Reactive Arthritis in Children: A Literature Review with Analysis of Uncommon Infectious Triggers and Clinical Presentations

Abstract

Background. Reactive arthritis (ReA) is an aseptic inflammatory arthritis that develops after infection and is characterized by considerable clinical and etiological heterogeneity. While diagnosis is primarily clinical and requires exclusion of septic arthritis, rare infectious triggers may complicate recognition, particularly in children.

Aim. To review current evidence on pediatric reactive arthritis and highlight uncommon infectious triggers through analysis of selected case reports.

Material and methods. A literature review was conducted using PubMed and Embase databases. The terms “reactive arthritis,” “post-infectious arthritis,” and “Reiter’s syndrome” were combined with “children” and/or “pediatric.” Studies involving individuals under 18 years of age were screened. Due to limited pediatric-specific evidence, earlier relevant publications were also included. Among 39 pediatric cases published since 2000, seven were selected for detailed analysis based on relevance and completeness of clinical data.

Results. The analyzed cases demonstrated a broad spectrum of uncommon infectious triggers, including Enterobius vermicularis, Giardia lamblia, Clostridioides difficile, SARS-CoV-2, tuberculosis, rotavirus, and enteroviruses. These reports underline the diversity of clinical presentations and the importance of considering atypical pathogens in the differential diagnosis of pediatric ReA.

Conclusions. Pediatric ReA exhibits substantial etiological and clinical variability. Awareness of rare infectious triggers and careful differential diagnosis are essential for timely recognition, appropriate management, and reduction of long-term complications.