eMedicine Specialties > Emergency Medicine > Rheumatology
Reactive Arthritis: Follow-up
Updated: Jun 18, 2009
Follow-up
Further Inpatient Care
- Inpatient care may be considered with patients who are unable to tolerate PO administration of medications, who are unable to ambulate because of significant joint involvement, who have intractable pain, or who have concomitant disease requiring admission.
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.
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 is associated with hip arthritis, 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
- For excellent patient education resources, visit eMedicine's Arthritis Center, Sexually Transmitted Diseases Center, and Bacterial and Viral Infections Center. Also, see eMedicine's patient education articles Knee Pain and Chlamydia.
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.
More on Reactive Arthritis |
| Overview: Reactive Arthritis |
| Differential Diagnoses & Workup: Reactive Arthritis |
| Treatment & Medication: Reactive Arthritis |
Follow-up: Reactive Arthritis |
| References |
| Further Reading |
| « Previous Page |
References
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].
Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. Jun 15 2004;69(12):2853-60. [Medline].
Kaarela K, Jantti JK, Kotaniemi KM. Similarity between chronic reactive arthritis and ankylosing spondylitis.A 32-35-year follow-up study. Clin Exp Rheumatol. Mar-Apr 2009;27(2):325-8. [Medline].
Rihl M, Barthel C, Klos A, Schmidt RE, Tak PP, Zeidler H, et al. Identification of candidate genes for susceptibility to reactive arthritis. Rheumatol Int. Jun 9 2009;[Medline].
Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM. Reactive arthritis and Reiter's syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis. Clin Infect Dis. Oct 1 2001;33(7):1010-4. [Medline].
Connor BA, Johnson EJ, Soave R. Reiter syndrome following protracted symptoms of Cyclospora infection. Emerg Infect Dis. May-Jun 2001;7(3):453-4. [Medline].
Amor B. Reiter's syndrome. Diagnosis and clinical features. Rheum Dis Clin North Am. Nov 1998;24(4):677-95, vii. [Medline].
Bauman C, Cron RQ, Sherry DD, Francis JS. Reiter syndrome initially misdiagnosed as Kawasaki disease. J Pediatr. Mar 1996;128(3):366-9. [Medline].
Cuttica RJ, Scheines EJ, Garay SM, Romanelli MC, Maldonado Cocco JA. Juvenile onset Reiter's syndrome. A retrospective study of 26 patients. Clin Exp Rheumatol. May-Jun 1992;10(3):285-8. [Medline].
Fan PT, Yu DTY. Reiters syndrome. In: Ruddy S, Harris ED Jr, Sledge CB, eds. Kelley's Textbook of Rheumatology. 6th ed. WB Saunders; 2001:1039-1067.
Hoogland YT, Alexander EP, Patterson RH, Nashel DJ. Coronary artery stenosis in Reiter's syndrome: a complication of aortitis. J Rheumatol. Apr 1994;21(4):757-9. [Medline].
Hughes RA, Keat AC. Reiter's syndrome and reactive arthritis: a current view. Semin Arthritis Rheum. Dec 1994;24(3):190-210. [Medline].
Kasper DL, ed. Reactive arthritis. In: Harrison's Online. Part 13. Section 2. Chap 305. McGraw Hill;2004.
Natarajan UR, Tan TL, Lau R. Reiter's disease following Mycoplasma pneumoniae infection. Int J STD AIDS. May 2001;12(5):349-50. [Medline].
Petersel DL, Sigal LH. Reactive arthritis. Infect Dis Clin North Am. Dec 2005;19(4):863-83. [Medline].
Rihl M, Klos A, Kohler L, Kuipers JG. Infection and musculoskeletal conditions: Reactive arthritis. Best Pract Res Clin Rheumatol. Dec 2006;20(6):1119-37. [Medline].
Further Reading
Clinical guidelines
Chlamydial urethritis and cervicitis.
Finnish Medical Society Duodecim - Professional Association. 2001 Jun 5 (revised 2006 Jun 3). Various pagings. NGC:005276
Diagnostic imaging guideline for musculoskeletal complaints in adults - an evidence-based approach. Part 2: upper extremity disorders.
Canadian Protective Chiropractic Association - Professional Association l'Université du Québec à Trois-Rivières - Academic Institution. 2008 Jan. 31 pages. NGC:006702
Clinical trials
New Immunomodulatory Therapy Strategies in Chronic Reactive Arthritis
Lovastatin for the Treatment of Mildly Active Rheumatoid Arthritis
Related eMedicine topics
Reactive Arthritis (Dermatology)
Reactive Arthritis (Rheumatology)
Reactive Arthritis, Musculoskeletal (Radiology)
Reactive Arthritis (Ophthalmology)
Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy (Rheumatology)
Keywords
Reiter's syndrome, Reiter syndrome, reactive arthritis, ReA, peripheral arthritis, arthritis, nongonococcal urethritis, conjunctivitis, seronegative spondyloarthropathies, rheumatic disease, urogenital infections, chronic arthritis, Shigella flexneri, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, Yersinia pseudotuberculosis
Follow-up: Reactive Arthritis