6: Reactive Arthritis

Question 1

What is reactive arthritis?

Answer 1

sterile inflammation in joints following infection

• especially urogenital (e.g. Chlamydia trachomatis) and
• gastrointestinal (e.g. Salmonella, Shigella, Campylobacter infections) infections

Question 2

What kind of disease is reactive arthritis?

Answer 2

is part of a family of inflammatory arthritic syndromes termed ‘seronegative spondyloarthropathies’

Question 3

When does reactive arthritis occur?

Answer 3

1-4 weeks after infection and this infection may be mild

Question 4

Describe the musculoskeletal symptoms of reactive arthritis?

Answer 4

1. Arthritis
   
   • asymmetrical
   • oligoarthritis (<5)
   • Typically: lower limbs
2. ENTHESITIS (inflammation of enthesis, site where tendons innervate bone)
   • heel pain (achilles tendon)
   • swollen fingers (dactylitis)
   • Painful feet (metatarsalgia due to plantar fasciitis)
3. Spondylitis (inflammation of the spine)
   
   • sacrolitis (inflammation of the sacro-iliac joint)
   • Spondolytis (inflammtion of the spine)
     *

Question 5

Describe the extra-articular features of reactive arthritis

Answer 5

1. Occular
   
   • sterile conjunctivitis
2. Geni-urinary
   
   • sterile urethritis
3. Skin
   
   • circinate balantis (on glans of penis)
   • Psoriasis-like rash on hands and feet ‘keratoderma blennorrhagicum’

Question 6

Comapre reactive arthritis and rheumatoid arthritis in their

• epidemiology
• presentation of arthritis
• involvement of skin, spondolytis, urethritis
• Rheumatoid facator

Answer 6

Question 7

Explain the diagnosis of reactive arthritis

Answer 7

•Investigations to exclude other causes of arthritis e.g. septic arthritis

• Microbiology: –> can cause reactive arthritis
  
  • Microbial cultures – blood, throat, urine, stool, urethral, cervical
  • Serology e.g. HIV, hepatitis C
• Immunology
  
  • Rheumatoid factor (exclude rheumatic arthritis)
  • (HLA-B27) (genetic predisposition?)
• Synovial fluid examination
  
  • Especially if only single joint affected –> exclude septic arthritis

Question 8

Compare septic and reactive arthritis

Answer 8

Question 9

Explain the treatment of reactive arthritis

Answer 9

In majority: disappers in 2-6 month

But can be treated by

• Articular
  
  • NSAIDs
  • intra-articular corticosteroids
• Extra-articular
  
  • self limiting –> symptomatic therapy (e.g. topographical corticosteroids)

If it does not help:

• oral glucocorticoid
• steroid-sparing agents e.g. sulphasalazine