Reactive arthritis 4.4/5 (5)

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Reactive arthritis

Joint inflammation in the left knee. Reactive arthritis attacks one knee most commonly, especially among young men. Wikimedia CC BY-SA 3.0,

Reactive arthritis ICD-10 M02.9


Reactive arthritis is arthritis (arthritis) that occurs after an infection, but without bacteria, viruses or other microbes found in the affected joints. The disease belongs to the group of spondyloarthropathies. Reactive arthritis should not be confused with Septic arthritis where one detects infection in joints. Reactive arthritis is most often triggered by infections with chlamydia (sexually transmitted) or intestinal infections. Symptoms of arthritis, urethritis (urethritis) and eye inflammation (conjunctivitis) was formerly called Reiter's syndrome.

Disease Cause

Some infections can cause a reaction in immune system so joints, skin, eyes and other organs are mistakenly attacked. People with the hereditary the tissue type HLA-B27 and men are most at risk. Often, the triggering infection is over when the rheumatic symptoms begin (except for chlamydia infection). The most current triggering bacteria are:


Reactive arthritis typically occurs 1XXX weeks after an infection

  • Most often adolescents (16-40 years). Rarely among children and older people
  • Men are attacked more frequently than women


stiffness, joint pain, swelling and heat over affected joints as symptoms of arthritis (arthritis)

Clinical examination demonstrates

  • Arthritis (arthritis) most often in one knee
  • Other joints, also in arms and hands, are attacked by approx. 50%
  • Possibly attacked tendons and tendons (enthesitis) causes pain, swelling and heat over, among other things Achilles Ener in some
  • Some fingers or toes may swell in their entire length (dactylitis, "Sausage finger"
  • Pelvic, hip or back pain may be due to Iliosacral joint (sakroiliitt) and the back (spondylitis) can be attacked
  • Eye Inflammation in the form of conjunctivitis, episcleritis, keratitis or uveitis occurs
  • Blood tests often show signs of rheumatic inflammation
    • Elevated CRP and sedimentation rate (ESR)
    • HLA B27 is not routinely tested, but is a determining factor (detected by 70-80%, against 8-10% in the southern Norwegian population and approximately 15% in northern Norway)
  • The study fluid is thin-liquid and examination (yellow-white) without bacteria or uric acid crystals.
  • Ultrasound examination confirms signs of arthritis


The diagnosis is made on the basis of

  • Medical history (prior signs of infection),
  • Examination (typical arthritis and other findings)
  • Exclude other cause of disease
  • Suspected chlamydia infection is tested with urine sample
  • Persistent bowel symptoms are examined with stool samples

Incorrect diagnosis (Similar diseases, Differential diagnoses)


Most refer to rheumatologist

  • Joint puncture, drainage of the joint fluid and insertion of the conductor span or other cortisone into the affected joint
  • Chlamydia infection is treated with antibiotics
  • Symptoms are reduced with pracetamol, Ibux, Naproxen, Diklofenac and the like (NSAIDs) painkillers drugs
  • Prednisone starting dose tablets 15-20 mg daily can be used for a few days if joint puncture or painkillers are not effective. Dose escalation and ends after a few weeks
  • Eye symptoms treated by an ophthalmologist


The course varies from person to person. Usually, the disease returns during the 3-5 months, but more chronic events occur in 10-20%.

Guidelines / Recommendations

EULAR (Early Arthritis), Combe B, 2016

European guidelines for the management of non-gonococcal urethritis (Horner PJ, 2016)

Norwegian Rheumatological Association


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