reactive arthritis

Question 1

define reactive arthritis

Answer 1

A sterile inflammatory arthritis due to synovitis that occurs within 4 weeks of infection

Question 2

causes of reactive arthritis

Answer 2

1. gastroenteritis
   - C jejuni
   - salmonella
   - shigella
2. STI
   - chlamidya

Question 3

what does reactive arthritis cause

Answer 3

Reactive Arthritis typically causes acute monoarthritis (in one joint) that is triggered by an infection.

Question 4

associations with reactive arthritis

Answer 4

“can’t see, pee, or climb a tree”
Bilateral conjunctivitis
Anterior uveitis
Urethritis
Circinate balanitis (dermatitis of the penis head)

• reiters triad

Question 5

when do symptoms of reactive arthritis begin

Answer 5

1-4 weeks after infection

Question 6

signs and symptoms of reactive arthritis

Answer 6

Peripheral arthritis
Axial arthritis
Dactylitis
Enthesitis
Painless mucosal ulcers
Circinate balanitis
Conjunctivitis
Anterior uveitis
Urethritis and sterile dysuria
Aphthous ulcers in the mouth
Dark maculopapular rash on palms and soles (keratoderma blenorrhagica)

Question 7

investigations for reactive arthritis

Answer 7

1. joint aspirate - mc+s shows no organism
2. plane polarised light microscopy - positive for crystal arthropathy
3. raised ESR + CRP
4. ANA - negative
5. RF - negative
6. X ray

Question 8

what does x ray for reactive arthritis show

Answer 8

sacroiliitis (pain in SI joints) or enthesopathy (inflamed ehtheses)

Question 9

treatment of reactive arthritis

Answer 9

1. Antibiotics may be given until septic arthritis is excluded
2. Treatment of triggering infection
   NSAIDS
3. Steroid injections into the affected joint
4. Systemic steroids (usually when multiple joints are affected)
5. DMARD or anti-TNF medications - chronic arthritis

Question 10

main differential diagnosis for reactive arthritis

Answer 10

septic arthritis - painful, hot swollen joint, red, +signs of infecton