GPAtlas🧭 When to suspect
Reactive arthritis (ReA) is a sterile, culture-negative inflammatory arthritis triggered by an infection at a distant site.
It is a peripheral form of spondyloarthritis (SpA) and is associated with human leukocyte antigen B27 (HLA-B27).
Suspect it in an acute, asymmetric oligoarthritis (a few joints):
• Predominantly of the lower limbs (knees, ankles, feet).
• Developing 1–4 weeks after a gastrointestinal or genitourinary infection.
Two trigger patterns are recognised: post-enteric ReA, after a diarrhoeal illness, and sexually acquired reactive arthritis (SARA), after a sexually transmitted infection (STI).
The classic triad of arthritis, urethritis and conjunctivitis is present in only a minority: most patients do not have all three, so its absence does not exclude the diagnosis.
The two priorities in primary care are to recognise the post-infective pattern and to never miss septic arthritis or sight-threatening anterior uveitis, both of which can masquerade as, or complicate, reactive arthritis.
| Post-enteric reactive arthritis |
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• Pathogens: Campylobacter, Salmonella, Shigella, Yersinia |
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• Preceding illness: diarrhoea ± vomiting, typically 1–4 weeks earlier |
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• Who: men and women affected roughly equally |
| Sexually acquired reactive arthritis (SARA) |
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• Pathogens: Chlamydia trachomatis (commonest); also Neisseria gonorrhoeae, Mycoplasma genitalium |
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• Preceding illness: urethritis/cervicitis – dysuria, discharge; recent new or unprotected sexual contact |
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• Who: more common in young men (up to around 9:1) |
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🧠 Clinical pearl • Do not wait for the full triad. • Most patients never develop arthritis, urethritis and conjunctivitis together. • The eponym Reiter's syndrome has been abandoned (Reiter was a convicted war criminal). • Consider reactive arthritis in any acute lower-limb oligoarthritis following a recent gut or genital infection – even with a single extra-articular clue such as heel pain or a red eye. |
Source: NICE NG65 · BASHH SARA 2021
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