Update on the diagnosis and management of Reactive arthritis (Reiter’s syndrome)

The reactive arthritis (Reiter’s syndrome) is an asymmetric, non septic inflammation of several joints, mainly of the lower limbs, associated with the occurrence of a change called "enthesitis" (inflammation of the tendon), and proceeded by an extraarticular manifestation and by infection of various microorganisms. Classically it includes the triad arthritis, urethritis, and conjunctivitis. Approximately 80% of patients are positive for the histocompatability antigen called human leukocyte antigen (HLA)-B27; therefore, reactive arthritis is strongly associated with HLAB27. The disease is classified as type of seronegative spondyloarthropathy. For most patients, symptoms will go away in 2-6 months. Reactive arthritis can affect the heels, toes, fingers, low back, and joints, especially of the knees or ankles. The infection that causes reactive arthritis usually presents as diarrhoea or as a sexually transmitted disease. Diagnosis of reactive arthritis is difficult due to vast variation of the clinical features, largely empiric, relapsing courses and classical triad. Systemic treatment of reactive arthritis can be done with nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, disease modifying agents, immunosuppressive therapy, biological agents and antibiotics. Reactive arthritis can also be managed by nutrient supplements and herbal agents. The present review discusses various aspects of reactive arthritis disease, which helps for the future investigations of diagnose and management.