Reactive Arthritis

A 2-year-old girl presents with a swollen, tender, erythematous knee. Two weeks ago she had fever and bloody diarrhea that lasted 4 days.

Postinfectious or reactive arthritis often occurs several weeks or months after an acute infection. Reactive arthritis frequently follows enteric infections with Shigella, Salmonella, Yersinia, and Campylobacter sp. As described in the vignette, affected children initially develop bloody diarrhea, followed by the onset of arthritis, typically 1 to 2 weeks after the triggering infection. Reactive arthritides are usually acute and self-limited, resolving within weeks or months. There is no specific treatment for reactive arthritis. The patient may need analgesics for pain relief. Of the choices listed, Shigella would be the most likely organism to cause bloody diarrhea and arthritis.

- other viral etiologies: mumps,varicella, hepatitis B, EBV, influenza,postimmunizationrubella, adenovirus, and parvovirus

Other important examples of reactive arthritis include postvenereal reactive arthritis (especially with Chlamydia trachomatis) and virus-related arthritis. A variety of viruses have been associated with reactive arthritis, including rubella, hepatitis B, mumps, parvoviruses, and herpesviruses. Poststreptococcal reactive arthritis and acute rheumatic fever (ARF) are two other examples of reactive arthritis. Children who have poststreptococcal reactive arthritis experience prolonged, persistent, and symmetric arthropathy that does not respond as well to aspirin as does typical ARF. In ARF, several joints are affected in quick succession, but each only briefly, producing a migratory polyarthritis.

Reactive arthritis does not typically follow infections with Escherichia coli, Giardia lamblia, Norwalk virus, or rotavirus.

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Fink CW. Reactive arthritis. Pediatr Infect Dis J. 1988;7:58-65
Miller ML, Cassidy JT. Postinfectious arthritis and related conditions. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co; 2000:712-713
Petty RE, Tingel AJ. Arthritis and viral infection. J Pediatr. 1988; 113:948-949