Reactive arthritis Flashcards
What is reactive arthritis?
It is typically an oligoarthritis
when does reactive arthritis develop?
it develops 1 to 4 weeks following an enteric or urethral infection
What are the seronegative spondyloarthropathies?
1) psoriatic arthritis
2) ankylosing spondylitis
3) reactive arthritis
What is the established criteria for diagnosing reactive arthritis?
- arthritis should predominantly involve the LOWER LIMB
Involve only 1 or only a few joints
should be ASYMMETRIC - there should be documented diarrhea or urethritis in the prior 4 weeks
- Patient should not have evidence that the joint itself is infected (ie septic arthritis)
other causes of monorarthritis (such as gout) or oligoarthritis (such as rheumatoid arthritis) should be ruled out
What are the infectious agents most commonly implicated in reactive arthritis?
- Yersinia
- Shigella
- Salmonella
- Campylobacter
- Clostridium difficile
- E. coli
It is associated with venereal urogenital infection with?
Chlamydia trachomatis
It also has been described with Chlamydia pneumoniae, Ureaplasma urealyticum and intravesicular BCG
Cutaneous manifestations of reactive arhritis?
- Keratoderma blenorrhagicum
- Circinate balanitis
- Aphthous ulcers
- nail changes
What are other associated extramusculoskeletal manifestations in addition to cutaneous findings?
inflammatory eye and cardiac disease
The HLA-B27 haplotype in reactive arthritis is?
- appears to be a risk factor
- associated with a more chronic prognosis
Reactive arthritis is often:
Self-limited in weeks to months.
as much as a third of patients may develop chronic disease.
How is reactive arthritis classified?
It is classified as spondyloarthritis.
with common clinical features including:
1. arthritis of the spine and sacroiliac joints
2. enthesitis
3. dactylitis
4. absence of serologies associated with rheumatoid arthritis
What is the other term for Reactive arthritis?
Reiter or Fiessinger-Leroy syndrome, along with Psa, is an inflammatory arthritis classified within the spondyloarthritis (SpA) family
Define oligoarhtritis
involves 2 to 4 joints
Spondyloarthritis (SpA) family also include?
AS (ankylosing spondylitis) and the arthritis of inflammatory bowel disease
What is the classic triad of symptoms in Reactive arthritis? (WHICH DOES NOT DEVELOP IN A MAJORITY OF PATIENTS)
- Urethral
- Ocular
- Articular inflammation
- occurs as a reaction to an antecedent infection
- generally self-limited
REACTIVE ARTHRITIS- within articular structures, it is a separate entity from septic arthritis due to inability to recover any infectious agent directly from the inflamed joints
REACTIVE ARTHRITIS- within articular structures, it is a separate entity from septic arthritis due to inability to recover any infectious agent directly from the inflamed joints
define chronic reactive arthritis
A significant portion can have symptoms extending beyond 6 months.
Although it is felt that the majority of patients with reactive arthritis have a self-limited course…
What is enthesitis?
inflammation of tendons, fascia and ligaments with a predilection for where these structures insert onto bone
What is a common finding in all forms of spondyloarthritis?
enthesitis
In reactive arthritis, swelling and discomfort of the heel results from what involvement? What is is called?
ACHILLES TENDON
- “Lover’s heel”
*with inflammation of the plantar fascial insertion site, patients will describe the early morning posterior foot when first getting out of bed.
What are the clinical features of reactive arthritis?
- 1 to 4 weeks following the triggering infection, the patient will develop an oligoarthritis (2 to 4 joints) that is asymmetric
- the predominant symptom in patients with enteric infection is diarrhea, which can be bloody
Describe the urogenital infections of reactive arthritis?
patient may describe dysuria with a purulent urehtral discharge or may be without symptoms
The classic triad of urethral, ocular, and articular inflammation is rarely present together
The classic triad of urethral, ocular, and articular inflammation is rarely present together
What are the cutaneous manifestations seen in Reactive arthritis? (CKSP)
- Circinate balanitis
- Keratoderma blenorrhagicum
- self-limited stomatitis
- Psoriatic like nail lesions
