Sexually-Associated Reactive Arthritis (SARA)

Valeria Fabre, M.D.
Sexually-Associated Reactive Arthritis (SARA) is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

  • Mechanism of SARA pathogenesis not completely known. Appears to be due to an immune response to urogenital organisms or to the persistence of the organism or antigenic debris in synovial tissue.
    • Chlamydia trachomatis (CT): organism most strongly linked to SARA.
      • Identified in 35-70% of cases using non-nucleic acid amplification techniques.
      • When CT is the underlying cause, an aberrant form with the repressed synthesis of the major outer membrane protein and active production of heat shock protein appears, contributing to the inflammatory response.
    • Neisseria gonorrheae: linked to up to 16% of cases, distinct from gonococcal arthritis.
    • Ureaplasma urealyticum and Mycoplasma genitalium linked to a few cases, a minor cause of SARA.
  • A causal role for other genital tract pathogens is unclear.

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PATHOGENS

  • Mechanism of SARA pathogenesis not completely known. Appears to be due to an immune response to urogenital organisms or to the persistence of the organism or antigenic debris in synovial tissue.
    • Chlamydia trachomatis (CT): organism most strongly linked to SARA.
      • Identified in 35-70% of cases using non-nucleic acid amplification techniques.
      • When CT is the underlying cause, an aberrant form with the repressed synthesis of the major outer membrane protein and active production of heat shock protein appears, contributing to the inflammatory response.
    • Neisseria gonorrheae: linked to up to 16% of cases, distinct from gonococcal arthritis.
    • Ureaplasma urealyticum and Mycoplasma genitalium linked to a few cases, a minor cause of SARA.
  • A causal role for other genital tract pathogens is unclear.

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Last updated: August 9, 2019