Reactive Arthritis is a spondyloarthritis following gastrointestinal or genitourinary infections, traditionally described as a triad of conjunctivitis, urethritis, and arthritis. It is important to identify patients with reactive arthritis as certain disease features portend a poorer prognosis. We present a case of reactive arthritis in a 36-year-old gentleman after a self-limited episode of gastroenteritis.
A 36-year-old man presented to the Rheumatology clinic for a 2-week history of multiple arthralgias. The patient reported that one week before the onset of arthritis he experienced a self-limited episode of gastroenteritis. Succeeding, the patient noticed pain and swelling to right wrist, left elbow, and pain and swelling to left wrist. Patient was found to have an elevated ESR and he was prescribed Medrol dose pack and indomethacin which did not resolve symptoms. Patient denied rashes, oral ulcers, conjunctivitis, or constitutional symptoms. Examination was remarkable for swelling of right elbow, bilateral wrists, left knee, and ankles. There was no conjunctivitis, oral ulcers, or keratoderma blenhorragicum. Labs showed negative ANA and rheumatoid factor, sedimentation rate of 107, CRP 8.9, positive HLA-B27. Patient was diagnosed with reactive Arthritis. He was started on Prednisone and Sulfasalazine.
Reactive arthritis is a spondyloarthritis that typically affects middle-aged men and is self-limited with remission being achieved by 6-18 months, while recurrence occurs in 25-50% of cases, especially in HLA-B27 positive patients. These patients could potentially develop long term disease resulting in enthesitis and destructive arthritis.
Loftis, Christine E. and Dulgheru, Emilia C., "Another One Bites the Joint: A Case of Reactive Arthritis in an Otherwise Healthy Hispanic Male" (2021). School of Medicine Publications and Presentations. 232.