Reactive arthritis Flashcards
Define reactive arthritis.
Reactive arthritis (ReA) is an inflammatory arthritis that occurs after exposure to certain gastrointestinal and genitourinary infections. It is part of the inflammatory spondyloarthropathies group.
What is the triad of reactive arthritis?
Conjunctivitis
Urethritis (non-gonococcal)
Arthritis
What is the aetiology of reactive arthritis?
Usually either sexually transmitted or associated with bacillary dysentery
What are the rates of ReA post Chlamydia vs post-dysentery?
The attack rate of ReA after:
- C trachomatis infection ranges from about 4% to 8%
- Dysentery ReA ranges from 1.5% to about 30%
What bacteria contribute to ReA?
- Chlamydia - C trachomatis and C pneumoniae
- Campylobacter jejuni
- Salmonella enteritidis
- Shigella
- Yersinia
What are the clinical features of reactive arthritis?
- Acute or gradual onset
- Widespread or monoarticular - usually large joints
- Ophthalmic symptoms and urethritis may occur separately
- Plantar fasciitis
- Achilles tendinitis
- Sacroiliitis
- Raised ESR
- Negative RF (seronegative)
What investigations should be done in ReA?
Bloods:
- ESR, CRP - elevated
- RF, ANA, urogenital and stool cultures - all negative, unless tested very early in onset of infection
- NAAT - may be positive for Chlamydia trachomatis or Neisseria gonorrhoeae
Imaging/invasive:
- Plain XR - look for asymmetrical sacroiliitis
- Arthrocentesis - rule out crystal-induced arthritis such as gout
Other:
- HLA-B27 - positive or negative
- MRI
- US
What is the management of ReA?
- NSAIDs
- Corticosteroids - may be used in acute flare or if symptoms are unresponsive to NSAIDs. Good for peripheral joint involevement
- DMARDs - used to prevent radiographic joint destruction
Other:
- Abx for urethritis - but difficult to eliminate
- Rest - to ease chronic joint symptoms
- Physiotherapy
What is the prognosis with ReA?
Approximately 50% of patients can expect symptoms to resolve within the first 6 months
30% to 50% of patients will develop chronic ReA
