Reactive Arthritis

Question 1

Reactive arthritis, formerly known as Reiter’s syndrome, is inflammation of a joint which usually develops after an infection. What is the incidence of reactive arthritis?

1 - 0.5 cases per 100,000
2 - 5 cases per 100,000
3 - 50 cases per 100,000
4 - 500 cases per 100,000

Answer 1

2 - 5 cases per 100,000

Question 2

Reactive arthritis, formerly known as Reiter’s syndrome, is inflammation of a joint which usually develops after an infection. What is the peak age reactive arthritis occurs in?

1 - 10-20
2 - 20-30
3 - 30-55
4 - 45-65

Answer 2

2 - 20-30

Question 3

Is reactive arthritis more common in men or women?

Answer 3

• men
• 2:1

Question 4

Reactive arthritis typically occurs following one of 2 infections. Which 2 of the following are common?

1 - lung
2 - GIT
3 - urogenital (STI)
4 - skin

Answer 4

2 - GIT
3 - urogenital (STI)

Question 5

What is the most common STI linked with causing reactive arthritis?

1 - syphilis
2 - gonorrhoea
3 - chlamydia trachomatis
4 - trichomoniasis

Answer 5

3 - chlamydia trachomatis

Question 6

Which of the following can bacteria can cause reactive arthritis following a GIT infection?

1 - Salmonella
2 - Shigella Campylobacter
3 - Yersinia
4 - Escherichia coli
5 - all of the above

Answer 6

5 - all of the above

All:
- gram negative
- contain lipopolysaccharides

Question 7

Typically following the initial infection, how long does it take reactive arthritis to begin?

1 - 24-48h
2 - 7-12 days
3 - 2-3 weeks
4 - 4-6 weeks

Answer 7

3 - 2-3 weeks

Question 8

In reactive arthritis is rhematoid factor present in the blood?

Answer 8

• no
• classed as a seronegative spondyloarthropathies

Question 9

Which human leukocyte antigens (HLA) is commonly linked with causing reactive arthritis?

1 - HLA-B27
2 - HLA-DR2
3 - HLA-DR4
4 - HLA-DQ2

Answer 9

1 - HLA-B27

• can be measured in patients but only positive in 40% patients

Question 10

Which of the following does NOT make up the classical triad of reactive arthritis?

1 - conjunctivitis
2 - urethritis
3 - rhinitis
4 - arthritis

Answer 10

3 - rhinitis

Cant:
- See
- Take a Pee
- Climb a Tree

Question 11

Which of the following joints in NOT typically affected in reactive arthritis?

1 - knee
2 - ankle
3 - heel pain
4 - elbow

Answer 11

4 - elbow

Knee is the most common, but multiple joints can be affected

Question 12

Which of the following are musculoskeletal manifestations of reactive arthritis?

1 - Peripheral arthritis
2 - Dactylitis (sausage digit)
3 - Enthesitis (ligament/tendon inflammation)
4 - Axial arthritis (spinal inflammation)
5 - all of the above

Answer 12

5 - all of the above

• sacroiliac and lumbosacral joint affected

Question 13

Which of the following is not an extra‑articular manifestation of reactive arthritis?

1 - gastrointestinal symptoms
2 - pneumonia
3 - mucosal and skin manifestations (feet mainly affected)
4 - circinate balanitis (painless ulcers)
5 - oral ulcers
6 - nail changes like onycholysis, subungual keratosis, or nail pits
7 - constitutional symptoms
8 - cardiac manifestations

Answer 13

2 - pneumonia

Question 14

Reactive arthritis is typically a clinical diagnosis based on the history and physical examination. Which 2 inflammatory markers are commonly raised in reactive arthritis?

1 - CRP
2 - serum amyloid A
3 - fibrinogen
4 - ESR

Answer 14

1 - CRP
4 - ESR

Question 15

Reactive arthritis is typically a clinical diagnosis based on the history and physical examination. What can be measured to diagnose Chlamydia trachomatis to identify a potential cause of the reactive arthritis?

1 - cervix biopsy
2 - Nucleic acid amplification testing (NAAT)
3 - cervix polyps
4 - all of the above

Answer 15

2 - Nucleic acid amplification testing (NAAT)

Question 16

What can be measured in the urine in acute reactive arthritis to help diagnose patients with reactive arthritis?

1 - leukocytes
2 - hematuria
3 - mild proteinuria
4 - all of the above

Answer 16

4 - all of the above

Question 17

Is imaging useful in the acute stage of reactive arthritis?

Answer 17

• no
• chronic untreated reactive arthritis can lead to joint damage and destruction though that can be detected on imaging

Question 18

Should a joint aspiration be performed in patients with suspected reactive arthritis?

Answer 18

• yes
• need to rule out septic arthritis

Reactive arthritis will always have negative synovial cultures

Question 19

Which of the following is the least likely differential for reactive arthritis?

1 - RA
2 - Septic arthritis
3 - Lyme arthritis
4 - Gout
5 - Pseudogout
6 - STI
7 - IBD
8 - ankylosing spondylitis

Answer 19

1 - RA

Question 20

Does reactive arthritis always need to be treated?

Answer 20

• no
• most cases resolve spontaneously

Question 21

Which of the following is the 1st line treatment for reactive arthritis?

1 - NSAIDs
2 - corticosteroids
3 - Disease-modifying antirheumatic drugs (DMARDs)
4 - Anti-TNF-α therapy

Answer 21

1 - NSAIDs

Question 22

Which of the following is the 2nd line treatment for reactive arthritis?

1 - NSAIDs
2 - corticosteroids
3 - Disease-modifying antirheumatic drugs (DMARDs)
4 - Anti-TNF-α therapy

Answer 22

2 - corticosteroids
- effective for acute flares

DMARDs = Sulfasalazine or Methotrexate, only if NSAIDs and corticosteroids fail

Question 23

Which of the following is NOT a common complication of reactive arthritis?

1 - Secondary osteoarthritis
2 - Ankylosing spondylitis
3 - Recurrent iritis/uveitis/cataracts
4 - Keratoderma blennorrhagicum (soles or palms)
5 - Cardiac complications
6 - Respiratory failure
7 - Rarely severe glomerulonephritis and immunoglobulin A nephropathy

Answer 23

6 - Respiratory failure