Reactive arthritis

Question 1

definition of reactive arthritis

Answer 1

Characterized by a sterile arthritis occurring after an extra-articular infection(commonly gastrointestinal or urogenital).

Reiter’s syndrome is defined by a triad of reactive arthritis, urethritis and conjunctivitis.

arthritis and other sx because of an autoimmune response to infection elsewhere in the body - GI or GU.

The preceding infection might have resolved or have been asymptomatic by the time the arthritis presents

Question 2

aetiology of reactive arthritis

Answer 2

associated with infections of GIT (salmonella, shigella, yersinia, campylobacter, e coli) and urogenital origin (Chlamydia trachomatis in 60%)

initial activation of immune system by microbial ag -> autoimmune rn involving skin, eyes and joints

HLA-B27 +Ve in 70-80% pts

HLA-B27 may share molecular characteristics with bacterial epitopes, fascilitating an auto-immune cross rn

Question 3

epidemiology of reactive arthritis

Answer 3

female more

20-40yrs

in 2% of pts with non-specific urethritis and 0.2% of those with dysentery

prevalence - 30-40/100000 adults

Question 4

sx of reactive arthritis

Answer 4

Symptoms may develop 3–30 days after the infection.

burning/stinging on passing water - urethritis

arthritis

low back pain - sacroiliitis

painful heels - enthesitis, plantar fasciitis

conjunctivitis

urinary and GI sx

Question 5

signs of reactive arthritis

Answer 5

arthritis

• symmetric oligoarthritis
• (often affecting the lower extremities, sausage-shaped digits).

conjunctivitis

• red eye

anterior uveitis

• painful red eye

oral ulceration

• usually painless

circinate balanitis

• scaling red patches
• painless penile ulceration, secondary to chlamydia
• may evolve - encircling the glans penis

Keratoderma blenorrhagica(10% of patients):

• Brownish-red macules,
• vesicopustules
• yellowish brown scales on soles or palms.

enthesitis

fever

nail dystrophy, hyperkeratosis, or onycholysis

Question 6

Ix for reactive arthritis

Answer 6

bloods

infectious serology

stool or urethral swabs and cultures - may be -ve by the time the arthritis develops

urine - screen for chlamydia trachomatis

plain XR in chronic cases

joint aspiration - exclude septic or crystal associated arthritis

sexual health review

Question 7

blood results for reactive arthritis

Answer 7

FBC - anaemia may be an indication of severity and extent of systemic illness

high ESR or CRP

HLA-B27 testing in pts with intermediated likelihood of reactive arthritis

Question 8

XR for chronic reactive arthritis

Answer 8

erosions at the insertion of tendons - entheses eg achilles tendon, plantar spurs, sacroiliitis, spinal disease with asymmetrical syndesmophytes

enthesitis with periosteal reaction

Question 9

mx of reactive arthritis

Answer 9

1. NSAIDs
2. Steroids
3. if unresponsive to NSAIDS: Sulfasalazine (DMARD)

Question 10

follow up for reactive arthritis

Answer 10

monthly visits with appropriate image for structural changes
dermatology, opthal, rheum

Question 11

complications of reactive arthritis

Answer 11

OA
uveitis/iritis
keratoderma blennorrhagicum
* pustular/plaque like lesions typically on soles/palms

Question 12

Px of reactive arthritis

Answer 12

50% recover
some expect chronic picture