Reactive Arthritis Flashcards
What is reactive arthritis?
Sterile inflammation in joints following infection, especially urogenital or gastrointestinal infections
Give an example of a urogenital infection which may result in reactive arthritis
Chlamydia trachomatis
Give examples of gastrointestinal infections which may result in reactive arthritis
Salmonella
Shigella
Campylobacter
For which two conditions could reactive arthritis be the first manifestation?
HIV
Hep C
Describe the genetic and environmental disposition to developing reactive arthritis
Genetic predisposition (HLA-B27) + environmental trigger (salmonella infection)
Which population does reactive arthritis affect?
Young adults
What is a common differential diagnosis from reactive arthritis and how do these conditions differ?
Septic arthritis is a common differential (infection in joints)
Synovial fluid culture is sterile in reactive arthritis but positive for infection in SA
Antibiotic therapy is helpful in SA but not for reactive arthritis
Joint lavage (cleaning) is helpful in SA but not reactive arthritis
Describe the three main musculoskeletal problems of reactive arthritis
Arthritis
Enthesitis
Spondylitis
Describe the symmetry and distribution of arthritis in reactive arthritis
Asymmetrical
Affects less than 5 joints (oligoarthritis)
Which part of the body does arthritis affect in reactive arthritis?
Lower limbs
What is enthesitis?
Inflammation where tendons or ligaments insert into bone
Which three areas are commonly affected by enthesitis in reactive arthritis?
Heel (achilles tendonitis)
Fingers are swollen (dactylitis)
Metatarsals of feet (due to plantar fasciitis)
What is spondylitis and which parts of the body are commonly affected by it?
Inflammation of:
Sacroiliac joints (sacroiliitis)
Spine (spondylitis)
Which four areas are commonly affected by extra-articular manifestations of reactive arthritis
Eyes
Skin
Entheses
Genitourinary
Describe the ocular and genitourinary extra-articular features of reactive arthritis
STERILE conjunctivitis
STERILE urethritis
Describe the extra-articular features of reactive arthritis on the skin
Circinate balantis - rashes on the penis
Keratoderma Blennorhagicum - psoriasis-like rash on hands and feet
Which HLA is associated with reactive arthritis?
HLA B27
Describe the gender epidemiology of reactive arthritis
M>F
Compare the arthritis of reactive and rheumatoid arthritis
Reactive arthritis:
Asymmetrical joints affected
Oligoarticular
Large joints affected
Rheumatoid arthritis:
Symmetrical
Polyarticular
Small and large joints affected
Compare the epidemiology of reactive and rheumatoid arthritis
Reactive arthritis:
M>F, 20-40yrs
Rheumatoid arthritis:
F>M, all ages
Compare the spondylitis of reactive and rheumatoid arthritis
There is no spine involvement in rheumatoid arthritis besides the atlanto-axial joint
Which investigations would be done for reactive arthritis?
Microbiological cultures of:
- blood
- throat
- urine
- stool
- urethra
- cervix
Serology for:
- HIV
- Hep C
- RF
- HLAB27
Synovial fluid examination (esp if only single joint affected)
Is rheumatoid factor positive or negative in reactive arthritis?
Negative
What is the prognosis for reactive arthritis?
Complete resolution within 2-6 months without antibiotics
How would you treat the articular manifestations of reactive arthritis?
NSAIDs
Intra-articular corticosteroid therapy
How would you treat the extra-articular manifestations of reactive arthritis?
Topical steroids
Keratolytic agents for keratoderma
Symptom management
How would you treat unmanageable (refractory) reactive arthritis?
Oral glucocorticoids
Steroid-sparing agents
Give an example of a steroid-sparing agent
Sulphasalazine
