Materiały źródłowe

• #1 Reactive Arthritis : Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/reactive-arthritis/diagnosis-treatment-and-steps-to-take

  There is no single test that doctors can use to diagnose reactive arthritis, but they may suspect that you have it if you have joint pain, and have had an infection of the digestive or urinary tract or the genitals in the past few weeks. […] The process doctors use to diagnose reactive arthritis typically involves the following. […] During the examination, the doctor usually: […] The doctor may order the following tests. […] This blood test looks for the presence of HLA-B27, a genetic risk factor for reactive arthritis. […] Culturing stool and urine specimens may reveal the presence of bacteria that frequently trigger reactive arthritis. […] This test is to assess the level of inflammation in the joint, and to rule out other causes for the pain, such as a joint infection or other condition, such as gout.

• #2 Reactive Arthritis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/reactive-arthritis-reiters-syndrome.html

  Reactive arthritis is a type of arthritis that occurs because of an infection. […] Diagnosis can be hard. This is because there are no specific tests that can confirm the condition. Some blood tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus. […] The process starts with a health history and a physical exam. […] Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. […] Tests for infections. This includes a test for chlamydia. It may also include tests for other infections that are linked to reactive arthritis. […] Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. Its tested to see if crystals, bacteria, or viruses are present. […] You may also have testing to rule out other forms of arthritis.

• #3 Reactive arthritis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/597

  Reactive arthritis (ReA) is an inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. Patients with ReA may give a history of an antecedent infection 1 to 4 weeks before onset. […] There is no specific test for diagnosing ReA. Rather, a group of tests is used to confirm the suspicion in someone who has clinical symptoms suggestive of an inflammatory arthritis in the post-venereal or post-dysentery period. […] Key diagnostic factors include presence of risk factors, peripheral arthritis, and axial arthritis. […] Other diagnostic factors include constitutional symptoms, enthesitis, mucous membrane involvement, skin rash, circinate balanitis, ocular manifestations, and cardiac manifestations. […] 1st investigations to order include erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibody (ANA), rheumatoid factor, urogenital and stool cultures, plain x-rays, and arthrocentesis with synovial fluid analysis. […] Investigations to consider include HLA-B27, nucleic acid amplification tests, MRI, and ultrasound.

• #4 Reactive arthritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/diagnosis-treatment/drc-20354843

  During the physical exam, your doctor is likely to check your joints for swelling, warmth and tenderness, and test range of motion in your spine and affected joints. Your doctor might also check your eyes for inflammation and your skin for rashes. […] Your doctor might recommend that a sample of your blood be tested for: Evidence of past or current infection, Signs of inflammation, Antibodies associated with other types of arthritis, A genetic marker linked to reactive arthritis. […] Your doctor might use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for: White blood cell count. An increased number of white blood cells might indicate inflammation or an infection. Infections. Bacteria in your joint fluid might indicate septic arthritis, which can result in severe joint damage. Crystals. Uric acid crystals in your joint fluid might indicate gout. This very painful type of arthritis often affects the big toe.

• #5 Reactive Arthritis Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/reactive-arthritis/diagnosis.html

  Diagnosis of reactive arthritis may be difficult, because there are no specific laboratory tests that can confirm it. However, diagnosis may be confirmed based on a personal medical history and reported symptoms. […] Certain blood tests may be performed to rule out other conditions, such as rheumatoid arthritis and lupus. […] Other diagnostic tests may include: […] Erythrocyte sedimentation rate (ESR or sed rate) […] Arthrocentesis (joint aspiration) […] Tests for certain infections that are often associated with reactive arthritis, including testing for Chlamydia […] X-ray – A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to check for spondylitis, sacroiliitis, swelling or damage to the joint.

• #6 Patient education: Reactive arthritis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/reactive-arthritis-beyond-the-basics/print

  Reactive arthritis diagnosis depends first and importantly on the distribution and location of pain and swelling of the extremities, and secondly on a history of recent prior symptoms of diarrhea or a sexually transmitted disease. […] It is helpful to identify the bacterial cause in the case of genital infections, as this will help guide treatment of the infections. […] Laboratory tests, such as stool cultures to test for Salmonella, Shigella, Campylobacter, and Yersinia, can sometimes confirm an infection. […] However, it is not always necessary or possible; by the time patients develop arthritis, the diarrhea has usually resolved, and the bacteria may no longer be retrievable. […] Urine and genital swab testing can sometimes detect Chlamydial trachomatis. […] The erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) may also be tested. […] However, ESR and CRP may be normal in more than half of the patients. […] In either form of reactive arthritis, there is no need to do joint biopsy for the purpose of identifying the causative bacteria.

• #7 Reactive Arthritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/joint-disorders/reactive-arthritis

  Reactive arthritis is an acute spondyloarthropathy that often seems precipitated by an infection, usually genitourinary or gastrointestinal. Diagnosis is clinical. […] Reactive arthritis should be suspected in patients with acute, asymmetric arthritis affecting the large joints of the lower extremities or toes, particularly if there is enthesitis, dactylitis, or a history of an antecedent diarrhea or dysuria. Diagnosis is ultimately clinical and requires the typical peripheral arthritis with symptoms of genitourinary or gastrointestinal infection or one of the other extra-articular features. […] Because these features may manifest at different times, definitive diagnosis may require several months.

• #8 Reactive arthritis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/symptoms-causes/syc-20354838

  Reactive arthritis develops in reaction to an infection in your body, often in your intestines, genitals or urinary tract. […] If you develop joint pain within a month of having diarrhea or a genital infection, contact your health care provider.

• #9 Reactive Arthritis Workup: Approach Considerations, Laboratory Studies, Radiography

  https://emedicine.medscape.com/article/331347-workup

  The diagnosis of reactive arthritis (ReA) is clinical, based on the history and physical examination findings. A high index of suspicion is required. No laboratory study or imaging finding is diagnostic of ReA. No specific tests or markers are indicated. Indicators of inflammation are usually abnormal. […] Chlamydia should be sought in every case of ReA. Serology is useful in some cases; however, culture techniques may not be reliable, causative agents are only identified in only 58% of cases with genitourinary (GU) symptoms, and there is a high positive rate in control populations (persons without ReA). […] The presence of human leukocyte antigen (HLA)-B27 correlates with axial disease, carditis, and uveitis. HLA-B27 test results are positive in 65-96% of ReA cases (67-92% of pediatric cases). HLA-B27 testing is not diagnostic of ReA and thus not required; however, it may be helpful for certain purposes (eg, supporting the diagnosis of ReA in patients with joint-restricted symptoms).

• #10 Reactive Arthritis (Reiter’s Syndrome) | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0801/p499.html

  Reactive arthritis, also called Reiter’s syndrome, is the most common type of inflammatory polyarthritis in young men. […] Reactive arthritis should always be considered in young men who present with polyarthritis. […] Initial treatment consists of high doses of potent nonsteroidal anti-inflammatory drugs. […] Laboratory abnormalities are nonspecific and include anemia, an elevated erythrocyte sedimentation rate or an elevated C-reactive protein level. […] Examination of joint fluid reveals inflammatory synovitis with 15,000 to 30,000 white blood cells per mm3 (15 to 30 109 per L), two thirds of which are typically neutrophils. […] The diagnosis of reactive arthritis should be considered in any patient with an asymmetric oligoarticular polyarthritis. […] Reactive arthritis may occur in HIVinfected patients and is sometimes the initial manifestation of the disease.

• #11 Reactive Arthritis Workup: Approach Considerations, Laboratory Studies, Radiography

  https://emedicine.medscape.com/article/331347-workup

  A tuberculin skin test may be appropriate in certain individuals, particularly those with demographics strongly suggestive of infectious tuberculosis (TB). […] Radiologic examination may demonstrate various arthritic changes. These changes tend to be asymmetric and oligoarticular and are more common in the lower extremities. However, radiologic signs are present in only 40-70% of cases, and they may be completely absent even in instances of severe disease. Early in the disease process, radiography often reveals no abnormalities at all. […] Arthrocentesis and fluid analysis are often needed to rule out an infectious process, especially in patients with monoarticular arthritis and constitutional symptoms. Synovial fluid analysis reveals a high WBC count (10,000-40,000/L), most often with polymorphonuclear leukocytes (PMNs) predominating. […] Synovial biopsy typically yields nonspecific inflammatory changes; infectious antigens have been found in the synovium.

• #12 Reactive Arthritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499831/

  The usual presentation of uveitis involves acute pain, photophobia, visual impairment, scleral injection, and hypopyon. […] HLA B 27 can be measured as it correlates with the severity of the disease but is not diagnostic. It is also important in the localization of arthritis. […] In a patient from an endemic population, the tuberculin skin test should be performed. […] Joint aspiration must be performed when possible to rule out other arthritis. Aspiration of the joint is often done to rule out septic arthritis and crystalline arthritis. […] The findings in synovial fluid are nonspecific and are characteristic of inflammatory arthritis, with elevated leukocyte counts (typically 2000 to 4000 WBC per ml), with neutrophil predominance.

• #12 Reactive Arthritis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499831/

  Reactive arthritis (ReA) is inflammatory arthritis that manifests several days to weeks after a gastrointestinal or genitourinary infection. It is also described as a classic triad of arthritis, urethritis, and conjunctivitis. However, a majority of patients do not present with the classic triad. […] American College of Rheumatology developed diagnostic guidelines for Reactive arthritis in 1999. The criteria were divided into […] Genitourinary symptoms, metatarsophalangeal joint involvement, elevated C reactive protein, and positive HLA- B27 render a 69% sensitivity and 93.5% specificity in diagnosing reactive arthritis. […] Although reactive arthritis is a clinical diagnosis, laboratory tests to detect the offending pathogens to confirm concomitant or preceding infections are usually performed to support the diagnosis.

• #13 Reactive Arthritis : Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/reactive-arthritis/diagnosis-treatment-and-steps-to-take

  These blood tests are measures of inflammation, but they are not specific for reactive arthritis. […] The doctor may order the following scans. […] X-rays can reveal the status of the joints, including signs of reactive arthritis such as inflammation of the sacroiliac joints, which are located in the lower back. […] These specialized imaging techniques are especially useful for visualizing joint changes that happen in the early stages of reactive arthritis. […] To rule out conditions that have similar symptoms, doctors may order other types of blood tests, such as:

• #14 Reactive arthritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/diagnosis-treatment/drc-20354843

  X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis. […] When you make the appointment, ask if there’s anything you need to do in advance, such as fasting before having a specific test. […] What tests do I need? […] Your doctor is likely to ask you a number of questions, such as: When did your symptoms begin? Have they been continuous or occasional? How severe are your symptoms? What, if anything, seems to improve your symptoms? What, if anything, appears to worsen your symptoms? Have you had a recent infection?

• #15 Blood Tests for Arthritis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/blood-tests-for-arthritis

  And although high CRP often correlates with more severe disease activity, some people with RA have normal CRP levels, even during flares. […] HLA-B27 is closely associated with a big family of rheumatic diseases called spondyloarthropathies. […] The test may be used for someone who has symptoms that suggest one of these diseases or other autoimmune conditions. […] Like other arthritis blood tests, HLA-B27 cant diagnose any disease. […] It adds one more piece of information that may help support or rule out a particular diagnosis. […] About 80% to 90% of people with AS have this gene. […] Many perfectly healthy people have HLA -B27 and never develop an autoimmune disease. […] Its also possible to develop a condition like AS without having the gene. […] The hope is that we can develop better blood-based tests, and we [at Mayo Clinic] and others around the world are working on this. […] Better tests could not only help people get a diagnosis and treatment more quickly, but they may help guide health care providers to more customized treatment choices. […] We need more predictive biomarkers that actually improve outcomes.

• #15 Blood Tests for Arthritis | Arthritis Foundation

  https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/blood-tests-for-arthritis

  Some of these patients may be diagnosed with whats known as seronegative RA. […] A positive anti-CCP test can rule out certain types of arthritis, but it’s not conclusive for RA. […] People with other conditions, including lupus, psoriatic arthritis (PsA) and active tuberculosis can also test positive. […] And a negative test doesnt rule out RA. […] ESR cant tell you or your doctor whats causing inflammation. […] A high sed rate does not mean you have an autoimmune disease, Dr. Davis says. […] Its inherently nonspecific. […] A high sed rate may be evidence of an inflammatory disease or it may be misleading, he says. […] Like sed rate, CRP cant pinpoint the cause of inflammation. […] Lots of conditions can cause a high CRP, including obesity, diabetes and chronic kidney disease as well as a long run or tough workout.

• #16 Getting a Diagnosis for Reactive Arthritis

  https://www.arthritis-health.com/types/reactive-arthritis/getting-diagnosis-reactive-arthritis

  There is no single test to determine whether or not a person has reactive arthritis. Instead, doctors must gather information to rule out or hone in on the cause of a patients symptoms. Information may be gathered from a patient interview, physical exam, lab tests, and medical imaging. A definitive diagnosis may take several days or even months. […] Diagnosing reactive arthritis may involve aspirating fluid from a joint for testing. […] If a doctor suspects a patient has reactive arthritis, he or she will typically order lab tests. […] A doctor may order none, some, or all of these lab tests depending on the patients symptoms, costs, and other circumstances. […] Doctors may recommend an x-ray or MRI of the painful joint. An x-ray may suggest joint swelling or other irregularities. An MRI can provide much more detailed images, but it takes longer and is more expensive. […] Doctors use the above diagnostic tools to rule out other conditions that can produce the same or similar symptoms.

• #17 Reactive arthropathy

  https://dermnetnz.org/topics/reactive-arthropathy

  Reactive arthropathy is also known as reactive arthritis. […] A diagnosis of reactive arthropathy is based on the pattern of symptoms and signs. […] Although there are no specific tests to confirm the diagnosis of reactive arthropathy, it may be suspected when the following key features are present and other causes for the symptoms have been excluded: A history of a preceding infection; Typical musculoskeletal symptoms such as arthritis, dactylitis, sacroiliitis, and enthesitis. […] The inability to culture a typical pathogen does not exclude the diagnosis of reactive arthropathy. […] Samples of fluid may be taken from swollen joints using a needle (arthrocentesis) to culture for the presence of microorganisms (found in septic arthritis) or to examine under microscopy for crystals (found in gout or pseudogout). […] HLA-B27 and HIV testing are recommended.

• #18 Reactive Arthritis & Reiter Syndrome | Riley Children’s Health

  https://www.rileychildrens.org/health-info/reactive-arthritis-reiter-syndrome

  Reactive arthritis occurs when the body’s immune system reacts to a recent infection, usually within the past four to six weeks, with joint swelling and pain. […] Pediatric rheumatologists diagnose reactive arthritis primarily by ruling out other conditions that could be causing the symptoms. The doctor must rule out: Current infection, Malignancies (such as tumors) that can cause arthritis, Other autoimmune diseases that can cause chronic arthritis. […] To diagnose reactive arthritis, your child’s rheumatologist will likely run a blood test to check for: Signs of previous or present infection, Inflammation, Antibodies related to other types of arthritis, A genetic link. […] If your child’s doctor suspects reactive arthritis, he or she may also recommend taking fluid out of the affected joint and testing it for white blood cell count, infection or uric acid crystals. […] It is important that a pediatric rheumatologist properly diagnose and treat your child for this condition. […] Your child’s doctor will need to rule out other conditions that can mimic the symptoms of reactive arthritis before making a correct diagnosis of this condition.

• #19 Reactive arthritis

  https://www.nhs.uk/conditions/reactive-arthritis/

  Reactive arthritis can be difficult to diagnose because several other conditions can have the same symptoms. […] You’ll usually need a range of tests to find out what’s causing your symptoms. […] Tests might include: a blood test, tests on a sample of your pee or a swab of your genitals, tests on a small amount of fluid removed from a painful joint using a needle (needle biopsy), an X-ray, MRI or ultrasound scan. […] You might be referred to a doctor who specialises in joints and inflammation (a rheumatologist) for tests and treatment. […] If reactive arthritis is affecting your eyes, you might also be treated by an eye specialist (ophthalmologist). If it’s affecting your skin, you might also see a skin specialist (dermatologist).

• #20 Reactive arthritis | Causes, symptoms, treatments

  https://versusarthritis.org/about-arthritis/conditions/reactive-arthritis/

  There isnt a specific test for reactive arthritis. Before making a diagnosis, your doctor will consider whether: […] Your doctor will probably take a blood sample, to make sure your problems havent been caused by another type of inflammatory arthritis. Blood tests can rule out conditions such as rheumatoid arthritis, psoriatic arthritis (saw-ree-at-ik arth-ri-tis), Behets syndrome (be-chets sin-drome) and gout (gowt). […] A blood sample can also: […] Your doctor may also ask for a urine or stool sample, or take swabs from your throat, penis or vagina, to check for signs of inflammation or infection. […] If your eyes are red and sore, you may be referred to an eye specialist, called an ophthalmologist (of-thal-mol-uh-jist). They will look into whether you have conjunctivitis or more serious inflammation of the eye, known as iritis or uveitis.

• #21 Reactive Arthritis

  https://rheumatology.org/patients/reactive-arthritis

  Reactive arthritis is an inflammatory disease that occurs in reaction to infections by certain bacteria particularly involving the genitourinary or gastrointestinal system. […] To diagnose reactive arthritis, a rheumatologist may look for these symptoms as well as signs of the original infection. […] Early diagnosis and treatment of reactive arthritis is key. Patients who notice arthritis symptoms about a month after a bacterial infection should see a healthcare professional right away to get a diagnosis.

• #22 What Is Reactive Arthritis?

  https://www.icliniq.com/articles/orthopedic-health/reactive-arthritis

  Reactive arthritis is inflammatory arthritis caused by a distant infection in joints where no cultivable bacteria exist. […] It can be difficult to pinpoint the initiating infection because rheumatic symptoms normally appear after the infection has passed. […] It is important to diagnose reactive arthritis early for the following reasons: Early identification and treatment will benefit less disease-related organ damage and joint damage, as well as better patient outcomes. […] History taking is essential to identify the primary infection, sexual history, and family history of spondyloarthropathy. […] The patient has to be examined for joint effusions, dactylitis, enthesitis, oral ulcers, ocular inflammation, skin rashes, and urethral discharge. […] For genitourinary infections, a urine sample or urethral swab is collected and sent for nucleic acid amplification testing.

• #23 Reactive Arthritis (Reiter’s Syndrome): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/reactive-arthritis-reiters-syndrome

  Reactive arthritis (Reiters syndrome) is a rare, temporary form of inflammatory arthritis thats triggered by a bacterial infection. […] If you’ve recently developed symptoms of arthritis, your healthcare provider will want to see them and hear about them. Certain combinations of symptoms will suggest reactive arthritis. […] You might have a variety of tests to help make the diagnosis, including: X-rays, Computed tomography (CT) scan, Magnetic resonance imaging (MRI), Joint aspiration (arthrocentesis), Throat culture, Urinalysis, Blood tests. […] Treatment for reactive arthritis may include: Antibiotics, NSAIDs, DMARDs, Corticosteroids. […] Reiters syndrome is usually self-limited, meaning it will clear up on its own in time (in three to 12 months). In the meantime, treatment can often repress symptoms and may help them to go away quicker. […] In a small percentage of people, Reiters syndrome seems to trigger a more serious and lasting form of spondyloarthritis.

• #24 Reactive arthritis — Arthritis Australia

  https://arthritisaustralia.com.au/types-of-arthritis/reactive-arthritis/

  Your doctor will diagnose reactive arthritis from your symptoms and a physical examination. Your doctor may also order blood tests for inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests. Blood tests may also help to rule out other types of arthritis. […] For most people reactive arthritis disappears completely with time and causes no permanent joint problems. More than four out of five people with reactive arthritis will recover completely within three to 12 months.

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