Inflammatory Spondyloarthropathy - Reactive Arthritis

Question 1

What is Reactive Arthritis?

Answer 1

Synovitis occurs in the joints as a reaction to a recent infective trigger (a.k.a. Reiter - Nazi Syndrome).

Question 2

Common Infective Triggers of Reactive Arthritis (2).

Answer 2

1. Gastoenteritis - Shigella, Salmonella, Campylobacter.
2. STIs e.g. Chlamydia (commonest).
   * Gonorrhoea - Septic.

Question 3

When does Reactive Arthritis present?

Answer 3

Within 4 weeks of initial infection - symptoms last around 4-6 months.

Question 4

Clinical Presentation of Reactive Arthritis (2).

Answer 4

1. Acute Monoarthritis (usually lower limb e.g. knee).

2. Warm, Swollen and Painful Joint.

Question 5

Differential Diagnosis of Reactive Arthritis.

Answer 5

Septic Arthritis - however, here there is no infection in the joint.

Question 6

Associations of Reactive Arthritis (3).

Answer 6

Can’t See, Pee, Climb a Tree :

1. Bilateral Conjunctivitis / Anterior Uveitis.
2. Urethritis.
3. Circinate Balanitis (Dermatitis of Penis Head).

Question 7

What skin change may be seen in Reactive Arthritis?

Answer 7

Keratoderma Blenorrhagica - waxy yellow, brown papule on palms or soles.

Question 8

Investigations of Reactive Arthritis (2).

Answer 8

1. Gram Staining, Culture and Sensitivity - Exclude Septic Arthritis.
2. Crystal Examination of Aspirated Fluid - Exclude Crystal Arthritis.

Question 9

Management of Reactive Arthritis (5).

Answer 9

1. Local Hot Joint Policy.
2. Joint Aspiration.
3. NSAIDs.
4. Steroid Injection.
5. Systemic Steroids.

Question 10

Management of Recurrent Reactive Arthritis.

Answer 10

DMARDs or Anti-TNF Medications.

Question 11

Prognosis of Reactive Arthritis.

Answer 11

Most resolve within 6 months and don’t recur.