Reactive Arthritis Flashcards
Define Reactive Arthritis?
Characterised by a sterile arthritis occuring after an extra-articular infection (commonly GI or urogenital)
What is Reiter’s Syndrome is defined as?
A triad of:
Reactive Arthritis
Urethritis
Conjunctivitis
What is the aetiology of Reactive Arthritis?
Associated with infections
It is thought that initial activation of the immune system by a microbial antigen is followed by an autoimmune reaction that involves the skin, eyes and joints
HLA-B27 allele is identified in 70-80% of patients
What are the GI infections that can cause Reactive Arthritis?
Salmonella
Shigella
Yersinia
Campylobacter
What is the Urogenital infection for Reactive Arthritis?
Chlamydia trachomatis (60%)
What is the epidemiology of Reactive Arthritis?
20x more common in MALES
Age of onset: 20-40 yrs
Seen in 2% of patients with non-specific urethritis
What are the presenting symptoms of Reactive Arthritis?
Symptoms can develop 3-30 days after infection
Burning or stinging when passing urine (due to urethritis)
Arthritis
Low back pain (due to sacroiliitis)
Painful heels (due to enthesitis and plantar fasciitis)
Conjunctivitis
What are the signs of Reactive Arthritis on physical examination?
Signs of Arthritis Signs of conjunctivitis Oral ulceration Circinate Balanitis Keratoderma Blenorrhagica Others
What are the signs of Arthritis you see in Reactive Arthritis?
Asymmetrical oligoarthritis
Often affects the lower extremities
Sausage-shaped digits
What are the Signs of Conjunctivitis you see in Reactive Arthritis?
anterior uveitis - painful red eyes
What is Circinate Balanitis?
Scaling red patches on the glans
What is Keratoderma Blenorrhagica?
Brownish-red macules
Vesicopustules
Yellowish-brown scales
Found on the SOLES and PALMS
What are the other signs of Reactive Arthritis you see on physical examination?
Nail dystrophy
Hyperkeratosis
Onycholysis
What investigations do you do for Reactive Arthritis?
Bloods Stool or Urethral Swabs and Cultures Urine Plain X-Rays Joint Aspiration
What bloods do we do for Reactive Arthritis?
FBC
High ESR and CRP
HLA-B27 testing
Why are stools sometimes bad?
May be negative by the time the arthritis develops (because the arthritis occurs post-infection)
Why do we do urinalysis for Reactive Arthritis?
Screen for Chlamydia trachomatis
Why do we Plain X-Rays for Reactive Arthritis?
Useful in chronic cases
Erosions seen at the entheses (insertions of tendons into bone)
Why do we do Joint Aspiration for Reactive Arthritis?
To exclude septic or crystal arthritis
