[5] Reactive Arthritis

Question 1

What is reactive arthritis?

Answer 1

Reactive arthritis is a form of arthritis that can cause inflammation and pain in the joints. It is thought to occur as a ‘reaction’ to an infection that started elsewhere in the body

Question 2

Other than joints, where can reactive arthritis affect?

Answer 2

• Skin
• Eyes
• Bladder
• Genitals
• Mucus membranes

Question 3

Where does the infection that triggers reactive arthritis typically come from?

Answer 3

Genitourinary or gastrointestinal tract

Question 4

When does reactive arthritis occur?

Answer 4

After exposure to, or infection caused by, certain types of bacteria

Question 5

What bacteria can cause reactive arthritis?

Answer 5

• Chlamydia
• Salmonella
• Shigella
• Yersina
• Campylobacter

Question 6

Does everyone that comes into contact with the causative bacteria get reactive arthritis?

Answer 6

No

Question 7

Who is more likely to develop reactive arthritis after exposure to certain bacteria?

Answer 7

Those who test positive for HLA-B27

Question 8

How long after a known infection does reactive arthritis typically occur?

Answer 8

1-3 weeks

Question 9

What is the mechanism of interaction between infecting organism and host in reactive arthritis?

Answer 9

Unknown, however it is thought to be autoimmune

Question 10

Describe the clinical pattern of reactive arthritis

Answer 10

It commonly consists of inflammation of fewer than 5 joints, which often include the knee or sacroiliac joint

Question 11

What are the joint symptoms of reactive arthritis?

Answer 11

• Pain
• Swelling
• Stiffness

Question 12

What are the joint symptoms of reactive arthritis often coupled with?

Answer 12

Other characteristic symptoms (previously referred to as Reiters syndrome) of conjunctivitis and urethritis

Question 13

What are the urethral symptoms of reactive arthritis?

Answer 13

Dysuria and increased frequency

These symptoms often present first

Question 14

What are the ocular symptoms of reactive arthritis?

Answer 14

• Redness of eyes
• Eye pain and irritation
• Blurred vision

Eye symptoms typically occur early in the course, and may come and go

Question 15

Other than joint, eye, and urethral symptoms, what symptoms might be present in reactive arthritis?

Answer 15

• Skin rashes that commonly appear as thickened red or brown spots
• Swelling of involved finger and toes, causing ‘sausage digits’
• Fingernail and toenail changes
• Fever and chills
• Enthesitis
• Genital sores

Question 16

How is a diagnosis of reactive arthritis made?

Answer 16

On the basis of clinical history, as well as investigations to support diagnosis and rule out similar conditiosn

Question 17

What tests may be done in the investigation of reactive arthritis?

Answer 17

• Swabs of urethra, cervix, and throat
• Testing for chlamydia
• Blood tests

Question 18

What is the importance of swabs in the investigation of reactive arthritis?

Answer 18

They can aid diagnosis and determine the causative organisms

Question 19

Why is testing for chlamydia important in reactive arthritis?

Answer 19

Studies have shown that early treatment of chlamdyia may reduce the progression of the disease

Question 20

How can blood tests results aid diagnosis in reactive arthritis?

Answer 20

• ESR and CRP should be increased
• Presence of rheumaroid factor or anti-nuclear antibodies indicate other forms of arthritis

Question 21

What is the main goal of treatment in reactive arthritis?

Answer 21

To identify and eradicate the underlying infectious source with appropriate antibiotics if still present

Question 22

Does treatment of underlying infection always make a difference in reactive arthritis?

Answer 22

No

Question 23

What treatments options are available for symptomatic relief in reactive arthritis?

Answer 23

• Analgesics, particularly NSAIDs
• Steroids, sulfasalazine, and immunosuppressant’s may be needed for patients with severe reactive symptoms that do not respond to any other treatment