Department of Endocrinology, Metabolism, Nephrology and Rheumatology, Kochi Medical School Hospital, Nankoku, 783-8505, Japan.
Department of Internal Medicine, Chikamori Hospital, Kochi, Japan.
Rheumatol Int. 2021 Aug;41(8):1387-1398. doi: 10.1007/s00296-021-04879-3. Epub 2021 May 1.
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.
反应性关节炎（ReA）是一种无菌性关节炎，发生在遗传易感性个体的关节外感染之后。关节外感染通常是胃肠道或泌尿生殖道的感染。感染相关性关节炎是一种与链球菌性扁桃体炎、关节外结核或膀胱癌内卡介苗（iBCG）治疗相关的无菌性关节炎。这些与感染相关的关节炎诊断通常基于发病机制与 ReA 一起归类。然而，这些实体的独特特征可能因分组而被掩盖。因此，我们回顾了经典 ReA、链球菌后 ReA、Poncet 病和 iBCG 诱导的 ReA 的临床特征。考虑到触发微生物、感染部位和 HLA-B27 的频率的多样性，这些是不同的疾病。然而，经典 ReA 和感染相关性关节炎实体之间的临床症状和细胞内寄生虫发病机制相似。因此，链球菌后 ReA、Poncet 病和 iBCG 诱导的 ReA 可以被包括在 ReA 的扩展谱中，特别是基于发病机制。
