Reactive arthritis Flashcards
What is reactive arthritis?
Spondyloarthritis develop in response to extra–articular infection typically GI, Gu infection
How does infection cause reactive arthritis?
Immune activation + cross reactivity with self antigens causing acute inflammation in affected joint and other tissues
Medications for reactive arthritis
NSAIDs
Corticosteroids - intra-articular, topical, oral
Antibiotics
DMARDs
What antibiotic used in chlamydial urethritis?
Tetracyclines eg doxycycline, minocycline
Investigations for reactive arthritis
Bloods - raised CRP, ESR, leucocytosis, thrombocytosis (acute phase) , HLA-B27, Serology - chlamydia
Xray
Joint aspiration
Throat, stool, urine culture
MRI
Reactive arthritis on x ray
Normal in early stages
Marginal erosions
Plantar spurs
Sacroilitis
Asymmetrical syndesmophytes (chronic)- bony growth in ligament
Why do joint aspiration in reactive arthritis + what is seen
rule out gout and septic
sterile, cloudy and high WCC in reactive
Risk factors reactive arthritis
Arthritis
Lower back pain
Enthesitis
Eyes - uveitis, episcleritis, keratitis, corneal ulcers
Dactylitis
Urethritis and circinate balanitis
Mouth ulcers
Nail dystrophy and keratoderma blenorrhagica
Reiter sydnromee
What is reiter syndrome
Conjunctivitis, urethritis and reactive arthritis triad
Cant see cant wee cant bend knee
When does reactive arthritis occur after infection
2-6 weeks
Enthesitis in feet
Plantar fasciitis and achilles tendonitis
Where does vit B12 def affect in body
Legs affected more than arms
Progressive symmetrical B12 neuropathy
Legs affected more than arms
Poor motor coordination
Memory lapses
Age related cognitive impairment
Syndromes of reactive arthritis
enthesopathic Syndrome.
2 peripheral arthritis: acute or subacute asymmetric oligoarticular arthritis, which affects the lower limbs.
3 axial and pelvic syndrome: spinal involvement with sacroiliitis.
4 extramusculoskeletal Syndrome
Investigations
ESR/CRP
HLA-B27, p-ANCA may be positive
