Giraudo Chiara, Astorri Davide, Reijnierse Monique
Unit of Advanced Clinical and Translational Imaging, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health - DCTV, University of Padova, Padova, Italy.
Rheumatology Unit, SS Giovanni e Paolo Hospital, Venice, Italy.
Skeletal Radiol. 2025 Jun 5. doi: 10.1007/s00256-025-04965-8.
Reactive arthritis, initially described at the beginning of the twentieth century, is characterized by a sterile articular inflammation occurring several days to weeks after a bacterial gastrointestinal or urogenital infection. The most common agents include Chlamydia trachomatis, Ureaplasma urealyticum, and Neisseria gonorrhea for the venereal type and Salmonella enteriditis, Shigella flexneri, Yersinia enterocolitica for the post-enteric type. The prevalence of reactive arthritis varies geographically but overall, worldwide, it is estimated as 1/1000 persons. It is more common in young adults (18 to 40 years old) and in terms of gender, there is not a significant difference between men and women for post-enteric infections while the risk of the endemic type is higher in men with a ratio of 9:1. Guidelines and diagnostic algorithms taking into account the identification of the etiological agent and the timing of infection have been proposed in the literature. Typically, it is an asymmetric mono- or oligo-arthritis with a predilection for the lower extremities falling under the spondyloarthritis umbrella having shared clinical features. At imaging, enthesitis is considered a hallmark of the disease although other typical signs of inflammatory joint disease such as synovitis, periostitis, and erosions can be detected taking advantage of the various radiological and hybrid techniques according to the affected areas.
反应性关节炎最初于20世纪初被描述,其特征是在细菌性胃肠道或泌尿生殖系统感染后数天至数周出现无菌性关节炎症。最常见的病原体包括性病型的沙眼衣原体、解脲脲原体和淋病奈瑟菌,以及肠道感染后型的肠炎沙门氏菌、福氏志贺菌、小肠结肠炎耶尔森菌。反应性关节炎的患病率因地域而异,但总体而言,全球估计为千分之一。它在年轻人(18至40岁)中更为常见,就性别而言,肠道感染后男女之间没有显著差异,而地方病型在男性中的风险更高,比例为9:1。文献中已经提出了考虑病原体鉴定和感染时间的指南和诊断算法。典型情况下,它是一种不对称的单关节炎或少关节炎,以下肢为好发部位,属于具有共同临床特征的脊柱关节炎范畴。在影像学上,附着点炎被认为是该病的一个标志,不过根据受累部位利用各种放射学和混合技术,也可以检测到其他典型的炎性关节疾病体征,如滑膜炎、骨膜炎和侵蚀。