Mucocutane afwijkingen bij reactieve artritis door Chlamydia trachomatis

Conflict of interest: none declared. Financial support: none declared.

• Reactive arthritis (previously known as Reiters syndrome) is an inflammatory arthritis that is a type of spondyloarthropathy.

• The disease consists of the classical triad of arthritis, urethritis and conjunctivitis, but mucocutaneous abnormalities also frequently appear: balanitis circinata, keratoderma blennorrhagicum, aphthous ulcers in the mouth and nail disorders. These skin lesions are mainly found in reactive arthritis induced by Chlamydia trachomatis (Ct).

• Reactive arthritis is often triggered by a sexually transmitted infection (Chlamydia trachomatis) or an enteric infection (such as Salmonella or Shigella). It is thought that human antibodies against the pathogen cross-react with the HLA antigen (mainly HLA-B27).

• To distinguish between reactive arthritis and psoriatic arthritis, screening of the urine or synovium for Ct infection should be carried out.

• Acute reactive arthritis is treated with NSAIDs as the first choice. In addition, patients may receive an intra-articular injection of glucocorticoids. The mucocutaneous abnormalities respond well to topical glucocorticoids.

• Although in the Netherlands a Ct induced reactive arthritis is not yet treated with antibiotics, a recent published clinical trial in patients with a chronic Ct induced reactive arthritis showed a significant reduction in complaints in the group treated with a combination of antibiotics for 6 months, compared to the placebogroup.

• Active genitourinary Ct infection should be treated with antibiotics, the first choice being azithromycin 1000 mg as a single dose. It is important that the patient’s partner is tested at the same time and if necessary treated simultaneously to prevent reinfection.