Diagnosing Reactive Arthritis

Criteria For Reactive Arthritis

How to classify and diagnose reactive arthritis is still an area where there is less than total consensus.

The history of its nomenclature begins in 1916 when Hans Reiter described a young soldier who had symptoms of polyarthritis, urethritis, and conjunctivitis (known as the clinical triad), following bloody diarrhea. In Germany, the clinical triad became known as "Reiter's syndrome".

In the United States, Reiter's syndrome (RS) has been used to describe other arthritides that did not possess all three features of the clinical triad. Over the past few decades the classification was broadened, and in 1969 the term "reactive arthritis" was introduced in place of "Reiter's syndrome".

The International Workshop

Prior to the 4th International Workshop on Reactive Arthritis, questionnaires were sent to 42 experts for the purpose of determining the points of agreement and disagreement regarding the classification of reactive arthritis. 81% of the experts replied to the questionnaire.

Most of the experts agreed that reactive arthritis:

Includes arthritides which occur following bacterial infection with one of the following:

• Chlamydia
• Yersinia
• Salmonella
• Shigella
• Campylobacter

• Has a preceding infection viewed as essential to the "reactive" diagnosis, but should not include post-streptococcal, Lyme disease, and viral arthritides which should be classified as "infection-related arthritides"
• Is associated with HLA-B27 and spondyloarthropathy
• Can be acute or chronic, with 6 months viewed as the distinction
• Has 1-7 days as the minimal interval between preceding symptoms and onset of arthritic symptoms and a maximum of 4-6 weeks
• Characteristically has asymmetrical joint pattern usually of the lower limbs
• Can be distinguished by enteric or urogenital symptoms

Disagreement of the experts on reactive arthritis with regard to:

• Whether arthritis was essential for the "reactive" diagnosis. Some felt uveitis and arthralgia were sufficient for the "reactive" diagnosis.
• Which arthritides are essential for the "reactive" diagnosis
• The significance of other symptoms of spondyloarthropathy
• The value of serological testing and stool cultures for the "reactive" diagnosis
• The importance of the determination and presence of HLA-B27

The Bottom Line

Despite considerable interest and research over the past two decades, there is more work to be done before diagnostic and classification criteria will be considered definite for reactive arthritis. Future studies on the epidemiology, pathogenesis, diagnosis, and treatment of reactive arthritis will rely on clear and specific criteria.

Related Resources

• Reactive Arthritis (Reiter's Syndrome)
• Guide to Reactive Arthritis

_{Source: The Journal Of Rheumatology (2000;27:2185-92)}