Reactive arthritis Flashcards

1
Q

Define reactive arthritis

A

Characterised by sterile arthritis occurring after an extra articular infection (commonly GI or urogenital)

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2
Q

Define reiter’s syndrome

3

A

TRIAD of:

  • reactive arthritis
  • urethritis
  • conjunctivitis
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3
Q

Aetiology of reactive arthritis

2

A

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

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4
Q

Associated infections of reactive arthritis

4 + 1

A
GI
Salmonella
Shigella
Yersinia
Campylobacter
Urogenital
Chlamydia trachomatis (60%)
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5
Q

Epidemiology of reactive arthritis

gender, age, association

A

20x more common in MALES
Age of onset 20-40 yrs
Seen in 2% of patients w/ non specific urethritis

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6
Q

Presenting symptoms of reactive arthritis

6

A

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

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7
Q

Signs of reactive arthritis on physical examination

6 groups

A
Arthritis
Conjunctivitis
Oral ulceration  
Circinate balanitis
Keratoderma blenorrhagica
Others
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8
Q

Signs of reactive arthritis on physical examination - arthritis
(3)

A

Asymmetrical oligoarthritis
Often affects lower extremities
Sausage shaped digits

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9
Q

Signs of reactive arthritis on physical examination - conjunctivitis

A

Anterior uveitis - painful red eye

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10
Q

Signs of reactive arthritis on physical examination - circinate balanitis

A

Scaling red patches on the glans of penis

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11
Q

Signs of reactive arthritis on physical examination - keratoderma blenorrhagica
(4)

A

Brownish-red macules
Vesicopustules
Yellowish-brown scales
Found on SOLES & PALMS

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12
Q

Signs of reactive arthritis on physical examination - others

3

A

Nail dystrophy
Hyperkeratosis
Onycholysis

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13
Q

Investigations for reactive arthritis

5 types

A
Bloods
Stool or urethral swabs & cultures
Urine
Plain X-rays
Joint aspiration
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14
Q

Investigations for reactive arthritis - bloods

3

A

FBC
High ESR/CRP
HLA-B27 testing

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15
Q

Investigations for reactive arthritis -

A

May be negative by the time arthritis develops (occurs post-infection)

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16
Q

Investigations for reactive arthritis - urine

A

Screen for Chlamydia trachomatis

17
Q

Investigations for reactive arthritis - plain X-rays

2

A

Useful in chronic cases

Erosions seen at entheses (insertion of tendons into bone)

18
Q

Investigations for reactive arthritis - joint aspiration

A

To exclude septic or crystal arthritis