Reactive arthritis (syn. Reiters syndrome)

Reactive arthritis refers to the development of spondyloarthritis and ocular inflammation following a genitourinary or gastrointestinal infection, it is strongly linked with the HLA‐B27 allele.

The chapter, which is set out as below, provides a brief overview of reactive arthritis:

• The exact cause of reactive arthritis remains unknown but it has been identified that people with a particular genetic type called HLA-B27 have an increased chance of developing the syndrome - about 80% of people with reactive arthritis carry this gene

• Chlamydia trachomatis is the most commonly associated infection, although Neisseria gonorrhoea, salmonella, shigella, and campylobacter have all been associated

• The classical clinical presentation comprises the triad of an asymmetrical large joint oligoarthritis with or without dactylitis, urethritis and ocular inflammation manifesting 1–6 weeks after the acute infection

• Skin lesions, most characteristically palmoplantar pustulosis (especially affecting the tips of the digits) and psoriasiform hyperkeratosis, develop in around 15% of men

• Mouth erosions, geographic tongue and circinate balanitis are common features

• There is no definitive treatment

• Management during the acute phase may include antibiotics to eliminate the primary bacterial infection, especially if genitourinary, and NSAID to manage joint symptoms

• Treatments, similar to those used in psoriasis, may be required for cutaneous features

• Prognosis - although the condition is usually self‐limiting, often resolving over a period of six months, it can progress to a chronic arthritis in around 15–20% of patients