Reactive Arthritis

Question 1

What is reactive arthritis associated with?

Answer 1

HLA-B27 Positivity

Question 2

What causes reactive arthritis?

Answer 2

This is when an infection elsewhere in the body, most commonly an STI, causes an autoimmune response with joint pain and inflammation

Question 3

What is the triad of reactive arthritis?

Answer 3

Can’t see, pee or climb a tree

Arthralgia
Urethritis
Conjunctivitis

Question 4

What do the seronegative spondyloarthropathies have in common? Reactive arthritis is one of these arthtopathies

Answer 4

HLA B27 Association
Dactylitis- swollen painful finger
Arthropathy affecting axial skeleton
ASymmetrical large joint arthritis 
Oral ulcers
Enthesitis- plantar fasciitis, achilles tendonitis, costochondritis
Anterior uveitis
Aortic valve incompetence
Psoriasiform rashes
IBD

Question 5

What tests should be done for reactive arthritis?

Answer 5

An acutely, hot, tender, swollen joint should be aspirated and send for MC+S, Polarised Light microscopy- Could be septic arthritis which is an emergency

Bloods- FBC, CRP, ESR, eGFR, Creatinine

Joint X-Ray

If STI- Swabs for NAAT and culture. Sexual health review

If GI infection suspected stool culture and C.Diff toxin

Question 6

What is the management for reactive arthritis?

Answer 6

NSAIDS or local steroid injections

If symptoms persist for more than 6 months methotrexate or sulfasalazine may be used.

Normally resolves within 12 months.