Reactive Arthritis

Question 1

What is reactive arthritis?

Answer 1

Sterile inflammation in joints following infection, especially urogenital or gastrointestinal infections

Question 2

Give an example of a urogenital infection which may result in reactive arthritis

Answer 2

Chlamydia trachomatis

Question 3

Give examples of gastrointestinal infections which may result in reactive arthritis

Answer 3

Salmonella
Shigella
Campylobacter

Question 4

For which two conditions could reactive arthritis be the first manifestation?

Answer 4

HIV

Hep C

Question 5

Describe the genetic and environmental disposition to developing reactive arthritis

Answer 5

Genetic predisposition (HLA-B27) + environmental trigger (salmonella infection)

Question 6

Which population does reactive arthritis affect?

Answer 6

Young adults

Question 7

What is a common differential diagnosis from reactive arthritis and how do these conditions differ?

Answer 7

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

Question 8

Describe the three main musculoskeletal problems of reactive arthritis

Answer 8

Arthritis
Enthesitis
Spondylitis

Question 9

Describe the symmetry and distribution of arthritis in reactive arthritis

Answer 9

Asymmetrical

Affects less than 5 joints (oligoarthritis)

Question 10

Which part of the body does arthritis affect in reactive arthritis?

Answer 10

Lower limbs

Question 11

What is enthesitis?

Answer 11

Inflammation where tendons or ligaments insert into bone

Question 12

Which three areas are commonly affected by enthesitis in reactive arthritis?

Answer 12

Heel (achilles tendonitis)
Fingers are swollen (dactylitis)
Metatarsals of feet (due to plantar fasciitis)

Question 13

What is spondylitis and which parts of the body are commonly affected by it?

Answer 13

Inflammation of:
Sacroiliac joints (sacroiliitis)
Spine (spondylitis)

Question 14

Which four areas are commonly affected by extra-articular manifestations of reactive arthritis

Answer 14

Eyes
Skin
Entheses
Genitourinary

Question 15

Describe the ocular and genitourinary extra-articular features of reactive arthritis

Answer 15

STERILE conjunctivitis

STERILE urethritis

Question 16

Describe the extra-articular features of reactive arthritis on the skin

Answer 16

Circinate balantis - rashes on the penis

Keratoderma Blennorhagicum - psoriasis-like rash on hands and feet

Question 17

Which HLA is associated with reactive arthritis?

Answer 17

HLA B27

Question 18

Describe the gender epidemiology of reactive arthritis

Answer 18

M>F

Question 19

Compare the arthritis of reactive and rheumatoid arthritis

Answer 19

Reactive arthritis:
Asymmetrical joints affected
Oligoarticular
Large joints affected

Rheumatoid arthritis:
Symmetrical
Polyarticular
Small and large joints affected

Question 20

Compare the epidemiology of reactive and rheumatoid arthritis

Answer 20

Reactive arthritis:
M>F, 20-40yrs

Rheumatoid arthritis:
F>M, all ages

Question 21

Compare the spondylitis of reactive and rheumatoid arthritis

Answer 21

There is no spine involvement in rheumatoid arthritis besides the atlanto-axial joint

Question 22

Which investigations would be done for reactive arthritis?

Answer 22

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)

Question 23

Is rheumatoid factor positive or negative in reactive arthritis?

Answer 23

Negative

Question 24

What is the prognosis for reactive arthritis?

Answer 24

Complete resolution within 2-6 months without antibiotics

Question 25

How would you treat the articular manifestations of reactive arthritis?

Answer 25

NSAIDs

Intra-articular corticosteroid therapy

Question 26

How would you treat the extra-articular manifestations of reactive arthritis?

Answer 26

Topical steroids
Keratolytic agents for keratoderma
Symptom management

Question 27

How would you treat unmanageable (refractory) reactive arthritis?

Answer 27

Oral glucocorticoids

Steroid-sparing agents

Question 28

Give an example of a steroid-sparing agent

Answer 28

Sulphasalazine