reactive osteoporosis Flashcards
what family is reactive arthritis in *
a familly of inflammatroy arthritic syndromes termed - seronegative spondylparthropathies
summarise reactive arthritis *
it is a sterile inflammation in joints following infection especially urogenital eg chlamydia trachomatis and GI (food poisening) - salmonella, shigella, campylobacter infections
may be the first presentation of HIV or Hep C
common in young adults with a genetic predisposition eg HLA-b27 and environmental trigger eg salmonella infection
HLA-b allele points to CD8 pathology because it is a class 1 allele
symptoms follow 1-4 weeks after an infection and the infection could be mild
it is not the same as infection in joints - this is septic arthritis
what are extra-articular manifestations of reactive arthritis *
enthesopathy - inflammation of the places where tendons insert eg plantar’s fascia insertion/insertion of the achilles tendon
skin inflammation
eye inflammation - uveitis (pus in anterior chamber of eye) and sterile conjunctivitis
genito-urinary - sterile urethritis
skin - circinate balantis (immunological reaction causing skin lesions on the glans of the penis) , psoriasis like rash in hands and feet (keratoderma blenorrhagicum)
what are the musculoskeletal symptoms of reactive arthritis *
arthritis - asymettrical, oligoarthritis (<5 joints affected), lower limbs typically effected - large joints
enthesitis - heel pain from achilles tendonitis, swollen fingers- dactylitis, painful feet - metatarsalgia due to plantar fascia
spondylitis - sarcoiliitis (inflammation of the sarco-iliac joints), spondylitis (inflammation of the spine)
gender ratio for reactive arthritis *
men more
men manifest with immune response more with this inflammation
age range for reactive arth *
20-40yrs
is there rheumatoid factor in reactive arth *
no
describe how you diagnose reactive arth *
clinical diagnosis/presentation
investigation into other causes of arthritis - if single hot swelling need to rule out septic - aspirate the swollen joint and gram stain the fluid that comes out (this is synovial fliod examination) - need to know if septic because septic arthritis will destroy the joint = irreversible damage - if multiple joints less likely to be septic arth
if septic more likely to look unwell, have high fever/rigoring (chill), high CRP
need to determine the underlying cause of reactive arth - eg send to a sexual heath clinic
check microbiology - cultures of blood, thoatm urine, stool, urethral, cervical and serology for HIV or hep C etc
immunology - check rheumatoid factor to differentiate between types of arthritis; HLA-B27 not useful because a lot of pop carry it anyway
difference in therapy for septic and reactive arth *
septic - give AB to treat the joint
reactive dont give AB (unless to treat the underlying infection)
joint lavage (wash out) for septic if large joint, not for reactive
example of how septic arth can damage >1 joint *
gonorrhoea - gonococcal arth - travels through blood and is seeded in joints- multiple joints involved - therefore might be missed that it is septic arth
luckily doesnt damage the joint in the same way
summarise typical septic arth
staph aures
normally in pt who is immunocomp - med/hiv/rheumatoid arth or lupus medication that suppresses immune system
if have RA and get 1 hot swollen joint could be infection
anyone with abnormal joints are at higher risk of an infection setting in
describe treatment for reactive arthritis *
in most patients resolution occurs in 2-6 months
articular treatment - NSAIDs, if one joint or particularly bad (and ruled ouit infection) - intra-articular coricosteroid therapy (inject into joint when you drain it)
extra-articular - self limiting, so symptomatic therapy eg topical steroids and keratolytic agents in keratoderma (creams that break down the keratin deposits)
refractory disease - oral glucocorticoids, steroid sparing agents eg sulphasalazine (tablet take daily) - in some cases need methotrexate or anti-TNF
