Reactive_Arthritis_Flashcards
What is reactive arthritis?
Reactive arthritis is an arthritis that develops following an infection where the organism cannot be recovered from the joint.
What term was formerly used to describe reactive arthritis and what did it encompass?
Reactive arthritis was formerly called Reiter’s syndrome, which described a classic triad of urethritis, conjunctivitis, and arthritis following a dysenteric illness during the Second World War.
What is the classic triad associated with reactive arthritis?
The classic triad associated with reactive arthritis is urethritis, conjunctivitis, and arthritis.
What is the epidemiology of post-STI and post-dysenteric forms of reactive arthritis?
The post-STI form is much more common in men (e.g. 10:1), while the post-dysenteric form has equal sex incidence.
What organisms are most commonly associated with the post-dysenteric form of reactive arthritis?
Organisms most commonly associated with the post-dysenteric form include Shigella flexneri, Salmonella typhimurium, Salmonella enteritidis, Yersinia enterocolitica, and Campylobacter.
What organism is most commonly associated with the post-STI form of reactive arthritis?
Chlamydia trachomatis is the organism most commonly associated with the post-STI form of reactive arthritis.
What are the management options for reactive arthritis?
Management options for reactive arthritis include symptomatic relief with analgesia, NSAIDs, intra-articular steroids, sulfasalazine, and methotrexate for persistent disease. Symptoms rarely last more than 12 months.
What is the typical time course for the development and duration of reactive arthritis symptoms?
Reactive arthritis typically develops within 4 weeks of the initial infection, and symptoms generally last around 4-6 months.
What percentage of patients with reactive arthritis have recurrent episodes or develop chronic disease?
Around 25% of patients have recurrent episodes, while 10% of patients develop chronic disease.
What are the typical features of arthritis in reactive arthritis?
Arthritis in reactive arthritis is typically an asymmetrical oligoarthritis of the lower limbs and may include dactylitis.
What are the common symptoms of urethritis in reactive arthritis?
Common symptoms of urethritis in reactive arthritis include dysuria and discharge.
What eye conditions are associated with reactive arthritis?
Eye conditions associated with reactive arthritis include conjunctivitis (seen in 10-30%) and anterior uveitis.
What skin conditions are associated with reactive arthritis?
Skin conditions associated with reactive arthritis include circinate balanitis and keratoderma blenorrhagica.
summarise reactive arthritis
Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It encompasses what was formerly called Reiter’s syndrome*, a term which described a classic triad of urethritis, conjunctivitis and arthritis following a dysenteric illness during the Second World War. Later studies identified patients who developed symptoms following a sexually transmitted infection (post-STI, now sometimes referred to as sexually acquired reactive arthritis, SARA).
Reactive arthritis is defined as an arthritis that develops following an infection where the organism cannot be recovered from the joint.
‘Can’t see, pee or climb a tree’
Epidemiology
post-STI form much more common in men (e.g. 10:1)
post-dysenteric form equal sex incidence
The table below shows the organisms that are most commonly associated with reactive arthritis:
Post-dysenteric form
- Shigella flexneri
- Salmonella typhimurium
- Salmonella enteritidis
- Yersinia enterocolitica
- Campylobacter
Post-STI form
-Chlamydia trachomatis
Management
symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months
*as Reiter was a member of the Nazi party the term is no longer used
Reactive arthritis: features
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Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It encompasses what was formerly called Reiter’s syndrome*, a term which described a classic triad of urethritis, conjunctivitis and arthritis following a dysenteric illness during the Second World War. Later studies identified patients who developed symptoms following a sexually transmitted infection (post-STI, now sometimes referred to as sexually acquired reactive arthritis, SARA).
Reactive arthritis is defined as an arthritis that develops following an infection where the organism cannot be recovered from the joint.
Features
time course
typically develops within 4 weeks of initial infection - symptoms generally last around 4-6 months
around 25% of patients have recurrent episodes whilst 10% of patients develop chronic disease
arthritis is typically an asymmetrical oligoarthritis of lower limbs
dactylitis
symptoms of urethritis
eye
conjunctivitis (seen in 10-30%)
anterior uveitis
skin
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
‘Can’t see, pee or climb a tree’
Keratoderma blenorrhagica
*as Reiter was a member of the Nazi party the term is no longer used
Management
eactive Arthritis
No treatment is required as it is self-resolving
Symptomatic relief:
o NSAIDs for pain-relief o Steroids (severe)
o DMARDs (on-going)
