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Reactive arthritis

David T Yu, MD
Section Editor
Joachim Sieper, MD
Deputy Editor
Paul L Romain, MD


Reactive arthritis is conventionally defined as an arthritis that arises following an infection, although the pathogens cannot be cultured from the affected joints. It is generally regarded as a form of spondyloarthritis (SpA).

The definition, clinical features, approach to diagnosis and differential diagnosis, and management of reactive arthritis will be reviewed here. Mechanisms that may play a role in reactive arthritis and in other spondyloarthritides are discussed separately. (See "Mechanisms for the induction of rheumatic symptoms by gastrointestinal disease" and "Pathogenesis of spondyloarthritis".)


The term “reactive arthritis” was introduced in 1969 as “an arthritis which developed soon after or during an infection elsewhere in the body, but in which the microorganisms cannot be recovered from the joint” [1]. The original definition did not specify the pathogens that were accepted as causes of reactive arthritis, and, in 1999, a panel of experts determined a specific list of gastrointestinal and urogenital pathogens that could be considered causative [2]. These included Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter [2]. Escherichia coli, Clostridium difficile, and Chlamydia pneumoniae have since been added to the list [3-7].

Additional causative pathogens, alternative terms, and diagnostic and therapeutic strategies for reactive arthritis have subsequently been proposed [8]. However, none of the newer diagnostic or therapeutic approaches or alternate names has been adequately validated. Another problem is that many of the studies generating these approaches involved patients seen in rheumatology clinics or followed outbreaks of disease after exposure to a common pathogen; such patients are not likely to be representative of the affected patients in the general community. Thus, the definition of reactive arthritis is still evolving.

Two major clinical features that characterize reactive arthritis were identified [2]:

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Literature review current through: Nov 2017. | This topic last updated: Jul 21, 2016.
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