Reactive Arthritis Flashcards
What is reactive arthritis?
inflammatory arthritis that occurs after exposure to certain GI + genitourinary infections where an organism can’t be recovered from the joint
A HLA-B27 associated seronegative spondyloarthropathy
What triad characterises reactive arthritis?
Urethritis
Conjunctivitis
Arthritis
‘Can’t see, pee or climb a tree’
Describe the epidemiology of reactive arthritis
Post-STI form M > F (10:1)
Post-dysenteric form M = F
What is the most common cause of post-STI reactive arthritis?
Chlamydia trachomatis
List 5 common causes of post-dysenteric reactive arthritis
Shigella flexneri
Salmonella typhimurium
Salmonella enteritidis
Yersinia enterocolitica
Campylobacter
Describe the time course of reactive arthritis
Sx manifest 1-4w post infection
Sx last 4-6 months
~25% have recurrent episodes whilst 10% develop chronic disease
Describe the arthritis in reactive arthritis
Asymmetrical oligoarthritis
Predilection for large joints in lower limbs
Inflammation leads to painful, swollen, warm, red, + stiff joints, esp. in the morning
Dactylitis (swelling of entire digits)
What ocular symptoms occur in reactive arthritis?
Conjunctivitis (10-30%): redness, tearing, sterile purulent discharge
Anterior uveitis
What skin manifestations arise in reactive arthritis?
Circinate balanitis: painless vesicles on coronal margin of prepuce
Keratoderma blenorrhagica: waxy yellow/ brown papules on palms + soles
Describe diagnosis of reactive arthritis
Clinical dx
What investigations may be performed for reactive arthritis?
CRP + ESR: raised
ANA + Rheumatoid Factor: r/o RhA
Urogenital + Stool culture: often -ve by time of arthritis
Arthrocentesis + synovial fluid analysis: r/o septic arthritis/ crystal arthropathy
Describe management of reactive arthritis
Self-limiting
NSAIDs: Naproxen/ Ibuprofen
Intra-articular steroids (mono/ oligo articular)
Systemic steroids (polyarticular/ ocular manifestations): Prednisolone
Sulfasalazine / Methotrexate (persistent)
