eMedicine Specialties > Emergency Medicine > Rheumatology

Reactive Arthritis: Follow-up

Author: Bo Burns, DO, FACEP, FAAEM, Assistant Professor, Assistant Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine, St Francis Hospital Trauma Emergency Center
Coauthor(s): Charles E Soliman, MD, Resident Physician, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa
Contributor Information and Disclosures

Updated: Feb 1, 2010

Follow-up

Further Inpatient Care

  • Inpatient care may be considered for patients who are unable to tolerate oral administration of medications, who are unable to ambulate because of significant joint involvement, who have intractable pain, or who have concomitant disease requiring admission.

Further Outpatient Care

  • Nonweightbearing of an affected joint may be necessary to allow healing.

Inpatient & Outpatient Medications

  • Nonsteroidal anti-inflammatory agents may control painful arthralgias. Patients must be instructed on compliance and possible need for adjustment to dose or to another agent.
  • Empiric antibiotics may be considered after appropriate cultures have been taken. Treat urethritis or cervicitis but generally not diarrhea.
  • Long-term antibiotic therapy may be warranted in cases of poststreptococcal reactive arthritis. This is currently a controversial topic.17,18

Complications

  • Recurrent arthritis (15-50%)
  • Chronic arthritis or sacroiliitis (15-30%)
  • Ankylosing spondylitis (30-50% of HLA-B27–positive patients)
  • Urethral stricture
  • Cataracts
  • Aortic root necrosis

Prognosis

  • Signs and symptoms usually remit within 6 months. However, a significant percentage of patients have recurrent episodes of arthritis (15-50%), and some patients develop chronic arthritis (15-30%).
  • Postdysenteric cases are associated with a better prognosis than postchlamydial cases.
  • Poor prognosis of reactive arthritis is associated with hip arthritis, lumbar-sacral stiffness, sedimentation rate higher than 30, poor efficacy of NSAIDs, oligoarthritis, onset when patients are younger than 16 years, and sausage finger or toe.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Septic arthritis must be ruled out if suspected.
  • HIV should be considered, particularly before institution of immunosuppressive therapy.

Special Concerns

  • Some pediatric cases involving ocular chlamydial infection have been reported.
  • Reactive arthritis was the first rheumatologic disease noted in association with HIV.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Thomas Scoggins, MD, and Igor Boyarsky, DO, to the development and writing of this article.



More on Reactive Arthritis

Overview: Reactive Arthritis
Differential Diagnoses & Workup: Reactive Arthritis
Treatment & Medication: Reactive Arthritis
Follow-up: Reactive Arthritis
Multimedia: Reactive Arthritis
References
Further Reading
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References

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Keywords

reactive arthritis symptoms, reactive arthritis treatment, reactive arthritis causes, Reiter's syndrome, Reiter syndrome, reactive arthritis, peripheral arthritis, seronegative spondyloarthropathies, rheumatic disease, chronic arthritis

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Contributor Information and Disclosures

Author

Bo Burns, DO, FACEP, FAAEM, Assistant Professor, Assistant Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine, St Francis Hospital Trauma Emergency Center
Bo Burns, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Soliman, MD, Resident Physician, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Gino A Farina, MD, Associate Professor of Clinical Emergency Medicine, Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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