Reactive arthritis Flashcards
what is the definition of ReA?
Reactive arthritis (ReA) is an inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. The classical triad of post-infectious arthritis, non-gonococcal urethritis, and conjunctivitis is frequently described but found only in a minority of cases and not required for diagnosis
what is the epidemiology of ReA?
Mainly in adults
what is the aetiology of ReA?
HLA B27
The bacteria associated with ReA are common causes of venereal disease and infectious dysentery. They are gram-negative organisms, with a lipopolysaccharide component within their cell wall. These bacteria and bacterial components have been identified in synovial tissue. The most commonly implicated bacterial species are Chlamydia, Salmonella, Campylobacter, Shigella, and Yersinia species, although ReA has been described after many other bacterial infections.
what are the risk factors for ReA?
Gut associated infections STIS (chlamydia) Male HLAB27 genotype BCG immunotherapy
what is the pathophysiology of ReA?
HLA B27 tissue type
Both Chlamydia trachomatis and C pneumoniae ribosomal RNA transcripts have been found in synovial tissue in patients with post-chlamydial ReA, demonstrating that viable organisms are in the joints. In addition, DNA from enterobacteria has been found in the synovial tissue of patients with post-dysentery ReA. The significance of synovial-based persistent pathogens in patients with post-chlamydial and post-enteric ReA is unclear. In a mouse model, chlamydial infection triggered a tumour necrosis factor (TNF)-related ReA that was dependent on a live infection; severity of the ReA correlated with bacterial load along with a reduced rate of bacterial clearance
what are the key presentations of ReA?
Arthritis (peripheral and axial)
Conjunctivitis
Sterile urethritis
Presence of risk factors
what are the signs of ReA?
Arthritis (peripheral and axial) Conjunctivitis Sterile urethritis Presence of risk factors Enthesitis Circinate balanitis Ocular and cardiac manifestations
what are the symptoms of ReA?
Constitutional symptoms
Skin rash
what are the first line and gold standard investigations for ReA?
ESR - high
CRP - high
ANA - negative
RF - negative
Urogenital and stool cultures - negative
Plain x-rays - sacroiliitis or enthesopathy
Arthrocentesis and synovial fluid analysis - negative
what are the differential diagnoses for ReA?
AS
Psoriatic arthritis
RA
how is ReA managed?
Symptomatic relief:
NSAIDs, corticosteroid
Persisting:
DMARD (sulfasalazine)
how is ReA monitored?
Expert opinion recommends close follow-up of patients diagnosed with reactive arthritis. Typically, return visits should be scheduled monthly for the first 3 to 6 months.
what are the complications of ReA?
Secondary osteoarthritis
Iritis / uveitis
Keratoderma blennorrhagicum
what is the prognosis of ReA?
Approximately 50% of patients can expect symptoms to resolve within the first 6 months
