ReA

Question 1

Define the term “Reactive Arthritis”

Answer 1

DEF: collection of syndromes characterised by sterile inflammation (DEF: lack of presence of infective agent DNA in urine test) of joints from infections at non-articular sites eg rheumatic fever.

Question 2

Briefly define the term “Reiter’s Syndrome”.

Answer 2

Reiter’s syndrome (RS) is a seronegative spondylarthropathy associated with:

• nonbacterial urethritis/cervicitis
• conjunctivitis
• mucocutaneous lesions

Question 3

Briefly compare the epidemiology and aetiology of the two forms of Reiter’s syndrome.

Answer 3

Sexually Transmitted
o mainly males 20-40 year olds
o usually infection with Chlamydia trachomatis

Dysenteric:
o usually seen in women, children and the elderly.
o most often follows enteric bacterial infection usually:
• Shigella
• Salmonella
• Yersinia
• Campylobacter

Question 4

List the key clinical features of acute phase Reiter’s syndrome.

Answer 4

Acute phase (resolves in 3-4 months)
•	asymmetrical inflammatory arthritis of the lower limb joints. 
o	knee and ankle are usually involved early on
o	SIJ and Lx spine possibly involved later on.
•	the joint may be:
o	acute painful  
o	hot   
o	swollen   
•	Enthesopathy 
o	tenderness of the Achilles tendon
o	plantar fasciitis
•	Backache
•	Mild:   
o	conjunctivitis   
o	bowel infection
o	cervicitis
o	urethritis   
o	cystitis
•	keratoderma blennorrhagica (vesicular or pustular dermatitis of the feet)   
•	balanitis
•	mild buccal ulceration

Question 5

List the key clinical features of chronic phase Reiter’s syndrome.

Answer 5

Chronic phase (occurs in 50% of patients and may last several years)

• Observe typical manifestations of spondylarthropathy
o 50% patients have mild, recurrent polyarthritis (including upper limb joints)
o 50% of polyarthritis patients develop sacroiliitis and/or spondylitis
o uveitis is common

Question 6

List the classic triad of ReA SSx.

Answer 6

• Noninfectious urethritis
• Arthritis
• Conjunctivitis