Reactive Arthritis

Question 1

Define reactive arthritis

Answer 1

It is when synovitis (synovial inflammation) occurs in the joints as a reaction to a recent infective

Question 2

What are the three characteristic features of reactive arthritis

Answer 2

Arthritis – joint inflammation

Urethritis – urethral inflammation

Conjunctivitis – inflammation of the conjunctiva

Only a small number of patients will present with this triad

Question 3

How many joints are usually affected in reactive arthritis

Answer 3

Monoarthritis, affecting a single joint in the lower limb (often the knee),

Question 4

How long after an infection does reactive arthritis usually occur

Answer 4

1-4 weeks

There is no infection in the joint at the time of presentation

Question 5

What is the difference between reactive and septic arthritis

Answer 5

Reactive arthritis occurs after an infection (usually 1-4 weeks)

Septic arthritis is when there is active infection in the joint

Question 6

What are the 3 risk factors for reactive arthritis

Answer 6

Classic presentation – young males with a preceding infection who have the HLA-B27 gene

• Male gender
• Genetic predisposition – HLA B27 positive
• Preceding infection, most commonly sexually transmitted or GI infection

Question 7

What are the two most common types of infections that trigger reactive arthritis

Answer 7

Gastroenteritis

Sexually transmitted infections

Question 8

What is the most common sexually transmitted cause of reactive arthritis

Answer 8

Chlamydia

Question 9

Name some of the extra-articular manifestations of reactive arthritis

Answer 9

Saying for these features: “can’t see, pee or climb a tree”

Bilateral conjunctivitis (non-infective)

Anterior uveitis – inflammation of the uvea (middle layer of the eye)

Circinate balanitis - dermatitis of the head of the penis

Question 10

What is key clinical features of reactive arthritis

Answer 10

Asymmetrical oligoathritis and/or axial involvement.

Question 11

The diagnosis of reactive arthritis based on the characteristic presentation in a patient with a preceding infection.

Name the 3 characterstic presentation

Answer 11

Asymmetric oligoarthritis

Inflammatory back pain – due to axial arthritis

Enthesitis – where a tendon or ligament attaches to bone

Question 12

How are the majority of reactive arthritis managed

Answer 12

Most are self-limiting and will resolve within 6 months

Some will go on to have chronic reactive arthritis (symptoms > 6 months)

Question 13

What are potential management options for symptom relief for reactive arthritis

Answer 13

• NSAIDs
• Corticosteroid injections into the affected joints
• Systemic steroids may be required, particularly where multiple joints are affected

Question 14

What medication can be consider in recurrent cases of reactive arthritis

Answer 14

DMARDs or anti-TNF medications.