Reactive arthritis

Question 1

Reactive Arthritis

Answer 1

Sterile arthritis 1-4wks after urethritis or intestinal inflammation (dysentery)

Question 2

Causative organisms

Answer 2

Urethritis: chlamydia

Dysentery:

• campylobacter
• salmonella
• shigella
• yersinia

Question 3

Presentation of reactive arthritis

Answer 3

Can’t see, can’t pee, can’t climb a tree

• conjunctivitis
• urethritis
• arthritis

Asymmetrical lower limb oligoarthritis: esp. knee

Iritis, conjunctivitis

Keratoderma blenorrhagica: plaques on soles/palms

Circinate balanitis: painless serpiginous penile ulceration

Enthesitis

Mouth ulcers

Question 4

Keratoderma blenorrhagica

Answer 4

plaques on soles/palms

Question 5

Circinate balanitis

Answer 5

painless serpiginous penile ulceration

Question 6

Ix of reactive arthritis

Answer 6

• ↑ESR, ↑CRP
• Stool culture if diarrhoea
• Urine chlamydia PCR
• negative RF

Question 7

Mx of reactive arthritis

Answer 7

NSAIDs and local steroids

Relapse may need sulfasalazine or methotrexate

Question 8

Enteropathic Arthritis

Answer 8

Arthritis with UC or Crohn’s

Question 9

Presentation of enteropathic Arthritis

Answer 9

• Asymmetrical large joint oligoarthritis mainly
  affecting the lower limbs.
• Sacroiliitis may occur

Question 10

Mx of enteropathic Arthritis

Answer 10

• Treat the IBD
• NSAIDs or articular steroids for arthritis
• Colectomy → remission in UC