Reactive Arthritis

Question 1

What is Reactive arthritis?

Answer 1

Sterile inflammation in joints following infection

Especially Urogenital (e.g. chlamydia) and GI infection (e.g. Salmonella)

Type of SERONEGATIVE spondyloarthropathy

May be first manifestation of HIV or Hep C infection

Different to SEPTIC arthritis which is infection IN the joints

Question 2

Musculoskeletal symptoms of reactive arthritis?

Answer 2

ASYMMETRICAL arthritis (typically lower limbs)
Enthesitis (heel pain, swollen fingers, painful feet)
Spondylitis (inflammation of spine)
Sacroiliitis (inflammation of sacro-iliac joints)

Question 3

Extra-articular symptoms of reactive arthritis?

Answer 3

Sterile conjunctivitis (eye inflammation)
Sterile urethritis (urethra inflammation)
Skin inflammation (Circinate balanitis, rash on hands/feet)

Question 4

Key differences between rheumatoid and reactive arthritis?

Answer 4

Rheumatoid:

More common in women (reactive is more in men)
ALL ages (reactive = 20-40)
SYMMETRICAL arthritis (reactive is asymmetrical)
POLYarticular - small AND large joints (reactive is only large joints)
NO enthesopathy, spondylitis, urethritis
Has RHEUMATOID FACTOR (reactive doesn’t)
HLA-DR4 (reactive = HLA-B27)

Question 5

Diagnosis?

Answer 5

1. Clinical diagnosis

2. Investigations to exclude other causes of arthritis (e.g. SEPTIC arthritis)

Question 6

Septic vs reactive arthritis?

Answer 6

Synovial fluid culture should be STERILE in reactive and positive in septic. Antibiotic therapy can be given to septic but not reactive

Question 7

Treatment for reactive?

Answer 7

Patients get well within 2-6 months, so aim for symptom management
NO antibiotics
NSAIDs/corticosteroids to treat articular inflammation symptoms