Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet\u2019s disease, and iBCG-induced ReA

Naoto Tamura,Yoshinori Taniguchi,Takeshi Yoshida,Kurisu Tada,Shigeto Kobayashi,Yoshio Terada,Hirofumi Nishikawa

doi:10.1007/s00296-021-04879-3

Abstract

Reactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

Highlights

The development of sterile arthritis after bacterial infection of the gastrointestinal or genitourinary tract is called reactive arthritis (ReA)
In 1969, Ahvonen et al proposed that reactive arthritis (ReA) be defined as aseptic or nonsuppurative arthritis following microbial infection of sites other than joints [1]
Arthritis following hemolytic streptococcal tonsillitis or upper respiratory tract infection originally reported in 1982, aseptic ReA accompanying tuberculosis (Poncet’s disease), and ReA after intravesical instillation of bacillus Calmette–Guerin therapy are considered ReA as they develop after the onset of another infection, and this has often caused confusion in the definition of ReA [2,3,4]

Summary

Introduction

The development of sterile arthritis after bacterial infection of the gastrointestinal or genitourinary tract is called reactive arthritis (ReA). Arthritis following hemolytic streptococcal tonsillitis or upper respiratory tract infection (i.e., poststreptococcal ReA [PSRA]) originally reported in 1982, aseptic ReA accompanying tuberculosis (Poncet’s disease), and ReA after intravesical instillation of bacillus Calmette–Guerin (iBCG) therapy are considered ReA as they develop after the onset of another infection, and this has often caused confusion in the definition of ReA [2,3,4]. On the one hand, according to a systematic review published in 2016, 3–8% of patients with Chlamydia trachomatis infection developed sexual intercourse-related ReA [18] It was reported in a study conducted in Japan that, of 123 patients with chlamydial infection, only 1 patient (0.8%) developed ReA [19].

10–40 No Yes No No

Findings

Conclusion