Reactive arthritis

Question 1

Define reactive arthritis

Answer 1

Type of inflammatory arthritis - secondary to recent infection (GIT or genitourinary)
Sterile - joints are not infected themselves

Question 2

What are the key triad features of reactive arthritis?

Answer 2

Can’t see. Can’t pee, Can’t climb a tree

Conjunctivitis, Urethritis, arthritis

Question 3

What is the key aetiology of reactive arthritis?

Answer 3

Infection up to 1month prior
STI (postveneral ReA) - chlamydia trachomatis - M20-30yrs
GIT - postenteric ReA - campylobacter jejuni, salmonella

Question 4

What genetics predisposes someone to a reactive arthritis?

Answer 4

HLA-B27 = 50x inc risk of occurence, severity and persistence

Question 5

What are the key features of reactive arthritis?

Answer 5

Arthritis - asymmetrical, large joints, lower limb, oligo
Dactylitis - whole digit
Enthesitis - tendon insertion onto bone
Achilles tendonitis/plantar fasciitis
Eye involvement first - conjucitivitis
Ketroderma blennorhagicum - rash on palms and soles of feet
Genitourinary inflammation
Constitutional - fever, malaise, fatigue

Question 6

What is the typical management of the joints symptoms in reactive arthritis?

Answer 6

NSAIDs first line
Second line - local steroid injection or oral steroid for oligo/poly -> must have stomach protection
If persistent - DMARDs -> sulfasalzine or biologics -> etanercept

Question 7

What is the prognosis of reactive arthritis?

Answer 7

Self-limiting with a duration of 3 to 5 months
25% symptoms persist longer than 6 months = chronic
Secondary osteoarthritis