31st January 2024

Reactive arthritis

Reactive arthritis is a seronegative arthritis resulting from an inflammatory response to an extra-articular infection (rather than intra-articular). It commonly presents with urogenital infection (such as Chlamydia) or gastrointestinal infection (such as Campylobacter, Shigella, Salmonella and Yersinia). There is a delay in joint manifestation following an acute infection, and aspiration of the joint will not yield a micro-organism, unlike in septic arthritis. There is a typical triad of symptoms- conjunctivitis, urethritis and arthritis, although other manifestations can also be present. It is also common for only 2 parts of the triad to be present in reactive arthritis. 

Reactive arthritis can present as a monoarthritis or a polyarthritis. It is typically asymmetrical, and a distant site of infection can be determined on thorough history taking and systems examination, which can include examination of the external genitalia. A detailed but sensitive sexual history is important here.