Reactive arthritis Flashcards
Define
A STERILE arthritis
Characterized by a sterile arthritis occurring after an extra-
articular infection (commonly gastrointestinal or urogenital)
Causes
Cause
Typically affects lower limb 1-4 weeks after urethritis or dysentery
- Urethritis - Chlamydia or Ureaplasma sp
- Dysentery - Campylobacter, Salmonella, Shigella, or Yersinia sp May be chronic or relapsing
Reiter’s syndrome is defined by a triad of Reactive arthritis, urethritis and conjunctivitis
Risk factors
associated with infections of the GI tract or urogenital origin
Epidemiology
M:F, 20:1 Much more common in MALES
Age of onset 20-40 years Prevalence ~30–40/100 000 adults
Seen in 2% of patients with non-specific urethritis and 0.2% of dysentery pts
Symptoms
May develop 3–30 days after the infection
Arthritis
Lower back pain (sacroiliitis)
Painful heels (enthesis, plantar fasciitis)
Urethritis: Burning or stinging on passing water
Conjunctivitis
Signs
- Signs of arthritis → asymmetric oligoarthritis (often affecting the lower extremities, sausage-shaped digits)
- Signs of conjunctivitis → red eye
- Anterior uveitis (10%) → painful red eye
- Oral ulceration → usually painless
- Circinate balanitis →painless scaling red patches encircling the glans penis (2nary to Chlamydia)
- Keratoderma blenorrhagica (10%)→ brownish-red macules, vesicopustules and yellowish brown scales on soles or palms
- Other → fever, nail dystrophy, hyperkeratosis or onycholysis
Investigations
Bloods
- FBC
- High ESR and CRP
- HLA-B27 testing
Stool or Urethral Swabs and Cultures
- May be negative by the time the arthritis develops (because the arthritis occurs post-infection)
Urine
- Screen for Chlamydia trachomatis
Plain X-Rays
- Useful in chronic cases
- Erosions seen at the entheses (insertion of tendons into bone)
Joint Aspiration
- To exclude septic or crystal arthritis
