Reactive arthritis

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Classification according to ICD-10
M02.1 Postenteritic Arthritis
M02.3 Reiter's disease
M02.8 other reactive arthritis
M02.9 Reactive arthritis, unspecified
ICD-10 online (WHO version 2019)

The reactive or post-infectious arthritis (abbreviated ReA ), and Reiter's disease called, is a flammable - rheumatic disease is selected from the group of spondyloarthritides . As a result of an infection , especially of the intestines or the urethra with bacteria , joints or other structures become inflamed without being infected themselves. According to the Berlin doctor Hans Reiter , who first described the symptoms of the disease in the First World War in 1916, the four main symptoms are

  1. Inflammation of the joints ( arthritis ),
  2. Inflammation of the urethra ( urethritis )
  3. Eye inflammation ( conjunctivitis / uveitis ) and
  4. typical skin symptoms (rider dermatosis)

as the Reiter Tetrad , the first three of which are called the Reiter Trias . If at least three of these symptoms are present in a patient, one speaks of Reiter's syndrome (from which Christopher Columbus possibly suffered, whose doctor reported arthritis and eye changes in the discoverer); however, this occurs only in every third reactive arthritis.


Young white men with a peak age of 20 to 30 (up to 45) years are mainly affected. The incidence of this worldwide occurring disease is 3.5 per 100,000 men under 50 years of age, in Western countries around 4–5 per 100,000. The gender ratio is inconsistent in the literature: according to the AWMF guideline, m: w = 3: 1, according to the German Rheuma League, m: w = 1: 1. A chronic course occurs in approx. 20% of the cases.


If synovial fluid is obtained from affected joints, no reproductive pathogens can be detected, but some antigens , DNA or RNA from pathogens can be detected. In the case of infection with chlamydia, it has been demonstrated that inactivated bacteria persist within cells. Reactive arthritis is therefore considered an autoimmune disease . Apparently the infection triggers a reaction of the immune system that is directed against the own body.

According to the underlying infection, two groups can be formed:

Since the symptoms of the previous disease urethritis or enteritis are often weak and fleeting, it can only be estimated that about 3% of all chlamydial infections and about every third chlamydial urethritis result in Reiter's syndrome.

The HLA-B27 cell characteristic ( HLA class I ) is detected in the blood in 60 to 80% of the sick people ; the disease obviously has a genetic component.


The symptoms of reactive arthritis usually appear 2 to 6 weeks after the infection, which is often not noticed by the patient. The main initial symptoms include possible fever and fatigue:

Skin changes of the feet

After 3–12 months (weeks to years), relapses can occur in up to 15% of patients . Also in 15% the disease can take a chronic course and lead to joint destruction.


  • Anamnesis of a previous infection (often not effective)
  • The laboratory examination of the blood shows unspecific changes: signs of inflammation; antinuclear antibodies and rheumatoid factors are absent. It therefore primarily serves to substantiate suspicions by excluding other causes.
  • The detection of HLA-B27 further corroborates the suspected diagnosis , but is by no means conclusive in individual cases , since around 8% of the healthy population also have this characteristic.
  • A urethral swab or cervical swab with an examination for chlamydia and mycoplasma should also be performed in patients who are symptom-free. The corresponding detection is carried out by means of pathogen culture or PCR . Chlamydia serology alone is not effective . In contrast, a titer determination of the Salmonella, Campylobacter and Yersinia antibodies is indicated in all cases.
  • X-rays and magnetic resonance imaging of the affected joints

In the frequent detection of HLA-B27, in the distribution pattern of the inflamed joints, in the involvement of the eyes and tendon attachments, and possibly in the skin manifestations, reactive arthritis resembles other spondyloarthritis such as ankylosing spondylitis , psoriatic arthritis or enteropathic arthritis . If the infection is not remembered and can no longer be detected, chronic reactive arthritis can be difficult to distinguish from these related diagnoses.

Differential diagnosis

In addition to the already mentioned psoriasis arthropathica, other manifestations of psoriasis such as


For rapid relief of inflammatory joint problems, the symptomatic administration of NSAIDs along with local anti-inflammatory measures (such as cold applications) is recommended . In addition, the elimination of the causative infection through appropriate antibiotic therapy is desirable, although a benefit has only been proven in the urogenital form (infection with Chlamydia trachomatis). Antibiotics are therefore rarely used - since usually no pathogens can be detected. If they are proven, however, treatment of the sexual partner (s) is also necessary.

If the disease progresses seriously and several joints are involved, especially if iridocyclitis occurs, corticosteroids must be used to avoid permanent changes.

Immunosuppressants such as methotrexate and sulfasalazine are only used in chronic cases .


  • Wolfgang Miehle: Joint and spinal rheumatism. Eular Verlag, Basel 1987, ISBN 3-7177-0133-9 , p. 43.

Web links

Individual evidence

  1. a b c d e Gerd Herold and colleagues: Internal Medicine 2017 . Self-published, Cologne 2016, ISBN 978-3-9814660-6-5 , p. 669 .
  2. Wolfgang Miehle: Joint and spinal rheumatism. Eular Verlag, Basel 1987, ISBN 3-7177-0133-9 , p. 11.
  3. See also Columbus suffered from Reiter's syndrome .