Reactive Arthritis

Question 1

What is reactive arthritis?

Answer 1

A form of inflammatory arthritis in response to an infection in another part of the body

Question 2

What infections commonly cause reactive arthritis?

Answer 2

Chlamydia trachomatis
Neisseria gonorrhoea (but more commonly causes septic arthritis)
Salmonella
Shigella
Yersinia enterocolitica
Campylobacter

Question 3

What are the risk factors for reactive arthritis?

Answer 3

Unprotected sex with new partners
Male sex
HLA-B27 positive
HIV positive

Question 4

What is the triad of reactive arthritis?

Answer 4

Arthritis
Conjunctivitis
Urethritis

Question 5

What are the symptoms of reactive arthritis?

Answer 5

Joint pain and swelling
Urethral discharge or dysuria
Painful red eyes
Rash
Rectal discharge

Question 6

What investigations are used in the diagnosis of reactive arthritis?

Answer 6

Swab from infected site
Stool sample
Joint aspiration - to rule out septic arthritis
- MC&S of synovial fluid
- Crystal examination for gout and pseudogout
STI screening
HLA-B27 serology
XR of affected joint

Question 7

What is seen on joint aspiration in reactive arthritis?

Answer 7

Sterile synovial fluid with a raised white cell count

Question 8

What is the first line management of reactive arthritis?

Answer 8

NSAIDs
Intra-articular steroid injections
Antibiotic therapy - if active STI is identified

Question 9

What is the second line management of reactive arthritis?

Answer 9

Oral corticosteroids
DMARDs e.g methotrexate or sulfasalazine