SARA Flashcards
What is SARA
Sexual acquired reactive arthritis.
One of the seronegative spondyloarthropathies (seronegative for rheumatoid factor but has an association with HLAB27).
An autoimmune inflammatory disorder which develops soon after an infection.
Sterile inflammation of the synovial membranes, fascia and tendons triggered by an infection at a distal site.
Linked STIs and % cases of SARA
CT (60%)
GC (16%)
MGen
Ureaplasma urealyticum
Sexual transmission of enteric pathogens (eg Shigella)
More common in men or women?
M:F - 10:1
Risk factors
- Male
- HLA B27 (increased susceptibility and severity)
- sub-Saharan HIV + (almost all HLAB27 negative)
-
What is seronegative spondyloarthritis?
Heterogeneous group of related polygenic diseases that affect the axial skeleton.
The most representative is axial spondyloarthritis (eg AS)
Other related diseases = psoriatic arthritis, IBD- associated arthritis and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO)
Seronegative = Rheumatoid factor is absent
History
- Genital Sx
- Urinary Sx
- FH / PMH: spondyloarthritis, iritis, psoriasis, IBD, SAPHO
- full sexual hx (usually history of SI with new partner within 3/12 of onset of arthritis Sx)
- on average genital Sx occur 14/7 before arthritis
There is usually a history of a new partner x months prior to onset of arthritis
3/12
How long on average of genital symptoms precede arthritis
14/7
Men or women most likely to be asymptomatic ?
Women
Arthritis features
Inflammatory therefore:
- at night
- swelling
- early morning stiffness
Asymmetrical
Oligoarthritis
Primarily lower limbs - knees, ankles, feet
Other MSK features
20-40%
Achilles enthesitis and / or Plantar fasciitis
(difficulty walking)
30%
Tenosynovitis
(Painful movements)
16%
Dactiylitis
(Fusiform swelling of finger / toe)
10%
Sacroiliitis
(Lower back pain and stiffness)
Eye Sx/signs
Irritable and red eyes with photophobia May be due to:
20-50%
Conjunctivitis
2-11%
Iritis
Less commonly
Disturbance of visual acuity and ocular pain with uveitis
Genital manifestations
STI Sx plus:
M: circinate balanitis
F: vulvitis
(14-40% of patients)
Extra genital mucocutaneous features
Psoriasisiform eruptions (12%)
Keratoderma blenorrhagica (5-33%)
Nail dystrophy (6-12%)
Oral ulceration / geographical tongue (minority)
Other rare extra-articular features which may have few or no Sx/signs
CVS: tachycardia, LV dilatation, aortic valve disease, cardiac conduction delays
Renal: proteinuria, microscopic haematuria, aseptic pyuria, GN
Others: CN palsies, meningoencephalitis, thrombophlebitis of LL, subcutaneous nodules.
