Reactive arthritis

Question 1

What is reactive arthritis?

Answer 1

Sterile inflammation in joints following infection especially urogenital (e.g. chlamydia trachomatis) and gastrointestinal (e.g. salmonella, Shigella, campylobacter infections) infections

Question 2

What are some of the important extra-atrciular manifestations of reactive arthritis?

Answer 2

Enthesopathy (disorder regarding the attachment of tendon to bone). Skin inflammation Eye inflammation

Question 3

Reactive arthritis maybe the first manifestations of which infections?

Answer 3

HIV and hepatits C

Question 4

What is the genetic predisposition gene for reactive arthritis?

Answer 4

HLA-B27

Question 5

What 2 things do you generally need to get reactive arthritis?

Answer 5

A genetic predisposition and an environmental trigger (e.g. salmonella)

Question 6

What is septic arthritis and how is it different to reactive arthritis?

Answer 6

Septic arthritis is an INFECTION in the joints and reactive arthritis is sterile INFLAMMATION in the joints

Question 7

Describe the arthritis features of reactive arthritis

Answer 7

Arthritis tends to be asymmetrical, oligoarthritis present (affecting less than 5 joints), and typically, the lower limbs are affected

Question 8

Describe the enthesitis features of reactive arthritis

Answer 8

Heel pain (achilles tendonitis), swollen fingers (dactylics), painful feet (metatarsalgia due to plantar fascilitis)

Question 9

Describe the spondylitis features of reactive arthritis

Answer 9

Sarolitis (inflammation of the sacroiliac joint), and spondylitis (inflammation of the spine).

Question 10

What are the extra-articular features of reactive arthritis?

Answer 10

Ocular- sterile conjunctivites Gentio-urinary- sterile urethritis Skin- Circinate balanitis (ring-shaped dermatitis on the glans of the penis) and psoriasis-like rash on hands and feet.

Question 11

What is the difference between rheumatoid arthritis and reactive arthritis?

Answer 11

Question 12

How is diagnoses of Reactive arthritis established?

Answer 12

• Clinical diagnosis
• Investigations to exclude other causes of arthritis e.g. septic arthritis
• Examples of important investigations:

Question 13

What are the 3 methods of diagnosis?

Answer 13

• Microbiology:
• Microbial cultures – blood, throat, urine, stool, urethral, cervical Serology e.g. HIV, hepatitis C
• Immunology- Rheumatoid factor and (HLA-B27)
• Synovial fluid examination. Especially if only single joint affected

Question 14

How would you determine the difference between septic arthritis and reactive arthritis?

Answer 14

Synovail fluid culture: septic arthritis positive result and reactive arthritis is sterile

Antibiotic therapy: septic arthritis needs antibiotics but reactive arthrits will not

Joint lavage (washing out debris inside the joint): Septic arthritis may need this (for large joints), not for reactive arthritis

Question 15

How quickly is reactive arthritis resolved?

Answer 15

In majoirty of patients complete resolution occurs within 2-6 months.

There is no role for antibiotics here.

Question 16

What are some of the treatments for reactive arthritis?

Answer 16

For articular problems- NSAIDs and intra-articular corticosteroid therapy.

For extra-articular problems- typically it is self-limiting, hence symptomatic therapy (e.g. topical corticosteroids and keratolytic agents in keratoderma).

For refractory disease- oral glucocorticoids, steroid-sparing agents e.g. sulphasalazine