Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Diagnosis of Reactive Arthritis in the Real World and Factors That Might Contribute to Its Under/Misdiagnosis.

Lin2,  Jenny, Shetty2,  Anjali G., Carter1,  John D.

Univ of South Florida, Tampa, FL
University of South Florida

Purpose:

Epidemiological data indicate that reactive arthritis (ReA) is under/misdiagnosed. Most epidemiologic studies demonstrate that ReA is the second most prevalent type of spondyloarthritis (SpA) with one study suggesting it is the most common. Other data demonstrate that the incidence of ReA should rival that of rheumatoid arthritis. A breadth of clinical experience, however, suggests that rheumatoid arthritis (RA) and other types of SpA are diagnosed far more often than ReA. The purpose of this study was to see how often rheumatologists diagnose ReA and determine factors that might contribute to this under/misdiagnosis.

Methods:

We designed an internet survey that was sent to rheumatologists worldwide. The aims of this 26 question internet survey were twofold: to determine how often practicing rheumatologists diagnose ReA compared to other types of SpA and RA, and to uncover factors that might lead to this under/misdiagnosis. The survey was sent out to random rheumatologists who are registered with the American College of Rheumatology.

Results:

The survey was delivered to 3,200 rheumatologists and 377 replied (11.8% response rate). Of the rheumatologists who replied 257/377 (68.2%) were male, 289/377 (76.7%) spend at least half there time in clinical care, 271/377 (71.9%) see at least 100 patients per month, 300/377 (79.6%) have been in clinical practice longer than 5 years since completion of their fellowship, and 256/377 (67.9%) practice in the U.S. In adult patients with new-onset diagnoses (disease duration <6 months), RA was the most common diagnosis followed by psoriatic arthritis (PsA), ankylosing spondylitis (AS), undifferentiated spondyloarthritis (uSpA), ReA, and inflammatory bowel disease related SpA; in patients with a disease duration of > 6 months, the order in decreasing frequency was RA followed by PsA, AS, uSpA, IBD related SpA, and ReA. PsA sine psoriasis was diagnosed only slightly less often than ReA in patients with disease duration of <6 months and at a nearly identical rate to ReA in patients >6 months disease duration. RA patients are more likely to have a monoarthritis or oligoarthritis if they are seronegative. Patients with inflammatory arthritis are queried about the possibility of preceding sexually transmitted diseases and dysentery, but they are more likely to be asked about the latter. Keratoderma blennorrhagicum is rarely diagnosed with 283/377 (75.1%) of respondents stating that they diagnose this in 0–10% of ReA patients; yet palmoplantarpustular psoriasis with arthritis is diagnosed nearly as often as ReA with an average of 4.4 vs. 6.13 cases per year respectively. Radiographic and advanced imaging work-up performed for ReA is the same as other types of SpA. There does not appear to be an overreliance on the HLA-B27 antigen or the complete triad of symptoms to make the diagnosis of ReA.

Conclusion:

Rheumatologists diagnose RA far more often than any type of SpA. ReA, specifically, is the second least commonly diagnosed type of SpA in acute patients and the most infrequent diagnosis in those with chronic SpA. ReA patients could be misdiagnosed as seronegative RA, PsA sine psoriasis, or palmoplantarpustular psoriasis with arthritis.

To cite this abstract, please use the following information:
Lin, Jenny, Shetty, Anjali G., Carter, John D.; The Diagnosis of Reactive Arthritis in the Real World and Factors That Might Contribute to Its Under/Misdiagnosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1647
DOI: 10.1002/art.29412

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