Reactive arthritis is an inflammatory arthritis that typically arises after specific infections, commonly affecting joints, eyes, and the urogenital system. Characterized by a triad of asymmetric arthritis, urethritis, and conjunctivitis, it is often linked to gastrointestinal and genitourinary pathogens, with a notable association with the HLA-B27 antigen. Effective management includes NSAIDs for inflammation, antibiotics for underlying infections, and lifestyle modifications to improve patient outcomes.

1. Reactive Arthritis:
Comprehensive
Overview
DONE BY-DHANASEKARAPANDIAN SHYAM KARTHICK
GROUP-51
SUBMITTED TO-KARABEKOVA NAZGUL

2. Introduction
 Definition
Reactive Arthritis (ReA) is a type of inflammatory arthritis that
occurs after certain infections.
Commonly involves joints, eyes, and the urogenital system
Known as a seronegative spondyloarthritis.

3. Historical Perspective
 First described in the early 20th century as "Reiter's Syndrome.“
 Renamed to Reactive Arthritis due to ethical controversies
surrounding Hans Reiter.

4. Epidemiology
Prevalence: Affects 3-4 per 100,000 annually.
Age: Most common in individuals aged 20–40 years.
Gender: Males are more commonly affected.Geographic variations in
prevalence due to infection patterns.

5. Pathophysiology
 Triggered by gastrointestinal or genitourinary infections.
 Cross-reactivity: Immune system attacks joint tissues due to bacterial
mimicry.
 Strong association with HLA-B27 antigen: Found in 50–80% of cases.

6. Infections Linked to Reactive
Arthritis
 Gastrointestinal Pathogens:Salmonella, Shigella, Campylobacter,
Yersinia.
 Genitourinary Pathogens:Chlamydia trachomatis, Mycoplasma
genitalium.
 Symptoms appear 1–4 weeks post-infection.

7. Clinical Features
Classic Triad:
1. Arthritis: Asymmetric, affects large joints (knees, ankles).
2. 2. Urethritis: Dysuria, discharge.
3. 3. Conjunctivitis: Eye redness, irritation.Extra-articular
manifestations:Skin lesions (keratoderma blennorrhagicum,
circinate balanitis).Enthesitis (inflammation at tendon insertions).

8. Musculoskeletal Manifestations
 Asymmetric oligoarthritis (involves 2-4 joints).
 Predominantly lower limbs.
 Dactylitis ("sausage fingers/toes").
 Sacroiliitis: Inflammation of the sacroiliac joint.

9. Extra-Articular Manifestations
 Ocular: Conjunctivitis, uveitis, episcleritis.
 Dermatological:Keratoderma blennorrhagicum (hyperkeratotic skin
lesions).Circinate balanitis (penile ulcers).
 Cardiac: Rare, but can include aortitis.

10. Diagnostic Workup
 Clinical Diagnosis: History of infection and characteristic symptoms.
 Laboratory Tests:
Elevated ESR and CRP.
HLA-B27 testing.
Negative rheumatoid factor (RF) and anti-CCP.
Stool or urine cultures for underlying infections.
 Imaging:
X-rays: Sacroiliitis, joint erosions.
MRI: Sensitive for detecting early joint inflammation.

11. Differential Diagnosis
 Rheumatoid arthritis
 Ankylosing spondylitis
 Psoriatic arthritis
 Septic arthritis
 Gout and pseudogout.

12. Treatment Approaches
Acute Management:
NSAIDs: First-line therapy for inflammation and pain.
Corticosteroids: Intra-articular injections for severe joint inflammation.
Chronic/Refractory Cases:
Disease-modifying antirheumatic drugs (DMARDs): Methotrexate,
sulfasalazine.
Biologics (e.g., TNF inhibitors) for severe, refractory cases.
Infections:
Antibiotics to treat underlying infections.

13. Non-Pharmacological
Interventions
 Physical therapy:
Maintain joint function and mobility.
 Lifestyle modifications:
Weight management.
Regular low-impact exercise.
Smoking cessation.

14. Prognosis
 Most cases resolve within 3-12 months.
 Risk of chronic arthritis or recurrent episodes in 15-20% of patients.
 Complications: Sacroiliitis, ankylosing spondylitis in severe cases.

15. Recent Advances
 Role of gut microbiota in modulating immune response.
 Emerging therapies:
Biologics (e.g., IL-17 inhibitors).
JAK inhibitors.
Genetic research on HLA-B27 and immune pathways.

16. Case Study
 Patient: 35-year-old male with recent diarrhea, presenting with knee
pain and red eyes.
 Clinical Workup: ESR elevated, HLA-B27 positive.
 Diagnosis: Reactive arthritis.
 Treatment: NSAIDs, intra-articular steroids.

17. Summary
 Reactive arthritis is a post-infectious inflammatory condition.
 Early diagnosis and treatment improve outcomes.
 Management involves addressing both symptoms and underlying
infections.

18. References
Include citations from textbooks, peer-reviewed journals, and clinical
guidelines.