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Z Year3 MSK Conditions > Reactive arthritis > Flashcards

Reactive arthritis Flashcards

1
Q

What is reactive arthritis?

A

Sterile, seronegative joint inflammation in response to extra-articular infection

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2
Q

What are RF for reactive arthritis?

A
  1. History of infection 1-4 weeks before e.g. chlamydia
  2. Male
  3. HLA-B27 genotype
  4. 20-40 yo
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3
Q

What is the distribution of arthritis like in reactive arthritis?

A

Peirpheral arthritis in ReA usually asymmetrical oligoarticular arthritis affecting large joints of lower limb(monoarticular and polyarticular arthritis can also occur)

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4
Q

What are symptoms and signs of reactive arthritis?

A
  1. Fever
  2. Peripheral and axial arthritis
  3. Enthesitis
  4. Dactylitis
  5. Conjunctivitis and iritis
  6. Skin lesions
  7. Peripheral arthritis
  8. Axial arthritis
  9. Fever
  10. Fatigue
  11. Weight loss
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5
Q

What are possible DDx for reactive arthritis?

A
  1. Ankylosing spondylitis
  2. Psoratic arthritis
  3. RA
  4. Rheuamtic fever
  5. Gout
  6. Septic arthritis
  7. Arthritis with IBD
  8. Etc
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6
Q

What bloods and results are for reactive arthritis?

A
  1. ESR: high
  2. CRP: high
  3. ANA: negative
  4. Rheumatoid factor
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7
Q

What other tests are used in reactive arthritis?

A
  1. Urogenital and stool cultures
  2. Plain X rays
  3. Athrocentesis with synovial fluid analysis: negative
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8
Q

What might the plain X rays show for reactive arthritis?

A

sacroillitis or enthesopathy

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9
Q

What is the management acute for reactive arthritis?

A

1st line: NSAID e.g. naproxen 250-500mg twice daily

2nd line: corticosteroid e.g. prednisolone

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10
Q

What is the management plan for persistent and ongoing reactive arthritis?

A

1st line: disease-modifying antirheumatic drug (DMARD) e.g. sulfasalazine

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11
Q

What are possible complications for reactive arthritis?

A
  1. Secondary osteoarthritis
  2. Irtitis/uvetis
  3. Keratoderma blennorrhagicum
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12
Q

What is the prognosis for reactive arthritis?

A
  1. 30-50% patients go on to develop some form of chronic ReA
  2. 50% symptoms resolve within first 6 months
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13
Q

What is patho arthritis?

A

Initial activation of immune system by microbial antigen stimulates AI reaction affecting skin, eyes & joints

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14
Q

What are common triggers in reactive arthritis?

A
  • GI infection - Salmonella, Shigella, Yersinia & Campylobacter
  • GU infection - chlamydia trachomatis, gonorrhoea
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15
Q

What are extrarticular manifestations for reactive arthritis?

A
  1. Retier’s
  2. Keratoderma blenorrhagicum
  3. Circinate balantis
    • Oral ulcers – painless, Cystitis/prostatitis
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16
Q

What is Reiter’s?

A

(Arthritis +) Urethritis + Conjunctivitis

17
Q

What is kertoderma blenorrhagicum?

A
  1. Vesicles - plaque/pustular

2. Soles/palms usually

18
Q

What is circinate blanatitis?

A
  1. Painless ulcers / plaques

2. Shaft or glans

19
Q

Why would you do joint aspiration in reactive arhtirtis?

A

Joint aspiration, gram stain, culture & sensitivities to exclude septic joint, crystal arthropathies

20
Q

What is the general management plan for RA?

A
  1. Abx until septic excluded
  2. NSAIDs
  3. Intraarticular steroids
  4. Systemic steroids (if multiple joints)
  5. DMARDs or anti-TNF if recurrent

Z Year3 MSK Conditions (26 decks)

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