Post-infectious Reactive Arthritis: A Systematic Review

Abstract

Aims: This study aims to systematically review the clinical manifestations, diagnostic approaches, and therapeutic strategies associated with post-infectious reactive arthritis, also known as Reiter’s Syndrome, based on 12 studies included in this systematic review. Study Design: Systematic literature review. Place and Duration of Study: Databases searched (PubMed, SciELO, LILACS, BVS, MEDLINE) between April and May 2025. Methodology: The review followed PRISMA guidelines. Descriptors used included “Reactive Arthritis,” “Reiter Syndrome,” “Diagnosis,” “Treatment,” and names of associated pathogens. Inclusion criteria were studies published between 2015 and 2024, including observational studies, reviews, and case reports focusing on clinical, diagnostic, or therapeutic aspects of the disease. Results: Reactive arthritis is most often triggered by Chlamydia trachomatis, Salmonella, Shigella, Yersinia, or Campylobacter. Common symptoms included asymmetric oligoarthritis, enthesitis, urethritis, conjunctivitis, and skin lesions like circinate balanitis. Diagnosis remains clinical, aided by HLA-B27 testing and pathogen identification. NSAIDs were the first-line treatment, while DMARDs were used for chronic or severe cases. Antibiotic use was controversial, being generally recommended only in cases with confirmed active infection, particularly by Chlamydia trachomatis, and discouraged in resolved infections.. A multidisciplinary approach proved essential for managing systemic and extra-articular symptoms. Conclusion: Post-infectious reactive arthritis presents consistent clinical patterns and requires early clinical suspicion, particularly in young adults with a recent infection. NSAIDs and DMARDs form the therapeutic backbone, but further research—particularly randomized trials—is needed to refine diagnostic and treatment protocols.