Reactive Arthritis/ Reiters

Question 1

Important Aspects of Hx

Answer 1

• Reactive Arthritis is triggered follwoing enteric or urogenital/STI infections
• Symptoms usually being 1-3 weeks after the infection
• Symptoms may present acutely or develop slowly over time
• Signs may go unnoticed (ie mild). Signs usually come and go over a period of several weeks to several months
• In most people, the initial symptoms disappear in 3 or 4 months
• in 50% of cases joints inflammation and other symptoms recur over several years
• Rraely permanently disabling
• Most affected invdividuals recover within 1 year; reactive arthritis can become chronic
• Not all symptoms occur in every person with Reiters; nor do they occur at once

Question 2

Systemic Manifestations (mild)

Answer 2

• Malaise
• Mild fever
• Myalgia (early)

Question 3

Urogenital Tract Manifestations. Males.

Answer 3

manifestations of Urethritis (common) (secondary to chlamydial infection)

• Urinary urgency (= a sudden, compelling urge to urinate); Incontinence.
• Urethral discharge
• Burning or stinging on urination
• Urinary hesitancy (difficulty in beginning the flow of urine)
• dull jaching pain in the delvic region

Manifestations of Cystitis

• Frequent urination
• Burning sensation when urinating
• Dull aching pain in the pelvic region
• Fever

Manifestations of Prostatisis (Less common)

• Fever; chills
• Urinary frequency = >8 times in 24 hours
• burning sensation when urinating
• Prostate tenderness

Question 4

Urogenital Tract Manifestations. Females.

Answer 4

• Cervicitis (often asympomatic)
• Manifestations of Urethritis (often asymptomatic)
• Manifestations of Cystitis (common)
• Manifestations of salpingitis (inflammation of the fallopian tubes)
• Manifestations of vulvovaginitis (inflammation of the vulva and vagina) (uncommon)

Question 5

Occular Manifestations

Answer 5

Occur in 1/3 of individuals with salmonella associated arthritis

Manifestations of Conjunctivits (common)

• Conjunctivitis (mild) (50% of caases with urogenital Reiter’s & 75% of people with enteric Reiter’s)
• – Usually appears within a few weeks of the onset of arthritis; inflammation typically resolves within 10 days without treatment
• – Red/pink, itchy eye
• – Discharge from the eye; lids may be stuck in the morning
• – Burning eye pain

Manifestations of Uveitis

• Redness of the eye
• Blurred vision
• Eye pain
• Photophobia

Question 6

Musculoskeltal Manifestations

Answer 6

ENTHESOPATHY

• Muscle aching
• Heel pain; heel spurs; plantar fasciitis
• Achilles tendon pain
• Costochondritis

ARTHRITIS (common)

• joint pain, heat swelling and stiffness, usually low-grade inflammation
• — Asymmetri, oligoarthritis i.e. a few joints are usually affected at once
• — Affects mainly lower extremities
• — Common: large joints (knee, ankle); toe joints
• — Uncommon: Wrists, fingers etc
• Low back pain (sponylitis; and asymmetric sacroiliitis)
• Sausage fingers/toes caused by uniform inflammation and enthesopathy
• Sponylitis or sacroiliitis ( less common)

MUCOUS MEMBRANE LESIONS

• small painless ulcers on the soft palate and tongue
• balanitis circinata: small, shallow, painless sores or ash on the glans penis

CUTANOUES LESIONS

• skin lesions on soles and palms, may resemble psoriasis
• Keratoderma blennorrhagica: rashes of small hard, nodules on the soles of the feet, and less often on the palm of the hands, or elsewhere, often begins as clear vesicles on erythematous bases and progress to macules, papules and nodules
• Skin redness or inflammation

CARDIAC MANIFESTATIONS

• Valvular Lesions (10% of cases) especially occurs in prolonged disease e.g. AOrtic regurgitation
• Pericarditis

GIT MANIFESTATIONS
- Dysentery: mild recurrent abdominal complaints after the precipitating epsiode of diarrhoea