Reactive arthritis Flashcards
Define reactive arthritis
Characterised by sterile arthritis occurring after an extra articular infection (commonly GI or urogenital)
Define reiter’s syndrome
3
TRIAD of:
- reactive arthritis
- urethritis
- conjunctivitis
Aetiology of reactive arthritis
2
Thought that initial activation of immune system by microbial antigen is followed by autoimmune reaction that involves skin, eyes & joints
HLA-B27 allele is identified in 70-80% of patients
Associated infections of reactive arthritis
4 + 1
GI Salmonella Shigella Yersinia Campylobacter
Urogenital Chlamydia trachomatis (60%)
Epidemiology of reactive arthritis
gender, age, association
20x more common in MALES
Age of onset 20-40 yrs
Seen in 2% of patients w/ non specific urethritis
Presenting symptoms of reactive arthritis
6
Symptoms can develop 3-30 days after infection
Burning or stinging when passing urine (due to urethritis)
Arthritis
Low back pain (due to sacroiliitis)
Painful heels (due to enthesitis & plantar fasciitis)
Conjunctivitis
Signs of reactive arthritis on physical examination
6 groups
Arthritis Conjunctivitis Oral ulceration Circinate balanitis Keratoderma blenorrhagica Others
Signs of reactive arthritis on physical examination - arthritis
(3)
Asymmetrical oligoarthritis
Often affects lower extremities
Sausage shaped digits
Signs of reactive arthritis on physical examination - conjunctivitis
Anterior uveitis - painful red eye
Signs of reactive arthritis on physical examination - circinate balanitis
Scaling red patches on the glans of penis
Signs of reactive arthritis on physical examination - keratoderma blenorrhagica
(4)
Brownish-red macules
Vesicopustules
Yellowish-brown scales
Found on SOLES & PALMS
Signs of reactive arthritis on physical examination - others
3
Nail dystrophy
Hyperkeratosis
Onycholysis
Investigations for reactive arthritis
5 types
Bloods Stool or urethral swabs & cultures Urine Plain X-rays Joint aspiration
Investigations for reactive arthritis - bloods
3
FBC
High ESR/CRP
HLA-B27 testing
Investigations for reactive arthritis -
May be negative by the time arthritis develops (occurs post-infection)