Reactive arthritis

Question 1

What is reactive arthritis?

Answer 1

Synovitis due to infective trigger.

Typically an acute monoarthritis

Question 2

Differential for reactive arthritis

Answer 2

Septic arthritis
Gout/pseudogout
Osteoarthritis

Question 3

Most common infective triggers of reactive arthritis

Answer 3

Gastroenteritis

STIs - most commonly chlamydia

(Gonorrhoea commonly causes a gonococcal septic arthritis)

Question 4

Gene association in reactive arthritis

Answer 4

There is a link with the HLA B27 gene.

It is considered part of the seronegative spondyloarthropathy group of conditions.

Question 5

Associations in reactive arthritis

Answer 5

Bilateral conjunctivitis (non-infective)
Anterior uveitis
Circinate balanitis is dermatitis of the head of the penis

Can’t see, can’t pee, can’t climb a tree - classic triad of urethritis, conjunctivitis and arthritis

Question 6

Management of reactive arthritis

Answer 6

Joint aspiration:

• With MC+S to rule out septic arthritis
• Can also send for crystal examination to look for gout and pseudogout.

Once septic arthritis excluded:
- NSAIDs first line
- Steroid injections may be used
(- Systemic steroids may be needed if multiple joints affected)

• Recurrent cases may require DMARDs or anti-TNF medication