Reactive arthritis

Question 1

What is reactive arthritis?

Answer 1

It is typically an oligoarthritis

Question 2

when does reactive arthritis develop?

Answer 2

it develops 1 to 4 weeks following an enteric or urethral infection

Question 3

What are the seronegative spondyloarthropathies?

Answer 3

1) psoriatic arthritis
2) ankylosing spondylitis
3) reactive arthritis

Question 4

What is the established criteria for diagnosing reactive arthritis?

Answer 4

1. arthritis should predominantly involve the LOWER LIMB
   Involve only 1 or only a few joints
   should be ASYMMETRIC
2. there should be documented diarrhea or urethritis in the prior 4 weeks
3. 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

Question 5

What are the infectious agents most commonly implicated in reactive arthritis?

Answer 5

1. Yersinia
2. Shigella
3. Salmonella
4. Campylobacter
5. Clostridium difficile
6. E. coli

Question 6

It is associated with venereal urogenital infection with?

Answer 6

Chlamydia trachomatis

It also has been described with Chlamydia pneumoniae, Ureaplasma urealyticum and intravesicular BCG

Question 7

Cutaneous manifestations of reactive arhritis?

Answer 7

1. Keratoderma blenorrhagicum
2. Circinate balanitis
3. Aphthous ulcers
4. nail changes

Question 8

What are other associated extramusculoskeletal manifestations in addition to cutaneous findings?

Answer 8

inflammatory eye and cardiac disease

Question 9

The HLA-B27 haplotype in reactive arthritis is?

Answer 9

• appears to be a risk factor

- associated with a more chronic prognosis

Question 10

Reactive arthritis is often:

Answer 10

Self-limited in weeks to months.

as much as a third of patients may develop chronic disease.

Question 11

How is reactive arthritis classified?

Answer 11

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

Question 12

What is the other term for Reactive arthritis?

Answer 12

Reiter or Fiessinger-Leroy syndrome, along with Psa, is an inflammatory arthritis classified within the spondyloarthritis (SpA) family

Question 13

Define oligoarhtritis

Answer 13

involves 2 to 4 joints

Question 14

Spondyloarthritis (SpA) family also include?

Answer 14

AS (ankylosing spondylitis) and the arthritis of inflammatory bowel disease

Question 15

What is the classic triad of symptoms in Reactive arthritis? (WHICH DOES NOT DEVELOP IN A MAJORITY OF PATIENTS)

Answer 15

1. Urethral
2. Ocular
3. Articular inflammation

• occurs as a reaction to an antecedent infection
• generally self-limited

Question 16

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

Answer 16

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

Question 17

define chronic reactive arthritis

Answer 17

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…

Question 18

What is enthesitis?

Answer 18

inflammation of tendons, fascia and ligaments with a predilection for where these structures insert onto bone

Question 19

What is a common finding in all forms of spondyloarthritis?

Answer 19

enthesitis

Question 20

In reactive arthritis, swelling and discomfort of the heel results from what involvement? What is is called?

Answer 20

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.

Question 21

What are the clinical features of reactive arthritis?

Answer 21

• 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

Question 22

Describe the urogenital infections of reactive arthritis?

Answer 22

patient may describe dysuria with a purulent urehtral discharge or may be without symptoms

Question 23

The classic triad of urethral, ocular, and articular inflammation is rarely present together

Answer 23

The classic triad of urethral, ocular, and articular inflammation is rarely present together

Question 24

What are the cutaneous manifestations seen in Reactive arthritis? (CKSP)

Answer 24

1. Circinate balanitis
2. Keratoderma blenorrhagicum
3. self-limited stomatitis
4. Psoriatic like nail lesions

Question 25

What is circinate balanitis?

Answer 25

inflammatory skin lesion that develops on the shaft or glans of the penis and more rarely on the scrotum
erythematous lesion can be both papular and pustular and develop raised borders around the meatus
In an uncircumcised patient, the lesions may harden to a hyperkeratotic dry crust resembling a psoriatic plaque that can be painful with subsequent scarring

Rarely, female patients can develop erythematous vulvar ulcerative lesions

Question 26

Keratoderma blenorrhagicum?

Answer 26

• it is an erythematous vesicular lesion that develops into pustular keratotic lesions before coalescing into psoriatic like plaques
• resembles a pustular psoriasis
• generally found on the palms and soles

Question 27

what is stomatitis in reactive arthritis?

Answer 27

A typically self-limited stomatitis
characterized by superficial ulcerations or erythematous grayish plaques involving the buccal mucosa, palate and tongue
These are PAINLESS, though they may bleed

Question 28

What are psoriatic-like nail lesions?

Answer 28

They may develop with subungual accumulation of debris and potential abscess formation.
Onycholysis, nail pitting, transverse ridging or periungual scaling can be seen in the minority of patients