Reaktywne zapalenie stawów – Etiologia i przyczyny

Reaktywne zapalenie stawów
Etiologia i przyczyny

Reaktywne zapalenie stawów (ReA) to zapalne zapalenie stawów rozwijające się po infekcji w innych narządach, najczęściej układu pokarmowego, moczowo-płciowego lub dróg moczowych, przy czym stawy nie są bezpośrednio zakażone. Etiologia ReA obejmuje bakterie takie jak Chlamydia trachomatis (najczęstszy patogen w infekcjach moczowo-płciowych), Neisseria gonorrhoeae, Salmonella enteritidis, Shigella flexneri, Yersinia enterocolitica, Campylobacter jejuni oraz inne. W około 40% przypadków nie udaje się zidentyfikować konkretnego patogenu. Patogeneza ReA opiera się na mechanizmach autoimmunologicznych, w tym reakcji krzyżowej przeciwciał skierowanych przeciwko antygenom bakteryjnym i tkankom własnym, zwłaszcza u nosicieli HLA-B27, u których ryzyko rozwoju choroby wzrasta nawet 50-krotnie. Fragmenty bakterii mogą być wykrywane w błonie maziowej stawów, co sugeruje immunologiczny charakter zapalenia, a nie bezpośrednie zakażenie stawów.

Reaktywne zapalenie stawów – etiologia, przyczyny, powstawanie

Patogeny wywołujące reaktywne zapalenie stawów
Mechanizm powstawania reaktywnego zapalenia stawów
Czynniki ryzyka rozwoju reaktywnego zapalenia stawów
Epidemiologia reaktywnego zapalenia stawów
Szczególne aspekty etiologiczne
Kolejne rozdziały

Reaktywne zapalenie stawów – etiologia, przyczyny, powstawanie

Reaktywne zapalenie stawów (ReA) jest formą zapalnego zapalenia stawów, które rozwija się w odpowiedzi na infekcję występującą w innej części ciała, najczęściej w układzie pokarmowym, narządach płciowych lub drogach moczowych. Charakterystyczną cechą tej choroby jest fakt, że stawy, w których rozwija się stan zapalny, same nie są zakażone, mimo że objawy stawowe mogą pojawić się od kilku dni do kilku tygodni po infekcji pierwotnej.¹²³

Patogeny wywołujące reaktywne zapalenie stawów

Reaktywne zapalenie stawów jest najczęściej wywoływane przez określone bakterie. Występowanie choroby powiązane jest z dwoma głównymi drogami zakażenia:⁴⁵⁶

Infekcje układu moczowo-płciowego

Najczęstszym patogenem związanym z reaktywnym zapaleniem stawów o etiologii moczowo-płciowej jest Chlamydia trachomatis. Do innych bakterii wywołujących ReA tą drogą należą:⁷⁸⁹

¹⁰¹¹

Infekcje układu pokarmowego

Reaktywne zapalenie stawów często rozwija się po zakażeniach przewodu pokarmowego. Bakterie najczęściej powodujące ReA tą drogą to:¹²¹³¹⁴

Salmonella enteritidis i Salmonella typhimurium
Shigella flexneri i Shigella dysenteriae
Yersinia enterocolitica
Campylobacter jejuni
Clostridioides difficile
Escherichia coli (szczepy enterotoksyczne)

¹⁵¹⁶¹⁷

Inne patogeny

W rzadszych przypadkach reaktywne zapalenie stawów może być wywołane przez:¹⁸¹⁹

Chlamydia pneumoniae (infekcje dróg oddechowych)
Mycobacterium tuberculosis
Streptococcus (paciorkowce beta-hemolizujące)
SARS-CoV-2 (raportowano przypadki ReA po COVID-19)
Bacillus Calmette-Guerin (po podaniu jako leczenie raka pęcherza moczowego)

²⁰²¹²²

Istotne jest to, że w około 40% przypadków reaktywnego zapalenia stawów nie można zidentyfikować konkretnego patogenu wywołującego chorobę.²³²⁴

Mechanizm powstawania reaktywnego zapalenia stawów

Chociaż dokładny mechanizm rozwoju reaktywnego zapalenia stawów nie jest w pełni poznany, istnieje kilka teorii wyjaśniających jego patofizjologię:²⁵²⁶

Reakcja autoimmunologiczna

Najczęściej przyjmowaną teorią jest, że reaktywne zapalenie stawów jest zaburzeniem autoimmunologicznym. Po zakażeniu układ odpornościowy zostaje pobudzony do zwalczania patogenu, ale z nieznanych przyczyn kontynuuje atak nawet po ustąpieniu infekcji. Prawdopodobnie dochodzi do reakcji krzyżowej, w której przeciwciała skierowane przeciwko antygenom bakteryjnym reagują z tkankami własnymi organizmu, szczególnie w stawach.²⁷²⁸²⁹

Transport fragmentów bakterii

Jedna z teorii sugeruje, że po pierwotnej infekcji fragmenty bakterii mogą być transportowane przez krwiobieg i gromadzić się w błonie maziowej stawów. W niektórych badaniach wykazano obecność fragmentów zakaźnych patogenów w zajętych stawach, chociaż nie można wyhodować z nich żywych bakterii. To wskazuje, że zapalenie stawów wydaje się wynikać z reakcji immunologicznej lub zapalnej na te fragmenty, a nie z bezpośredniego zakażenia stawu.³⁰³¹³²

Mimikra molekularna

W tym mechanizmie antygeny bakteryjne mogą wykazywać podobieństwo strukturalne do antygenów własnych organizmu, co prowadzi do nieprawidłowej odpowiedzi immunologicznej skierowanej przeciwko własnym tkankom. Dotyczy to szczególnie osób posiadających gen HLA-B27, gdzie struktura molekularna tego genu może wykazywać podobieństwo do epitopów bakteryjnych, ułatwiając reakcję autoimmunologiczną zaangażowaną w patogenezę choroby.³³³⁴

Czynniki ryzyka rozwoju reaktywnego zapalenia stawów

Nie każda osoba zakażona patogenami mogącymi wywołać reaktywne zapalenie stawów rozwinie chorobę. Istnieją określone czynniki, które zwiększają ryzyko jej wystąpienia:³⁵³⁶

Czynniki genetyczne

Najważniejszym czynnikiem genetycznym związanym z reaktywnym zapaleniem stawów jest obecność antygenu HLA-B27. Około 70-80% pacjentów z reaktywnym zapaleniem stawów jest nosicielami tego genu, w porównaniu z około 8% populacji ogólnej. Gen HLA-B27 zwiększa ryzyko rozwoju ReA nawet 50-krotnie.³⁷³⁸³⁹

Jednakże posiadanie genu HLA-B27 nie gwarantuje rozwoju choroby, a niektóre osoby z reaktywnym zapaleniem stawów nie posiadają tego markera genetycznego. Sugeruje to istnienie innych, jeszcze niepoznanych czynników genetycznych i środowiskowych, które przyczyniają się do rozwoju choroby.⁴⁰⁴¹

Czynniki demograficzne

Płeć: Reaktywne zapalenie stawów występuje częściej u mężczyzn niż u kobiet, szczególnie w przypadku postaci związanej z infekcjami przenoszonymi drogą płciową. Forma pojawiająca się po infekcji pokarmowej występuje z podobną częstością u obu płci.
Wiek: Choroba najczęściej dotyka osoby w wieku 20-40 lat, choć może wystąpić w każdym wieku. U dzieci rzadko występuje, ale może pojawić się u nastolatków.

⁴²⁴³⁴⁴

Inne czynniki ryzyka

Zakażenie HIV/AIDS: Osoby z obniżoną odpornością z powodu zakażenia HIV są bardziej narażone na rozwój reaktywnego zapalenia stawów.
Czas trwania biegunki i utrata masy ciała: Uważane są za czynniki ryzyka w rozwoju ReA po infekcjach jelitowych.
Wcześniejsze epizody ReA: Osoby, które wcześniej miały reaktywne zapalenie stawów, są bardziej narażone na nawroty choroby.
Nasilenie pierwotnego zakażenia: Chociaż ReA może wystąpić po łagodnej infekcji, która mogła przejść niezauważona, istnieje pewna korelacja między nasileniem pierwotnej infekcji a ryzykiem rozwoju choroby.

⁴⁵⁴⁶⁴⁷

Epidemiologia reaktywnego zapalenia stawów

Częstość występowania reaktywnego zapalenia stawów jest zróżnicowana i zależy od szeregu czynników, takich jak geografia, rozpowszechnienie patogenów wywołujących oraz metodologia badań. Szacuje się, że:⁴⁸

Po zakażeniach układu moczowo-płciowego (głównie Chlamydia trachomatis) reaktywne zapalenie stawów rozwija się u około 2-4% zakażonych osób.
Po zakażeniach przewodu pokarmowego (Salmonella, Shigella, Campylobacter lub Yersinia) częstość występowania ReA waha się od 0% do 15%.

⁴⁹⁵⁰

Częstość występowania może być modyfikowana przez czynniki epidemiologiczne i środowiskowe, patogenność bakterii oraz różnice w metodologii badań. Reaktywne zapalenie stawów enteropatyczne występuje częściej po infekcjach jelitowych, jednak ReA związane z chlamydią jest endemiczne, szczególnie w krajach rozwiniętych.⁵¹

Szczególne aspekty etiologiczne

Reaktywne zapalenie stawów jest złożonym schorzeniem o wieloczynnikowej etiologii. Ważne jest zrozumienie, że:⁵²⁵³

Samo reaktywne zapalenie stawów nie jest zakaźne, choć bakterie je wywołujące mogą być przenoszone drogą płciową lub przez zanieczyszczoną żywność.
Większość osób zakażonych bakteriami mogącymi wywołać ReA nie rozwinie choroby.
W niektórych przypadkach infekcja wywołująca może być na tyle łagodna, że nie powoduje zauważalnych objawów, co utrudnia powiązanie choroby stawów z wcześniejszą infekcją.
Leczenie pierwotnej infekcji antybiotykami nie zawsze zapobiega rozwojowi reaktywnego zapalenia stawów.

⁵⁴⁵⁵⁵⁶

Zrozumienie etiologii i mechanizmów powstawania reaktywnego zapalenia stawów jest kluczowe dla opracowania skutecznych strategii diagnostycznych i terapeutycznych. Mimo postępów w badaniach, nadal istnieje wiele niewyjaśnionych aspektów tej choroby, wymagających dalszych badań naukowych.⁵⁷

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Materiały źródłowe

#1 Reactive arthritis | Altru Health System
https://www.altru.org/health-library/conditions/reactive-arthritis
Reactive arthritis develops in reaction to an infection in your body, often in your intestines, genitals or urinary tract. You might not be aware of the triggering infection if it causes mild symptoms or none at all. […] Numerous bacteria can cause reactive arthritis. Some are transmitted sexually, and others are foodborne. The most common ones include: Campylobacter, Chlamydia, Clostridioides difficile, Escherichia coli, Salmonella, Shigella, Yersinia. […] Reactive arthritis isn’t contagious. However, the bacteria that cause it can be transmitted sexually or in contaminated food. Only a few of the people who are exposed to these bacteria develop reactive arthritis.
#2 What is Reactive Arthritis? Symptoms, Causes & Flare Ups | NIAMS
https://www.niams.nih.gov/health-topics/reactive-arthritis
Reactive arthritis, as the name suggests, occurs in reaction to something in this case, an infection. The condition is caused by a bacterial infection in the digestive or urinary tract or the genitals, but arthritis symptoms typically do not set in until after you have recovered from the infection. […] Reactive arthritis is triggered by an infection frequently a sexually transmitted or food-borne bacterial infection but it is separate from the infection and typically sets in after the infection has cleared. The bacteria that commonly trigger it are Salmonella, Yersinia, Campylobacter, Shigella, and Chlamydia, but only a small number of people infected with them develop the condition. Scientists do not fully understand why some people are predisposed to getting reactive arthritis. […] Genetics seems to partly explain susceptibility to the condition, as many affected individuals have a gene called HLA-B27. However, many people who get reactive arthritis lack this genetic marker so there are other, unknown genetic and environmental contributing factors.
#3 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. […] Reactive arthritis happens when an infection in your urinary tract, genitals, digestive system or throat triggers an unusual reaction from your immune system. […] Reactive arthritis starts with a bacterial infection. Its usually a urinary tract infection (UTI), sexually transmitted infection (STI), gastrointestinal infection (such as food poisoning), or throat infection (sore throat). […] Reiters syndrome begins several days to weeks after the original infection ends, and only in a small percentage of people. It appears that the infection triggers an autoimmune response. […] Reactive arthritis belongs to a group of inflammatory arthritis conditions called spondyloarthritis. […] You dont have to have a severe infection to trigger reactive arthritis. One possible factor is a gene called HLA-B27. Many people who get spondyloarthritis and Reiters syndrome have it.
#4 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#5 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#6 Reactive arthritis – UpToDate
https://www.uptodate.com/contents/reactive-arthritis
Reactive arthritis is conventionally defined as an arthritis that arises following an infection, although the pathogens cannot be cultured from the affected joints. […] 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.” […] In 1999, a panel of experts determined a specific list of gastrointestinal and urogenital pathogens that could be considered causative. These included Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter. […] Escherichia coli, Clostridioides difficile, and Chlamydia pneumoniae have since been added to the list. […] Other rare, infectious agents have been linked to reactive arthritis, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
#7 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#8 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. An HLA-B27 genotype is a predisposing factor in over two thirds of patients with reactive arthritis. The syndrome most frequently follows genitourinary infection with Chlamydia trachomatis, but other organisms have also been implicated. Reactive arthritis may also follow enteric infections with some strains of Salmonella or Shigella, but use of antibiotics in these patients has not been shown to be effective. […] Multiple organisms can trigger Reiter’s syndrome following a genitourinary infection or infectious enteritis. Chlamydia trachomatis infection is the most common antecedent of reactive arthritis and accounts for most cases of venereal origin. Reactive arthritis has occurred following a well-documented gonococcal infection, despite adequate treatment of the infection.
#9 Reactive Arthritis: Causes, Symptoms and Treatments | Arthritis Foundation
https://www.arthritis.org/diseases/reactive-arthritis
Reactive arthritis is an inflammatory type of arthritis that affects the joints, eyes, and urinary tract (bladder, vagina, urethra). It occurs when bacteria enters the blood stream and causes your body to react with inflammation in different parts of the body. The types of bacteria that cause reactive arthritis are usually contracted through sexual contact or by eating spoiled food. […] Being infected with certain bacteria has been linked to reactive arthritis. The ones most commonly associated with reactive arthritis are: Chlamydia trachomatis. It is spread through sexual contact. The infection may begin in the vagina, bladder or the urethra. Salmonella, Shigella, Yersinia and Campylobacter. These bacteria typically infect the gastrointestinal tract. […] In rare cases, the bacterium Chlamydia pneumoniae, which causes respiratory infections, may also cause reactive arthritis. The bacteria typically enter your body in one of two ways: Urogenital tract. Bacteria can enter through the vagina or urethra during sexual contact and spread to the bladder. Gastrointestinal (GI) tract. Bacteria can enter the body if you eat spoiled food or food that came into contact with contaminated surfaces. […] Doctors are not sure why some people exposed to these bacteria get the disease and others dont. However, researchers have identified a gene, called human leukocyte antigen (HLA) B27, that makes a person more likely to get reactive arthritis. Not everyone who inherits this gene will get the disease.
#10 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#11 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#12 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#13 Reactive arthritis – Wikipedia
https://en.wikipedia.org/wiki/Reactive_arthritis
Reactive arthritis, previously known as Reiter’s syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. […] The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis); however, it also can happen after group A streptococcal infections. […] Reactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence of enthesitis as the basic pathologic lesion and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis. Other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp. A bout of food poisoning or a gastrointestinal infection may also precede the disease (the last four genera of bacteria mentioned above are enteric bacteria).
#14 Reactive Arthritis Causes, Symptoms, Treatments, and More
https://www.webmd.com/arthritis/arthritis-reactive-arthritis
The cause of reactive arthritis is still unknown, but research suggests the disease is caused, in part, by a genetic predisposition: Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA-B27. […] In sexually active males, most cases of reactive arthritis follow infection with Chlamydia trachomatis or Ureaplasma urealyticum, both sexually transmitted diseases. In other cases, people develop the symptoms following an intestinal infection with shigella, salmonella, yersinia, or campylobacter bacteria.
#15 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#16 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#17 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. […] Two forms of reactive arthritis are common: sexually transmitted and dysenteric. […] The sexually transmitted form occurs primarily in men aged 20 to 40. Genital infections with Chlamydia trachomatis are most often implicated. […] Men or women can acquire the dysenteric form after enteric infections, primarily Shigella, Salmonella, Clostridioides difficile, Yersinia, or Campylobacter. […] Bacille Calmette-Guerin injection for bladder cancer has also been reported to trigger reactive arthritis. […] In approximately 40% of cases, infectious pathogens cannot be identified. […] Reactive arthritis is postinfectious arthritis. Although there is evidence of microbial antigens in the synovium, organisms cannot be cultured from joint fluid.
#18 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#19 Reactive arthritis – UpToDate
https://www.uptodate.com/contents/reactive-arthritis
Reactive arthritis is conventionally defined as an arthritis that arises following an infection, although the pathogens cannot be cultured from the affected joints. […] 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.” […] In 1999, a panel of experts determined a specific list of gastrointestinal and urogenital pathogens that could be considered causative. These included Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter. […] Escherichia coli, Clostridioides difficile, and Chlamydia pneumoniae have since been added to the list. […] Other rare, infectious agents have been linked to reactive arthritis, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
#20 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Reactive arthritis (ReA), formerly termed Reiter syndrome, is an autoimmune condition that develops in response to an infection. It has been associated with gastrointestinal (GI) infections with Shigella, Salmonella, Campylobacter, and other organisms, as well as with genitourinary (GU) infections (especially with Chlamydia trachomatis). […] Cases of ReA following COVID-19 infection have been reported. […] ReA is usually triggered by a genitourinary or gastrointestinal infection and thus is sometimes classified as venereal or dysenteric. Such infections are mostly the result of gram-negative, obligate, or facultative intracellular pathogens. […] Organisms that have been associated with ReA include the following: Chlamydia trachomatis/C pneumoniae, Ureaplasma urealyticum, Neisseria gonorrhoeae, Shigella flexneri, Salmonella enterica serovars Typhimurium, Enteritidis, and Hadar, Mycoplasma pneumoniae, Mycobacterium tuberculosis, Cyclospora, Yersinia enterocolitica and Y pseudotuberculosis, Campylobacter jejuni and C coli, Clostridioides difficile, Giardia lamblia, Leptospira, Babesia microti, Beta-hemolytic and viridans streptococci, Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2).
#21 Reactive Arthritis – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version
https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/joint-disorders/reactive-arthritis
There is some evidence that the chlamydia bacteria and possibly other bacteria actually spread to the joints, but the roles of the infection and the immune reaction to it are not clear. […] A treatment for bladder cancer called Bacille Calmette-Guerin injection may also trigger reactive arthritis. […] In many people, no infection can be found to have preceded reactive arthritis. […] When reactive arthritis is caused by infection of the genitals or urinary tract, antibiotics are given, but this treatment does not always relieve the arthritis and its optimal duration is not known. […] In most people, the initial symptoms of reactive arthritis disappear in 3 or 4 months. However, up to 50% of people have recurring joint inflammation or other symptoms over several years, especially in people with chlamydial infection or those who have the HLA-B27 gene.
#22 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. […] Two forms of reactive arthritis are common: sexually transmitted and dysenteric. […] The sexually transmitted form occurs primarily in men aged 20 to 40. Genital infections with Chlamydia trachomatis are most often implicated. […] Men or women can acquire the dysenteric form after enteric infections, primarily Shigella, Salmonella, Clostridioides difficile, Yersinia, or Campylobacter. […] Bacille Calmette-Guerin injection for bladder cancer has also been reported to trigger reactive arthritis. […] In approximately 40% of cases, infectious pathogens cannot be identified. […] Reactive arthritis is postinfectious arthritis. Although there is evidence of microbial antigens in the synovium, organisms cannot be cultured from joint fluid.
#23 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. […] Two forms of reactive arthritis are common: sexually transmitted and dysenteric. […] The sexually transmitted form occurs primarily in men aged 20 to 40. Genital infections with Chlamydia trachomatis are most often implicated. […] Men or women can acquire the dysenteric form after enteric infections, primarily Shigella, Salmonella, Clostridioides difficile, Yersinia, or Campylobacter. […] Bacille Calmette-Guerin injection for bladder cancer has also been reported to trigger reactive arthritis. […] In approximately 40% of cases, infectious pathogens cannot be identified. […] Reactive arthritis is postinfectious arthritis. Although there is evidence of microbial antigens in the synovium, organisms cannot be cultured from joint fluid.
#24 Reactive arthropathy
https://dermnetnz.org/topics/reactive-arthropathy
Reactive arthropathy describes the inflammation of joints following an infection usually involving the gastrointestinal or urogenital tracts. […] Reactive arthropathy is triggered by an infection of the urogenital or gastrointestinal tracts. Cross-reactivity of the immune system between infectious antigens and self-proteins is thought to result in an autoimmune response. […] In the Caucasian population, HLA-B27 antigen and HIV/AIDS are strongly associated with reactive arthropathy. […] The inability to culture a typical pathogen does not exclude the diagnosis of reactive arthropathy. In up to 40% of patients, no infectious organism is found.
#25 Reactive Arthritis – Harvard Health
https://www.health.harvard.edu/pain/reactive-arthritis-a-to-z
Reactive arthritis is triggered by an infection, usually by a sexually transmitted organism or by certain gastrointestinal bacteria. […] The most common infection causing reactive arthritis is the sexually transmitted disease (STD) chlamydia. Reactive arthritis can also be caused by gastrointestinal infection from bacteria such as salmonella, shigella, campylobacter or Yersinia, infections that can cause diarrhea and vomiting. […] Scientists believe that people who develop reactive arthritis have a certain genetic makeup. Supporting the theory that genetic makeup is a risk factor, about 50% of people with reactive arthritis carry a gene called HLA-B27, compared with 8% of the general population. […] Reactive arthritis is thought to be an autoimmune disorder, which means the body’s immune system mistakenly attacks its own tissues. In this case, the immune system is jolted into action by the infection but continues attacking after the infection is gone.
#26 Reactive Arthritis: Symptoms, Treatment, and Causes
https://patient.info/bones-joints-muscles/arthritis/reactive-arthritis
Reactive arthritis is a type of arthritis in which you develop inflammation in joints after you have had an infection in some other part of the body. […] The infection which triggers reactive arthritis is not actually in the joint, but is usually in the digestive system or urethra (the small tube that urine flows out of). […] When you have an infection your immune system tries to fight it off. This usually works well and that’s why we recover from infections. But sometimes your immune system goes into overdrive and accidentally tries to fight your own body. This is thought to be what happens in reactive arthritis: your body produces antibodies against your own joint. This makes it red, swollen and painful. There isn’t actually any infection in the joint itself but your body thinks there is.
#27 Reactive Arthritis – Harvard Health
https://www.health.harvard.edu/pain/reactive-arthritis-a-to-z
Reactive arthritis is triggered by an infection, usually by a sexually transmitted organism or by certain gastrointestinal bacteria. […] The most common infection causing reactive arthritis is the sexually transmitted disease (STD) chlamydia. Reactive arthritis can also be caused by gastrointestinal infection from bacteria such as salmonella, shigella, campylobacter or Yersinia, infections that can cause diarrhea and vomiting. […] Scientists believe that people who develop reactive arthritis have a certain genetic makeup. Supporting the theory that genetic makeup is a risk factor, about 50% of people with reactive arthritis carry a gene called HLA-B27, compared with 8% of the general population. […] Reactive arthritis is thought to be an autoimmune disorder, which means the body’s immune system mistakenly attacks its own tissues. In this case, the immune system is jolted into action by the infection but continues attacking after the infection is gone.
#28 Reactive Arthritis: Symptoms, Treatment, and Causes
https://patient.info/bones-joints-muscles/arthritis/reactive-arthritis
Reactive arthritis is a type of arthritis in which you develop inflammation in joints after you have had an infection in some other part of the body. […] The infection which triggers reactive arthritis is not actually in the joint, but is usually in the digestive system or urethra (the small tube that urine flows out of). […] When you have an infection your immune system tries to fight it off. This usually works well and that’s why we recover from infections. But sometimes your immune system goes into overdrive and accidentally tries to fight your own body. This is thought to be what happens in reactive arthritis: your body produces antibodies against your own joint. This makes it red, swollen and painful. There isn’t actually any infection in the joint itself but your body thinks there is.
#29 Signs of reactive arthritis | Ada
https://ada.com/conditions/reactive-arthritis/
ReA is not an infection of the joints, and the severity of the initial infection is not related to the severity of the ensuing arthritis. […] Reactive arthritis is thought to be an autoimmune disorder, in which the body produces antibodies attacking healthy tissue that causes inflammation. […] Reactive arthritis (ReA) is always brought on by an infection elsewhere in the body. The most common infections to trigger reactive arthritis are: […] It is not known exactly what predisposes a person to develop ReA in response to infection. Certain factors that are more common in people with the condition include being:
#30 Reactive arthritis | Causes, symptoms, treatments
https://versusarthritis.org/about-arthritis/conditions/reactive-arthritis/
Reactive arthritis is a type of inflammatory arthritis. […] One theory is that once your immune system has dealt with the infection, fragments of bacteria travel through your bloodstream and collect in the lining of your joints. […] We don’t yet know why some people get reactive arthritis, but we do know that it’s linked to a gene that some people inherit, called HLA-B27. […] The most common causes of reactive arthritis are: stomach upsets, diarrhoea, other infections in the gut, a throat infection – usually caused by a streptococcus bacteria, slapped cheek syndrome, glandular fever. […] The infection that causes reactive arthritis can be so mild that you may not feel unwell, until you’re aware of the pain in your joints. […] It can also follow an infection of the genitals or a sexually transmitted infection (STI), such as chlamydia. […] However, the condition tends to be more common in people with HLA-B27.
#31 Reactive Arthritis – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version
https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/joint-disorders/reactive-arthritis
Reactive arthritis (previously called Reiter syndrome) is a spondyloarthritis causing inflammation of the joints and tendon attachments at the joints, often related to an infection. […] Joint pain and inflammation can occur in response to an infection, usually of the genitourinary or gastrointestinal tract. […] Reactive arthritis is so called because the joint inflammation seems to be a reaction to an infection originating in the digestive (gastrointestinal) tract or the genitals or urinary (genitourinary) organs. […] Most people who have these infections do not develop reactive arthritis. People who develop reactive arthritis after exposure to these infections seem to have a genetic predisposition to this type of reaction, related in part to the same HLA-B27 gene found in people who have ankylosing spondylitis.
#32 Reactive Arthritis | UW Orthopaedic Surgery and Sports Medicine
https://orthop.washington.edu/patient-care/articles/arthritis/reactive-arthritis.html
Reactive arthritis is a form of arthritis that produces pain swelling redness and heat in the joints. […] The direct cause of reactive arthritis is not known; however both genetic and environmental factors are involved. About 75 percent of people with reactive arthritis have a gene called HLA-B27. […] When people get reactive arthritis through inflammation of the intestinal tract it usually follows a bout of diarrhea caused by eating foods contaminated with bacteria such as salmonella shigella campylobacter or yersinia. […] Some researchers have found fragments of infectious agents in the affected joints. The arthritis appears to result from an immune or inflammatory reaction to the fragments. […] Studies show that some people develop or have a relapse of reactive arthritis after having sexual intercourse with a new partner yet reactive arthritis itself cannot be transmitted through sexual contact.
#33 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Data suggest that chlamydial ReA is underdiagnosed and that asymptomatic chlamydial infections might be a common cause. […] ReA has an important genetic component; it tends to cluster in certain families and almost exclusively affects males, and HLA-B27 is identified in 70-80% of patients. […] HLA-B27 may share molecular characteristics with bacterial epitopes, facilitating an autoimmune cross-reaction instrumental in pathogenesis. HLA-B27 contributes to the pathogenesis of the disease and reportedly increases the risk of ReA 50-fold. […] ReA triggered by adalimumab and leflunomide in a patient with ankylosing spondyloarthropathy and Crohn disease has been described. […] Duration of diarrhea and weight loss are also considered risk factors in the development of ReA after enteric infections.
#34 Pulsenotes | Reactive arthritis
https://app.pulsenotes.com/medicine/rheumatology/notes/reactive-arthritis
Reactive arthritis is one of the spondyloarthropathies that is defined as arthritis occurring after an infection. […] ReA most commonly occurs after a causative infection from the urogenital or gastrointestinal tract. […] ReA is suspected to occur in patients who are genetically predisposed following an infection. […] Like all SpAs, the major genetic contribution is the HLA-B27 gene that occurs in 30-50% of patients with ReA. […] It is suspected that following infection there is a defective immune response with microbial antigens potentially cross-reacting with self-antigens in a process known as molecular mimicry. This leads to the immune system reacting to self-antigens as 'foreign’ and initiating an autoimmune reaction.
#35 Reactive Arthritis: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/reactive-arthritis
Reactive arthritis is a type of arthritis that an infection in the body can trigger. Most commonly, a sexually transmitted infection or bacterial infection in the intestines triggers development of reactive arthritis. […] Bacterial infection of the urinary tract or intestines is the most common cause of reactive arthritis. The most common bacterium associated with reactive arthritis is Chlamydia trachomatis (which is responsible for chlamydia infections). This bacterium usually spreads through sexual contact. […] Bacteria that cause food poisoning can also produce reactive arthritis symptoms. Examples of these bacteria include Shigella and Salmonella. […] Genetics may be a factor in whether or not you develop reactive arthritis. According to NIAMS, people who have the gene HLA B27 are more likely to develop reactive arthritis. However, not everyone with the HLA B27 gene will develop reactive arthritis if they get an infection.
#36 What is Reactive Arthritis? Symptoms, Causes & Flare Ups | NIAMS
https://www.niams.nih.gov/health-topics/reactive-arthritis
Reactive arthritis, as the name suggests, occurs in reaction to something in this case, an infection. The condition is caused by a bacterial infection in the digestive or urinary tract or the genitals, but arthritis symptoms typically do not set in until after you have recovered from the infection. […] Reactive arthritis is triggered by an infection frequently a sexually transmitted or food-borne bacterial infection but it is separate from the infection and typically sets in after the infection has cleared. The bacteria that commonly trigger it are Salmonella, Yersinia, Campylobacter, Shigella, and Chlamydia, but only a small number of people infected with them develop the condition. Scientists do not fully understand why some people are predisposed to getting reactive arthritis. […] Genetics seems to partly explain susceptibility to the condition, as many affected individuals have a gene called HLA-B27. However, many people who get reactive arthritis lack this genetic marker so there are other, unknown genetic and environmental contributing factors.
#37 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Data suggest that chlamydial ReA is underdiagnosed and that asymptomatic chlamydial infections might be a common cause. […] ReA has an important genetic component; it tends to cluster in certain families and almost exclusively affects males, and HLA-B27 is identified in 70-80% of patients. […] HLA-B27 may share molecular characteristics with bacterial epitopes, facilitating an autoimmune cross-reaction instrumental in pathogenesis. HLA-B27 contributes to the pathogenesis of the disease and reportedly increases the risk of ReA 50-fold. […] ReA triggered by adalimumab and leflunomide in a patient with ankylosing spondyloarthropathy and Crohn disease has been described. […] Duration of diarrhea and weight loss are also considered risk factors in the development of ReA after enteric infections.
#38 Reactive Arthritis Causes, Symptoms, Treatments, and More
https://www.webmd.com/arthritis/arthritis-reactive-arthritis
The cause of reactive arthritis is still unknown, but research suggests the disease is caused, in part, by a genetic predisposition: Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA-B27. […] In sexually active males, most cases of reactive arthritis follow infection with Chlamydia trachomatis or Ureaplasma urealyticum, both sexually transmitted diseases. In other cases, people develop the symptoms following an intestinal infection with shigella, salmonella, yersinia, or campylobacter bacteria.
#39 Reactive Arthritis (Reiter’s Syndrome) Causes | Stanford Health Care
https://stanfordhealthcare.org/medical-conditions/bones-joints-and-muscles/reactive-arthritis/causes.html
Reactive arthritis, or Reiter’s syndrome, is usually preceded by an infection caused by bacteria, such as Chlamydia trachomatis (a sexually transmitted disease) or Salmonella (a bacteria that can contaminate foods). […] It is important to note that the disease reactive arthritis itself is not contagious, but, rather, the bacteria that causes it. […] About 75 percent of persons with the tendency to develop this disease have a special gene marker called HLA-B27.
#40 What is Reactive Arthritis? Symptoms, Causes & Flare Ups | NIAMS
https://www.niams.nih.gov/health-topics/reactive-arthritis
Reactive arthritis, as the name suggests, occurs in reaction to something in this case, an infection. The condition is caused by a bacterial infection in the digestive or urinary tract or the genitals, but arthritis symptoms typically do not set in until after you have recovered from the infection. […] Reactive arthritis is triggered by an infection frequently a sexually transmitted or food-borne bacterial infection but it is separate from the infection and typically sets in after the infection has cleared. The bacteria that commonly trigger it are Salmonella, Yersinia, Campylobacter, Shigella, and Chlamydia, but only a small number of people infected with them develop the condition. Scientists do not fully understand why some people are predisposed to getting reactive arthritis. […] Genetics seems to partly explain susceptibility to the condition, as many affected individuals have a gene called HLA-B27. However, many people who get reactive arthritis lack this genetic marker so there are other, unknown genetic and environmental contributing factors.
#41 Reactive Arthritis: Causes, Symptoms and Treatments | Arthritis Foundation
https://www.arthritis.org/diseases/reactive-arthritis
Reactive arthritis is an inflammatory type of arthritis that affects the joints, eyes, and urinary tract (bladder, vagina, urethra). It occurs when bacteria enters the blood stream and causes your body to react with inflammation in different parts of the body. The types of bacteria that cause reactive arthritis are usually contracted through sexual contact or by eating spoiled food. […] Being infected with certain bacteria has been linked to reactive arthritis. The ones most commonly associated with reactive arthritis are: Chlamydia trachomatis. It is spread through sexual contact. The infection may begin in the vagina, bladder or the urethra. Salmonella, Shigella, Yersinia and Campylobacter. These bacteria typically infect the gastrointestinal tract. […] In rare cases, the bacterium Chlamydia pneumoniae, which causes respiratory infections, may also cause reactive arthritis. The bacteria typically enter your body in one of two ways: Urogenital tract. Bacteria can enter through the vagina or urethra during sexual contact and spread to the bladder. Gastrointestinal (GI) tract. Bacteria can enter the body if you eat spoiled food or food that came into contact with contaminated surfaces. […] Doctors are not sure why some people exposed to these bacteria get the disease and others dont. However, researchers have identified a gene, called human leukocyte antigen (HLA) B27, that makes a person more likely to get reactive arthritis. Not everyone who inherits this gene will get the disease.
#42 Reactive arthritis Information | Mount Sinai – New York
https://www.mountsinai.org/health-library/diseases-conditions/reactive-arthritis
Reactive arthritis is a type of arthritis that follows an infection. It may also cause inflammation of the eyes, skin and urinary and genital systems. […] The exact cause of reactive arthritis is unknown. However, it most often follows an infection, but the joint itself is not infected. Reactive arthritis most often occurs in men between the ages of 20 and 40, although it does sometimes affect women. It may follow an infection in the urethra after unprotected sex. The most common bacteria that cause such infections is called Chlamydia trachomatis. Reactive arthritis can also follow a gastrointestinal infection (such as food poisoning). In up to one half of people thought to have reactive arthritis, there may be no infection. It is possible that such cases are a form of spondyloarthritis. […] Certain genes may make you more likely to get this condition. […] The disorder is rare in young children, but it may occur in teenagers. Reactive arthritis may occur in children ages 6 to 14 after Clostridium difficile gastrointestinal infections.
#43 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. […] Two forms of reactive arthritis are common: sexually transmitted and dysenteric. […] The sexually transmitted form occurs primarily in men aged 20 to 40. Genital infections with Chlamydia trachomatis are most often implicated. […] Men or women can acquire the dysenteric form after enteric infections, primarily Shigella, Salmonella, Clostridioides difficile, Yersinia, or Campylobacter. […] Bacille Calmette-Guerin injection for bladder cancer has also been reported to trigger reactive arthritis. […] In approximately 40% of cases, infectious pathogens cannot be identified. […] Reactive arthritis is postinfectious arthritis. Although there is evidence of microbial antigens in the synovium, organisms cannot be cultured from joint fluid.
#44 Reactive Arthritis – Harvard Health
https://www.health.harvard.edu/pain/reactive-arthritis-a-to-z
Risk factors for more severe disease include one or more of the following: male gender, venereal infection (rather than intestinal infection), sacroiliac or hip joint involvement, swelling of a finger or toe, blood tests showing evidence of marked body-wide inflammation, presence of gene marker, HLA-B27, poor response to initial therapy.
#45 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. The most common infections include the sexually transmitted infection Chlamydia trachomatis, and bowel infections like Clostridium difficile, Campylobacter, Salmonella, Shigella and Yersinia. […] People who test positive for the HLA-B27 gene may be at higher risk for severe or chronic arthritis, but those who test negative may get reactive arthritis too. People with weakened immune systems from HIV or AIDS may also develop reactive arthritis.
#46 Reactive Arthritis: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/331347-overview
Data suggest that chlamydial ReA is underdiagnosed and that asymptomatic chlamydial infections might be a common cause. […] ReA has an important genetic component; it tends to cluster in certain families and almost exclusively affects males, and HLA-B27 is identified in 70-80% of patients. […] HLA-B27 may share molecular characteristics with bacterial epitopes, facilitating an autoimmune cross-reaction instrumental in pathogenesis. HLA-B27 contributes to the pathogenesis of the disease and reportedly increases the risk of ReA 50-fold. […] ReA triggered by adalimumab and leflunomide in a patient with ankylosing spondyloarthropathy and Crohn disease has been described. […] Duration of diarrhea and weight loss are also considered risk factors in the development of ReA after enteric infections.
#47 Learn About Reactive Arthritis | SPONDYLITIS.ORG
https://spondylitis.org/about-spondylitis/overview-of-spondyloarthritis/reactive-arthritis/
Reactive arthritis (ReA) is thought to occur as a reaction to an infection that started elsewhere in the body, generally in the genitourinary or gastrointestinal tract. […] Reactive arthritis occurs after exposure to or infection caused by certain types of bacteria. […] No everyone exposed to these bacteria, however, will contract ReA. Those who go on to develop ReA are more likely to test positive for the HLA-B27 genetic marker, although other genetic factors may be involved. Thus, it is an interaction between an individuals genetic make-up and the initial infection that causes reactive arthritis. […] A tendency does exist for more severe and long-term disease in patients who test positive for HLA-B27, as well as in those who have a family history of spondyloarthritis. […] In about 15 to 20 percent of people with ReA, the condition recurs, sometimes brought on by reinfection. There is also a possibility of developing a chronic form of arthritis.
#48 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#49 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#50 Reactive Arthritis
https://labtestsonline.org.uk/conditions/reactive-arthritis
Reactive arthritis is a self-limiting condition that affects the joints and usually develops after certain types of infection such as a bowel or genital infection. […] Reactive arthritis is so called because it normally occurs as a reaction a few weeks after an infection. The exact mechanism is unclear but scientists believe that either the body reacts against itself (autoimmune) or fragments of the infection get into the joint to cause inflammation. […] The most common infection in the UK that triggers reactive arthritis is a gut infection such as food poisoning. Around 1-2% of people with food poisoning will develop joint inflammation after. Less commonly it can occur after sexually transmitted diseases particularly chlamydia. Occasionally it can be caused after a throat infection particularly if caused by a bacterium called streptococcus. It can also be caused by other bacterial infections or an unknown viral infection.
#51 Reactive Arthritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK499831/
Reactive arthritis is known to be triggered by a bacterial infection, particularly of the genitourinary (Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma hominis, and Ureaplasma urealyticum) or gastrointestinal (GI) tract (Salmonella enteritidis, Shigella flexneri, and S. disenteriae, Yersinia enterocolitica, Campylobacter jejuni, Clostridium difficile). The incidence is about 2% to 4% after a urogenital infection, mainly with Chlamydia trachomatis, and varies from 0% to 15% after gastrointestinal infections with Salmonella, Shigella, Campylobacter, or Yersinia. This might be affected by the epidemiological and environmental factors, the pathogenicity of the bacteria, and differences in the study designs. The enteric ReA occurs commonly following enteric infections. However, chlamydia associated ReA is endemic, especially in developed countries. […] Today, it is believed that the disorder is due to an aberrant autoimmune response to the gastrointestinal infection caused by salmonella, shigella, campylobacter, or chlamydia.
#52 What is Reactive Arthritis? What Are the Symptoms and How Do I Prevent Myself From Getting It? | Tristate Arthritis & Rheumatology
https://tristatearthritis.com/reactive-arthritis/what-is-reactive-arthritis-what-are-the-symptoms-and-how-do-i-prevent-myself-from-getting-it/
Reactive Arthritis (AKA Reiters Syndrome) is when an infection in another part of your body triggers joint pain and swelling. […] Bacteria that are transmitted sexually or through food are the main causes of reactive arthritis. Only a small amount of people who are exposed to these bacteria will get reactive arthritis. […] Its also good to know that the bacteria that cause reactive arthritis are contagious but the actual reactive arthritis is not.
#53 Reactive Arthritis â Causes & Diagnosis | MHA
https://muscha.org/reactive-arthritis/
Reactive arthritis is a type of arthritis caused by certain types of bacterial infection. […] Reactive arthritis, formerly called Reiters syndrome, is a type of arthritis that occurs as a reaction to a bacterial infection in another part of your body, particularly a bowel or genital tract infection. […] Bacterial infections that are known to cause reactive arthritis include: the food poisoning bacterium Salmonella, bacteria that cause gastrointestinal illness such as Shigella, Yersinia or Campylobacter, and the sexually transmitted infection chlamydia (caused by the bacterium Chlamydia trachomatis). […] Most people who catch one of these bacterial infections don’t develop reactive arthritis. We don’t know why some people develop arthritis and others don’t. […] If you have a genetic marker known as HLA-B27 you are more likely to develop reactive arthritis. Having the HLA-B27 gene could also make you more likely to have further episodes in the future. […] However many other people have this marker and never develop reactive arthritis. So the reason some develop reactive arthritis and others don’t is still a mystery.
#54 Reactive arthritis | Altru Health System
https://www.altru.org/health-library/conditions/reactive-arthritis
Reactive arthritis develops in reaction to an infection in your body, often in your intestines, genitals or urinary tract. You might not be aware of the triggering infection if it causes mild symptoms or none at all. […] Numerous bacteria can cause reactive arthritis. Some are transmitted sexually, and others are foodborne. The most common ones include: Campylobacter, Chlamydia, Clostridioides difficile, Escherichia coli, Salmonella, Shigella, Yersinia. […] Reactive arthritis isn’t contagious. However, the bacteria that cause it can be transmitted sexually or in contaminated food. Only a few of the people who are exposed to these bacteria develop reactive arthritis.
#55 Reactive arthritis
https://www.nhs.uk/conditions/reactive-arthritis/
Reactive arthritis can happen after having an infection that’s usually in your stomach (such as food poisoning), or a sexually transmitted infection (STI), such as chlamydia. […] Your joints later become swollen because your immune system begins to attack them by mistake. […] If the infection that causes reactive arthritis was very mild, you might not remember having it before your joint pain began.
#56 Reactive Arthritis – Bone, Joint, and Muscle Disorders – Merck Manual Consumer Version
https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/joint-disorders/reactive-arthritis
There is some evidence that the chlamydia bacteria and possibly other bacteria actually spread to the joints, but the roles of the infection and the immune reaction to it are not clear. […] A treatment for bladder cancer called Bacille Calmette-Guerin injection may also trigger reactive arthritis. […] In many people, no infection can be found to have preceded reactive arthritis. […] When reactive arthritis is caused by infection of the genitals or urinary tract, antibiotics are given, but this treatment does not always relieve the arthritis and its optimal duration is not known. […] In most people, the initial symptoms of reactive arthritis disappear in 3 or 4 months. However, up to 50% of people have recurring joint inflammation or other symptoms over several years, especially in people with chlamydial infection or those who have the HLA-B27 gene.
#57
https://link.springer.com/article/10.1007/s40588-020-00152-6
Reactive arthritis is considered to be part of the spectrum of the spondyloarthritis. […] The understanding of pathophysiological models is challenging, but recent studies contribute to elucidate the major factors involved in the development of the disease. […] This book highlight the importance of infectious agents in the etiology and pathogenesis of musculoskeletal disorders including Reactive arthritis, as well as the role they play in affecting the natural course, disease expression, progression, and clinical response to conventional and biological therapy. […] This study clarifies the pathophysiology of ReA by showing the characteristic of the gut microbiota for post infectious arthritis patients. […] Reactive arthritis: defined etiologies, emerging pathophysiology, and unresolved treatment.