Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet's disease, and iBCG-induced ReA

Rheumatol Int. 2021 Aug;41(8):1387-1398. doi: 10.1007/s00296-021-04879-3. Epub 2021 May 1.

Abstract

Reactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette-Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet's disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet's disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

Keywords: Infection-related arthritis; Postinfectious arthritis; Reactive arthritis; Spondyloarthritis.

Publication types

  • Review

MeSH terms

  • Arthritis, Reactive / etiology
  • Arthritis, Reactive / microbiology*
  • Arthritis, Reactive / physiopathology
  • HLA-B27 Antigen
  • Humans
  • Infections / complications
  • Syndrome

Substances

  • HLA-B27 Antigen