Reactive Arthritis Flashcards
What causes reactive arthritis?
What organisms are involved?
Synovitis which occurs due to infective trigger from recent infection (2-6 weeks previous)
I.e. gastroenteritis/chlamydia
GI:
- salmonella
- shigella
- neisseria
- yersinia
- campylobacter
STI
- chlamydia
- gonococcus
How does reactive arthritis generally present?
Classic triad:
- conjunctivitis
- arthritis
- urethritis
Lower limb oligoarthritis Lower back pain and buttock pain Enthesitis eg achilles/heel pain Unwell/temp Conjunctivits Keratoderma blennorhagica Urethritis i.e. discharge Circinate balantine (dermological changes on penis)
What investigations would you do for reactive arthritis?
Stool cultures GUM clinic if STI suspected RF FBC/U+E/LFT RF CRP ANA Joint aspirate esp if monoarthritis Xray of sacroiliac joints
Reactive arthritis is considered part of seronegative spondyloarthropathy. What does this mean and which other conditions are included in this category?
-ve RF and -ve anti-CCP
Ankylosing spondylitis
Enteropathic arthritis
Psoaritic arthritis
Reiter’s syndrome
How does reactive arthritis differ from Reiter’s syndrome?
Reiter’s syndrome is where reactive arthritis occurs recurrently and requires treatment with anti-TNF
What associated symptoms of reactive arthritis means a patient “can’t see, pee or climb a tree”?
Can’t see= bilateral conjunctivitis + anterior uveitis (inflammation of middle layer of eye= RED EYE)
Can’t pee= circinate balanitis i.e. dermatitis of head of penis
Can’t climb and tree= due to arthritis
How would you summarise reactive arthritis?
Seronegative mono or oligo arthritis usually following infection of GI tract or STI
How do you manage reactive arthritis?
Symptomatic treatment (self-limiting)
Treated with antibiotics until septic arthritis is excluded
NSAIDs
Steroid injections i.e intra-articular cortisone
DMARDs when conditions becomes chronic
Doxicycline for swab +ve patients (gonoccocus or chlamydia)
