermatol. Oct 2005;53(4):720-3. [Medline].

  3. Braun J, Laitko S, Treharne J, et al. Chlamydia pneumoniae--a new causative agent of reactive arthritis and undifferentiated oligoarthritis. Ann Rheum Dis. Feb 1994;53(2):100-5. [Medline].

  4. Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin North Am. Feb 2009;35(1):21-44. [Medline].

  5. Lauhio A, Leirisalo-Repo M, Lähdevirta J, Saikku P, Repo H. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum. Jan 1991;34(1):6-14. [Medline].

  6. Carter JD, Valeriano J, Vasey FB. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol. Oct 2004;31(10):1973-80. [Medline].

  7. Inman RD. Innate immunity of spondyloarthritis: the role of toll-like receptors. Adv Exp Med Biol. 2009;649:300-9. [Medline].

  8. Braun J, Kingsley G, van der Heijde D, Sieper J. On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999. J Rheumatol. Sep 2000;27(9):2185-92. [Medline].

  9. Rohekar S, Pope J. Epidemiologic approaches to infection and immunity: the case of reactive arthritis. Curr Opin Rheumatol. Jul 2009;21(4):386-90. [Medline].

  10. Hajjaj-Hassouni N, Burgos-Vargas R. Ankylosing spondylitis and reactive arthritis in the developing world. Best Pract Res Clin Rheumatol. Aug 2008;22(4):709-23. [Medline].

  11. Kuipers JG, Sibilia J, Bas S, Gaston H, Granfors K, Vischer TL, et al. Reactive and undifferentiated arthritis in North Africa: use of PCR for detection of Chlamydia trachomatis. Clin Rheumatol. Jan 2009;28(1):11-6. [Medline].

  12. Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. Oct 1994;21(10):1883-7. [Medline].

  13. Birnbaum J, Bartlett JG, Gelber AC. Clostridium difficile: an under-recognized cause of reactive arthritis?. Clin Rheumatol. Feb 2008;27(2):253-5. [Medline].

  14. De Vos M, Cuvelier C, Mielants H, Veys E, Barbier F, Elewaut A. Ileocolonoscopy in seronegative spondylarthropathy. Gastroenterology. Feb 1989;96(2 Pt 1):339-44. [Medline].

  15. El Karoui K, Méchaï F, Ribadeau-Dumas F, Viard JP, Lecuit M, de Barbeyrac B. Reactive arthritis associated with L2b lymphogranuloma venereum proctitis. Sex Transm Infect. Jun 2009;85(3):180-1. [Medline].

  16. Jansen TL, Janssen M, de Jong AJ, Jeurissen ME. Post-streptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever. J Intern Med. Mar 1999;245(3):261-7. [Medline].

  17. Kroot EJ, Hazes JM, Colin EM, Dolhain RJ. Poncet's disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature. Rheumatology (Oxford). Mar 2007;46(3):484-9. [Medline].

  18. Sahin N, Salli A, Enginar AU, Ugurlu H. Reactive arthritis following tetanus vaccination: a case report. Mod Rheumatol. 2009;19(2):209-11. [Medline].

  19. Aksu K, Keser G, Doganavsargil E. Reactive arthritis following tetanus and rabies vaccinations. Rheumatol Int. Dec 2006;27(2):209-10. [Medline].

  20. Tektonidou MG. Reiter's syndrome during intravesical BCG therapy for bladder carcinoma. Clin Rheumatol. Aug 2007;26(8):1368-9. [Medline].

  21. Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum. May 1992;35(5):564-8. [Medline].

  22. Kvien TK, Gaston JS, Bardin T, Butrimiene I, Dijkmans BA, Leirisalo-Repo M. Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study. Ann Rheum Dis. Sep 2004;63(9):1113-9. [Medline].

  23. Carter JD et al. Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis. ACR/ARHP Annual Scientific Meeting, Philadelphia PA. (abstract 1152). October 19, 2009.

  24. Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M. Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis. Ann Rheum Dis. Sep 2003;62(9):880-4. [Medline].

  25. Clegg DO, Reda DJ, Weisman MH, Cush JJ, Vasey FB, Schumacher HR Jr, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. Dec 1996;39(12):2021-7. [Medline].

  26. Calin A. A placebo controlled, crossover study of azathioprine in Reiter's syndrome. Ann Rheum Dis. Aug 1986;45(8):653-5. [Medline].

  27. Bravo G, Zazueta B, Lavalle C. An acute remission of Reiter's syndrome in male patients treated with bromocriptine. J Rheumatol. May 1992;19(5):747-50. [Medline].

  28. Schafranski MD. Infliximab for reactive arthritis secondary to Chlamydia trachomatis infection. Rheumatol Int. May 23 2009;[Medline].

  29. Gill H, Majithia V. Successful use of infliximab in the treatment of Reiter's syndrome: a case report and discussion. Clin Rheumatol. Jan 2008;27(1):121-3. [Medline].

  30. Abdelmoula LC, Yahia CB, Testouri N, Tekaya R, Ben M'barek R, Chaabouni L, et al. [Treatment of reactive arthritis with infliximab]. Tunis Med. Dec 2008;86(12):1095-7. [Medline].

  31. Aho K. Bowel infection predisposing to reactive arthritis. Baillieres Clin Rheumatol. Aug 1989;3(2):303-19. [Medline].

  32. Ahvonen P, Sievers K, Aho K. Arthritis associated with Yersinia enterocolitica infection. Acta Rheumatol Scand. 1969;15(3):232-53. [Medline].

  33. Anandarajah A, Ritchlin CT. Treatment update on spondyloarthropathy. Curr Opin Rheumatol. May 2005;17(3):247-56. [Medline].

  34. Arnett FC. Incomplete Reiter's syndrome: clinical comparisons with classical triad. Ann Rheum Dis. 1979;38 Suppl 1:suppl 73-8. [Medline].

  35. Brower A. Arthritis in Black and White. 2nd ed. Philadelphia, Pa: WB Saunders; 1997:252.

  36. Calin A, Fries JF. An "experimental" epidemic of Reiter's syndrome revisited. Follow-up evidence on genetic and environmental factors. Ann Intern Med. May 1976;84(5):564-6. [Medline].

  37. Carter JD. Reactive arthritis: defined etiologies, emerging pathophysiology, and unresolved treatment. Infect Dis Clin North Am. Dec 2006;20(4):827-47. [Medline].

  38. Fiessenger N, Leroy E. Contribution a l'etude d'une epidemie de dysenterie dans la Somme. Bull Mem Soc Med Hop Paris. 1916;40:2030-69.

  39. Flagg SD, Meador R, Hsia E, Kitumnuaypong T, Schumacher HR Jr. Decreased pain and synovial inflammation after etanercept therapy in patients with reactive and undifferentiated arthritis: an open-label trial. Arthritis Rheum. Aug 15 2005;53(4):613-7. [Medline].

  40. Iliopoulos A, Karras D, Ioakimidis D, Arvanitis A, Tsamis N, Iakovou I. Change in the epidemiology of Reiter's syndrome (reactive arthritis) in the post-AIDS era? An analysis of cases appearing in the Greek Army. J Rheumatol. Feb 1995;22(2):252-4. [Medline].

  41. Inman R. Reactive arthritis and enteropathic arthritis. In: Klippel J, Stone J, Crofford L. White P. Primer on the Rheumatic Diseases. 13th. Atlanta, Ga: National Arthritis Foundation; 2008:217-21.

  42. Isomäki H, Raunio J, von Essen R, Hämeenkorpi R. Incidence of inflammatory rheumatic diseases in Finland. Scand J Rheumatol. 1978;7(3):188-92. [Medline].

  43. Keat A. Reiter's syndrome and reactive arthritis in perspective. N Engl J Med. Dec 29 1983;309(26):1606-15. [Medline].

  44. Kingsley G, Panayi G. Antigenic responses in reactive arthritis. Rheum Dis Clin North Am. Feb 1992;18(1):49-66. [Medline].

  45. Lee AT, Hall RG, Pile KD. Reactive joint symptoms following an outbreak of Salmonella typhimurium phage type 135a. J Rheumatol. Mar 2005;32(3):524-7. [Medline].

  46. Leirisalo M, Skylv G, Kousa M, Voipio-Pulkki LM, Suoranta H, Nissilä M. Followup study on patients with Reiter's disease and reactive arthritis, with special reference to HLA-B27. Arthritis Rheum. Mar 1982;25(3):249-59. [Medline].

  47. Moll JM, Haslock I, Macrae IF, Wright V. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome. Medicine (Baltimore). Sep 1974;53(5):343-64. [Medline].

  48. Petersel DL, Sigal LH. Reactive arthritis. Infect Dis Clin North Am. Dec 2005;19(4):863-83. [Medline].

  49. Putschky N, Pott HG, Kuipers JG, Zeidler H, Hammer M, Wollenhaupt J. Comparing 10-day and 4-month doxycycline courses for treatment of Chlamydia trachomatis-reactive arthritis: a prospective, double-blind trial. Ann Rheum Dis. Nov 2006;65(11):1521-4. [Medline].

  50. Reveille JD, Arnett FC. Spondyloarthritis: update on pathogenesis and management. Am J Med. Jun 2005;118(6):592-603. [Medline].

  51. Rohekar S, Tsui FW, Tsui HW, Xi N, Riarh R, Bilotta R. Symptomatic acute reactive arthritis after an outbreak of salmonella. J Rheumatol. Aug 2008;35(8):1599-602. [Medline].

  52. Sieper J, Fendler C, Laitko S, Sörensen H, Gripenberg-Lerche C, Hiepe F. No benefit of long-term ciprofloxacin treatment in patients with reactive arthritis and undifferentiated oligoarthritis: a three-month, multicenter, double-blind, randomized, placebo-controlled study. Arthritis Rheum. Jul 1999;42(7):1386-96. [Medline].

  53. Solitar BM, Lozada CJ, Tseng CE, Lowe AM, Krajewski WM, Blanchard K. Reiter's syndrome among Asian shipboard immigrants: the case of The Golden Venture. Semin Arthritis Rheum. Apr 1998;27(5):293-300. [Medline].

  54. Toivanen A, Toivanen P. Aetiopathogenesis of reactive arthritis. Rheumatol Eur. 1995;24(1):5-8.

  55. Toivanen A, Toivanen P. Epidemiologic, clinical, and therapeutic aspects of reactive arthritis and ankylosing spondylitis. Curr Opin Rheumatol. Jul 1995;7(4):279-83. [Medline].

  56. Townes JM, Deodhar AA, Laine ES, Smith K, Krug HE, Barkhuizen A. Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis. Dec 2008;67(12):1689-96. [Medline].

  57. van Bohemen CG, Lionarons RJ, van Bodegom P, Dinant HJ, Landheer JE, Nabbe AJ. Susceptibility and HLA-B27 in post-dysenteric arthropathies. Immunology. Oct 1985;56(2):377-9. [Medline].

  58. Wakefield D, McCluskey P, Verma M, Aziz K, Gatus B, Carr G. Ciprofloxacin treatment does not influence course or relapse rate of reactive arthritis and anterior uveitis. Arthritis Rheum. Sep 1999;42(9):1894-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

reactive arthritis, Reiter syndrome, Reiter's syndrome, RS, ReA, nongonococcal urethritis, conjunctivitis, oculo-urethro-synovial syndrome, Chlamydia reactive arthritis, chlamydial reactive arthritis , Shigella dysentery, gastrointestinal infections, Salmonella, Campylobacter, Chlamydia trachomatis, C trachomatis, Yersinia, ankylosing spondylitis, psoriatic arthritis, seronegative spondyloarthropathy, infectious diarrhea, genitourinary infection

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Carlos J Lozada, MD, Director of Rheumatology Fellowship Program, Associate Professor, Department of Medicine, Division of Rheumatology and Immunology, Jackson Memorial Medical Center, University of Miami School of Medicine
Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians and American College of Rheumatology
Disclosure: Nothing to disclose.

Coauthor(s)

Maria F Carpintero, MD, Fellow, Department of Rheumatology, University of Miami, Jackson Memorial Medical Center, Miami Veterans Affairs Medical Center
Maria F Carpintero, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

John Varga, MD, Professor, Department of Internal Medicine, Division of Rheumatology, Northwestern University
John Varga, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology, Central Society for Clinical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.