Reactive Arthritis Flashcards
what is reactive arthritis
arthritis (~4wks) post-infection where organism cannot be recovered from joint
a hla-b27 associated seronegative spondyloarthropathy
what is the classic triad in reactive arthritis?
urethritis (-> dysuria)
conjunctivitis (-> eye discharge)
arthritis (-> painful swelling of joint)
what dermatological features can be seen in reactive arthritis?
keratoderma blennorrhagica - waxy, scaly yellow/brown papules on palms and soles
circinate balanitis - painless vesicles on coronal margin of prepuce
how long do sx last for reactive arthritis?
~4-6 months
epidemiology of reactive arthritis?
post-sti form more common in men
post-dysenteric form equal sex incidence
organisms a/w post-dysenteric form of reactive arthritis?
shigella flexneri
salmonella typhimurium
salmonella enteritidis
yersinia enterocolitica
campylobacter
organisms a/w post-sti form of reactive arthritis?
chlamydia trachomatis
mx of reactive arthritis?
symptomatic: analgesia, nsaids, (intra-articular) steroids
sulfasalazine, methotrexate if persistent disease
how long do symptoms last for in reactive arthritis?
rarely for longer than a year
what type of arthritis is seen in reactive arthritis?
assymmetrical oligoarthritis of lower limbs
time course of reactive arthritis?
usually develops within 4wks of infection with symptoms for 4-6 months
25% with recurrent episodes
10% with chronic disease
triad for disseminated gonococcal disease (DIFFERENT TO RA)
tenosynovitis
migratory polyarthritis
dermatitis
exposure to gi and gu infections a/w reactive arthritis - implicated bacteria?
chlamydia
salmonella
c. jejuni
cefalexin + nitrofurantoin coprescription increases risk of?
risk of nephrotoxicity
if cefalexin being given for recurrent UTIs then may consider switching to nitrofurantoin instead
when would you stop methotrexate?
signs of infection
neutropenic sepsis
when would oral steroids be preferred to intraarticular steroids in reactive arthritis mx?
(severe) polyarthritis
systemic unwellness
dose of oral steroids in reactive arthritis mx?
based on severity
starting doses 20-40mg/day
tapering to lowest effective dose
what is celecoxib?
NSAID
when are intraarticular steroid injections particularly useful in reactive arthritis mx?
large joint effusions
when are intra-articular injections especially useful in reactive arthritis mx?
large joint infusions
when are DMARDs indicated in reactive arthritis mx?
may be indicated in patients with acute reactive arthritis refractory to NSAIDs and/or corticosteroids or for those who develop chronic disease
what type of NSAIDs do pt with reactive arthritis typically require?
long half-life
high dose
e.g. naproxen 500mg BD
