Reaktive Arthritis

ZUSAMMENFASSUNG

Die reaktive Arthritis (ReA) ist definiert als sterile Gelenkentzündung, die innerhalb von Tagen bis Wochen nach einer extraartikulären bakteriellen Infektion (Primärinfektion) auftritt. Die häufigsten auslösenden Infektionen stellen eine Urethritis durch Chlamydia trachomatis bzw. eine Gastroenteritis durch Enterobakterien, seltener respiratorische Infekte, dar. Die Erreger oder Erregerbestandteile persistieren im Gelenk, sind aber im Gegensatz zur septisch-bakteriellen Arthritis nicht aus dem Gelenk anzüchtbar. Die typische artikuläre Manifestation der HLA-B27-assoziierten ReA, die zur Gruppe der Spondyloarthritiden (SpA) gezählt wird, ist die asymmetrische Oligoarthritis der unteren Extremität; seltener sind der Befall des Achsenskelettes oder extraartikuläre Manifestationen wie Enthesitis oder Iritis. Die Arthritis ist zu Beginn oft sehr schmerzhaft und hochentzündlich und zumeist selbstlimitierend. Chronische Verläufe, die nicht ausreichend auf symptomatische Therapie ansprechen, treten in bis zu 30 % der Patienten auf; für diese Formen sind immunmodulierende Therapien reserviert. Eine zunehmende Zahl von Fallbeschreibungen und kleineren, prospektiven Untersuchungen zeigen eine sehr gute Wirksamkeit von Biologika wie TNF-α-, IL6- und IL17-Inhibitoren.

ABSTRACT

Reactive arthritis (ReA) is defined as a sterile joint inflammation following an extra-articular infection (primary infection) mostly caused by Chlamydia trachomatis (urethritis) or enterobacter species (gastroenteritis). A pivotal phenomenon of ReA is the presence of non-culturable bacteria or fragments thereof persisting in the joint in contrast to septic arthritis, where the causing bacteria can be cultivated from the affected joint. The HLA-B27 associated form of ReA is defined as part of the spondyloarthritis (SpA) group and characterized by a mostly self-limiting oligoarthritis of the lower limbs, very often with acute and highly inflammatory onset. Up to 30 % of patients develop chronic symptoms not responding sufficiently to symptomatic treatment. These patients are treated with immunomodulatory agents. An increasing number of case reports or small prospective studies show very good efficacy of biologics such as TNFα-, IL6- und IL17-inhibitors.

Schlüsselwörter

Reaktive Arthritis - Spondyloarthritis - Primärinfektion - Chlamydia trachomatis - Persistenz

Keywords

Reactive arthritis - spondyloarthritis - primary infection - Chlamydia trachomatis - persistence

Publikationsverlauf

Artikel online veröffentlicht:
19. April 2022

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