Clostridioides difficile-related reactive arthritis: A scoping review of the literature

Abstract

Reactive arthritis (ReA) is an inflammatory arthritis triggered by preceding infection. While various bacterial pathogens are well-established as causative agents, the role of Clostridioides difficile remains less elucidated. Α scoping review was conducted to evaluate the existing literature on CDI-induced ReA to determine clinical features, management, and disease trajectory. Sixty-one CDI-related ReA cases were identified (61 % male, mean age 38.8 years). HLA-B27 positivity was 64 % (30/47 tested). Prior antibiotic use was reported in 89 % of cases, with arthritis onset 8.5 days post-CDI. Oligoarthritis predominated (41 %), involving a median of 3 joints (knee 67 %, ankle 44 %, hand 26 %). Extra-articular manifestations were present in 20 %. Only 10 % required treatment escalation to disease-modifying anti-rheumatic drugs (DMARDs). Remission was achieved in 87 % within 21 days, with 9 % relapse rate. HLA-B27 positive patients had fewer affected joints (2 vs 5, p = 0.03) and older age at onset (43.1 vs 29.1, p = 0.02). Pediatric patients were more likely to experience hip arthritis than adults (54 % vs 10 %, p = 0.003). This study confirms CDI as a cause of ReA, highlighting its typically benign course with high remission rates. Further research is warranted, particularly regarding refractory cases.