Article

Reactive or infectious arthritis

Hochschule Hannover, Hanover, Lower Saxony, Germany
Annals of the Rheumatic Diseases (Impact Factor: 9.27). 12/1999; 58(11):661-4. DOI: 10.1136/ard.58.11.661
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    ABSTRACT: Reactive arthritis is an inflammatory joint disease induced by a preceding, sometimes asymptomatic bacterial infection outside the joints. With an estimated prevalence of 40/100,000 inhabitants, the disease primarily affects adults between the ages of 20 and 40 years. The clinical presentation is typically characterized by monoarthritis to oligoarthritis of the lower extremities with possible accompanying enthesitis, bursitis, tenosynovitis, sacroiliitis, dactylitis and rare extra-articular manifestations. Because of the similar clinical symptoms and an association with HLA-B27, reactive arthritis is attributed to the spondyloarthropathies. Typical triggering pathogens are Chlamydia, Salmonella, Yersinia, Shigella and Campylobacter. In about 20 % of the cases the usually self-limiting disease becomes chronic. The pathogenesis is not yet understood in detail but it is currently assumed that the intracellular persistence of the pathogen causes an immune reaction resulting in arthritis. Common international diagnostic criteria do not yet exist; therefore the diagnosis is made largely on the basis of clinical findings, medical history and the direct and/or indirect pathogen detection. Several therapeutic options are used to treat reactive arthritis. Ongoing extra-articular infections, with the exception of enteritis should be treated with antibiotics. Besides symptom-orientated treatment of acute arthritis, in prolonged and chronic reactive arthritis an immunomodulatory therapy with steroids, sulfasalazine or methotrexate is used. The role of long-term antibiotic therapy for eradication of persistent intra-articular pathogens in chronic cases is the subject of current research.
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    ABSTRACT: During the past year, no big advances were reported in understanding the pathogenesis or treatment of reactive arthritis (ReA). The need for generally accepted diagnostic criteria has become a central issue. Regarding pathogenesis, attention has been drawn to a similarity between ReA and the experimental antigen-induced arthritis. Molecular mechanisms of the HLA-B27-associated pathogenesis have remained, in spite of intensive research, so far a mystery. It is apparent that antibiotics have no effect on the fully developed reactive arthritis, with the exception of patients with Chlamydia-triggered ReA, who might benefit from a course of antibiotics.
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