REACTIVE ARTHRITIS

Question 1

What is reactive arthritis?

Answer 1

• one of the HLA-B27 associated seronegative spondyloarthropathies
• A condition in which arthritis and other clinical manifestations occur as an autoimmune response to infection elsewhere in the body
• preceding infection may have resolved or be asymptomatic by the time the arthritis is present

Question 2

What is the classic triad associated with reactive arthritis?

Answer 2

Reiter’s syndrome:

• conjunctivitis/uveitis
• urethritis
• arthritis

Question 3

Describe the pathophysiology of reactive arthritis

Answer 3

• An autoimmune response to infection elsewhere in the body

- Typically affects the lower-limb

Question 4

What are the main causes of reactive arthritis?

Answer 4

GI infections:Salmonella, Shigella

Sexually acquired:
Urethritis from chlamydia trachomatis

Question 5

What are risk factors of reactive arthritis?

Answer 5

• unprotected sex

- immunocompromised

Question 6

Describe the epidemiology of reactive arthritis

Answer 6

• In males who are HLA-B27 positive they have an 30-50 fold increased risk
• Women are LESS COMMONLY AFFECTED

Question 7

What is the signs and symptoms of reactive arthritis?

Answer 7

• Asymmetrical joint pain: Warm, Red, Sudden onset
• Typically develops within 4 weeks of initial infection-symptoms generally last around 4-6 months
• typically an asymmetrical oligoarthritis of lower limbs
• Dactylitis
• Mouth ulcers
• classic triad; uveitis/conjunctivitis, urethritis(dysuria), arthritis
• Enthesitis
• Skin signs; circinate balanitis and keratoderma blennorrhagia
• sacroiliitis and spondylitis may develop
• nail dystrophy

Question 8

What are the investigations for reactive arthritis?

Answer 8

• Bloods: ESR, CRP - raised in acute phase
• Culture stool if diarrhoea
• GUM referral - sexual health review
• Aspirated synovial fluid is sterile with a high neutrophil count, can exclude crystal/septic arthritis
• X-rays-may show enthesitis

Question 9

What is the treatment for reactive arthritis?

Answer 9

There is no specific cure

Non-Pharmacological
-Splint the affected joint

Pharmacological

• NSAIDs or local steroid injections - for joint inflammation
• Treat persisting infections with antibiotics - Treating the original infection may make little difference.
• Consider sulfasalazine or methotrexate if symptoms last for >6 months - Majority of individuals with reactive arthritis have a single attack that settles, but a few develop disabling relapsing and remitting arthritis.
• If that doesn’t work and is severe and persistent disease then use TNF-alpha blockers such as Etanercept and Golimumab but rarely necessary