Reactive arthritis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

If left untreated, patients with reactive arthritis may progress to develop myalgias and joint pain especially in the lower extremities. Over the course of time, patient develops urethritis and conjunctivitis. Complications of reactive arthritis are seen with chronic course and may include chronic arthritis with remitting relapsing course, urethral stricture, vitreous floaters, macular edema, cataracts or glaucoma, ankylosing spondylitis, and aortitis. Prognosis is generally good for patients with reactive arthritis. Patients who receive and respond to treatment generally have rapid reversal of symptoms. It is estimated that around 25% of patients may develop long term complication of arthropathy.

The symptoms of reactive arthritis usually develop after 1-3 weeks of initial infection (in another part of the body) and start with symptoms such as malaise, fatigue, and fever.
Majority of the patients have a self limited course with complete healing within 3-12 months.
If left untreated, patients with reactive arthritis may progress to develop myalgias and joint pain especially in the lower extremities. Over the course of time, patient develops urethritis and conjunctivitis.
Urethritis presents with dysuria, increased frequency, urgency, and urethral discharge whereas conjunctivitis leads to pain, burning, and tearing sensation in eyes.

Complications of reactive arthritis are seen with chronic course and may include:^[1]^[2]^[3]^[4]

Prognosis is generally good for patients with reactive arthritis.^[5]^[6]
Patients who receive and respond to treatment generally have rapid reversal of symptoms.
It is estimated that around 25% of patients may develop long term complications of arthropathy.
Long term complications are mostly seen in patients who are unresponsive to NSAIDs and have elevated ESR.
Patients who are HLA-B27 positive have a high rate of recurrence (upto 50%).

↑ Hoogland YT, Alexander EP, Patterson RH, Nashel DJ (April 1994). "Coronary artery stenosis in Reiter's syndrome: a complication of aortitis". J. Rheumatol. 21 (4): 757–9. PMID 8035407.
↑ Deer T, Rosencrance JG, Chillag SA (June 1991). "Cardiac conduction manifestations of Reiter's syndrome". South. Med. J. 84 (6): 799–800. PMID 2052981.
↑ Wollenhaupt J, Zeidler H (July 1998). "Undifferentiated arthritis and reactive arthritis". Curr Opin Rheumatol. 10 (4): 306–13. PMID 9725091.
↑ Kingsley G, Sieper J (August 1996). "Third International Workshop on Reactive Arthritis. 23-26 September 1995, Berlin, Germany. Report and abstracts". Ann. Rheum. Dis. 55 (8): 564–84. PMC 1010245. PMID 8815821.
↑ Wechalekar MD, Rischmueller M, Whittle S, Burnet S, Hill CL (March 2010). "Prolonged remission of chronic reactive arthritis treated with three infusions of infliximab". J Clin Rheumatol. 16 (2): 79–80. doi:10.1097/RHU.0b013e3181d06f70. PMID 20216128.
↑ Amor B, Santos RS, Nahal R, Listrat V, Dougados M (October 1994). "Predictive factors for the longterm outcome of spondyloarthropathies". J. Rheumatol. 21 (10): 1883–7. PMID 7837155.