Reactive arthritis Flashcards
What is the definition of ReA?
Sterile inflammatory synovitis occurring within 4 weeks of an infection elsewhere in the body (distant), primarily urogenital or enteric/GI infections
What are the 2 types of infection that usually are followed by ReA?
Urogenital
Enteric/GI
What term was ReA previously referred to as, when was this term discovered, and what were the classic clinical features?
Reiter’s syndrome
discovered in 1916
presents with classic triad of conjunctivitis, arthritis, nongonococcal (not caused by gonorrhoea) urethritis
Why is the term Reiter’s syndrome no longer used?
Not referred to as Reiter’s syndrome anymore due to Hans Reiter’s participation in Nazi medical experimentation during WW2
How many new cases of ReA develop per year?
30-40/100000 cases per year
What is the ratio of men to women affected by ReA?
1:1
What age range has the highest prevalence of ReA overall, and how can this different types of ReA affect prevalence in this age range?
Overall most prevalent in young adults aged 20-40
Higher risk for women of enteric/GI form
Higher risk for men of urogenital form
What percentage of individuals with ReA are HLA-B27 positive, and does this affect the extent of ReA?
65-96% are HLA B27 positive cases, tend to be more chronic and severe
Is the infection that is followed by sterile joint inflammation distant or localised, in ReA?
Distant infection initially occurs then is followed by sterile joint inflammation
Give 2 ways in which an individual can get an urogenital infection, and give 2 common examples of urogenital infections that can lead to ReA?
Occurs after sexual exposure/STI or UTl
chlamydia, neisseria causes gonorrhoea
Give 4 examples of enteric/GI infections that can lead to ReA?
Salmonella (raw/undercooked meat, poultry, eggs)
Shigella (type of food poisoning) causes shigellosis
Yersinia (in raw/undercooked pork) causes yersiniosis
Campylobacter (in raw/undercooked poultry) causes campylobacteriosis
What are the 3 most common situations in which an individual can get an infection that leads to ReA?
After sexual exposure to STI
UTI
Food poisoning
Other than urogenital and GI infections, give 4 examples of infections that can lead to ReA?
Streptococcal sore throat
meningococci
borrelia
viral infection
Are the hallmarks for Reiter’s syndrome the same as the hallmarks for ReA?
Hallmarks of Reiter’s syndrome are acute onset of complete triad of arthritis, conjunctivitis, urethritis, but in ReA most patients don’t have complete classic triad
What is usually the initial clinical feature that presents in ReA?
Urethritis
After initial infection, when does urethritis occur and what are the 2 common presenting features?
Begins up to 1 week after infection
Presents as dysuria, pyuria (high WBC count/pus in urine)
After initial infection, when does conjunctivitis occur and what are the 4 common presenting features?
Develops weeks after infection
Presents as red, watery, sticky eyes and discharge from eyes
After initial infection, when does arthritis occur, and describe the arthritis in terms of symmetry and number of joints involved?
Typically asymmetrical oligoarthritis in lower limbs
Apart from joint inflammation, what other structure can become inflamed in ReA?
Enthesitis occurs due to inflammation of entheses
Is there spine involvement in ReA?
Inflammation and arthritis in lumbosacral area (lower back) and sacroiliac joints
What 2 conditions can occur in feet due to inflammation, in ReA?
Plantar fasciitis
Achilles tendonitis
Describe the 2 characteristic skin lesions of ReA, and what form are these predominantly associated with?
Circinate balanitis: pink-red ulcers (often painless) on the prepuce and glans penis
Keratoderma blennorrhagia: waxy yellow–brown skin lesions, particularly affecting the palms and soles
Associated with urogenital form
What clinical feature of ReA involves the mouth, and how does it commonly present?
Buccal erosion, presents as mouth ulcers
How does the nail dystrophy (abnormal changes) in ReA compare to in PsA?
Identical in both conditions
nail pitting, cracking, onycholysis, accompanying nail disease
Give 4 examples of common systemic features of ReA?
Malaise
Weight loss
Fever
Fatigue
Give 2 examples of GI symptoms of ReA?
Diarrhoea
Abdominal pain
In lab investigations of ReA, which 3 inflammatory markers are seronegative, and which 2 markers are elevated?
Seronegative RF, ANA, Anti-Citrullinated Peptide Antibody (ACPA)
Elevated ESR and CRP
In lab investigations of ReA, what 2 conditions can be ruled out by aspirating affecting joints and testing a culture?
Septic arthritis
Crystal arthritis
Why is a high vaginal swab performed on individuals with ReA or suspected ReA?
High vaginal swab can test for presence of chlamydia, which indicates urogenital infection
What 4 lab investigations can be done to identify signs of bacterial infection that has led to ReA?
Gram staining, polarised light microscopy, PCR, culture
Give 6 examples of where a culture can be obtained from to test for bacterial infection, in ReA?
Stool, urethral, cervical, throat, blood, urine (urinalysis)
How does radiographic sacroiliitis appear on X-ray in ReA?
asymmetrical and unilateral
Are bone erosions seen on X-ray if the ReA is acute or chronic?
Chronic ReA, as erosions occur in recurrent disease activity
What 3 radiological features of ReA can be seen on X-ray?
soft tissue swelling, joint space narrowing and erosions
In acute ReA, what 3 management modalities can be given to provide symptomatic relief?
Rest, analgesics and NSAIDs
If ReA causes severe synovitis, what type of injection can be given?
Intra-articular corticosteroid injections
What are the 2 ways of treating nonspecific chlamydial urethritis?
short course of doxycycline or single dose of azithromycin
What 2 clinical features of ReA can occasionally require use of DMARDs?
Severe, progressive arthritis and keratoderma blennorrhagica
Why does anterior uveitis need urgent referral, and how is it treated in ReA?
Anterior uveitis is a medical emergency that needs urgent referral
Requires topical or systemic glucocorticoids.
What guides how skin conditions caused by ReA are treated?
Treated as psoriasis
