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DipGUM > Sexually acquired reactive arthritis (SARA) > Flashcards

Sexually acquired reactive arthritis (SARA) Flashcards

1
Q

Reactive arthritis - define?

A

Sterile inflammation of the synovial membrane, tendons and fascia
triggered by an infection at a distant site,
usually gastro­intestinal or genital

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2
Q

SARA - define?

A

Reactive arthritis triggered by STI

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3
Q

What is the triad of (controversial) ‘Reiter’s’ syndrome?

A

urethritis, arthritis and conjunctivitis

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4
Q

Which sites of STI are most commonly associated with SARA?

A

lower genital tract
Urethra
Cervix

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5
Q

Which organism is most commonly linked to SARA?

A

Chlamydia trachomatis

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6
Q

How often is chlamydia linked to SARA?

A

35-69% of cases

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7
Q

What other bacterial STIs have been linked to SARA?

A

Neisseria gonorrhoea

Ureaplasma urealyticum

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8
Q

What is the possible pathogenesis of chlamydia induced SARA?

A

Chlamydia infection persists in the synovium
repressed synthesis of the major outer membrane protein AND
active production of heat shock protein contributes to inflammatory response

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9
Q

Who is SARA more common in? Men or women?

A

Men

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10
Q

How much more common is SARA in men?

A

10 times more common

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11
Q

What genetic factor may predispose to SARA?

A

HLA B27

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12
Q

How much more susceptible to SARA is a person positive for HLA B27?

A

50 fold

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13
Q

When does SARA onset following an exposure to STI?

A

within 30 days of sexual contact

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14
Q

What proportion of SARA onset within 30 days of sexual contact?

A

88%

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15
Q

What proportion of men will have a recent history of urethral discharge or dysuria?

A

80%

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16
Q

What is the typical presentation and distribution of the arthritis?

A

Pain +/- swelling and stiffness
1 or more joints, usually less than 6
Knees, ankles, feet

17
Q

Enthesitis/fasciitis can also occur in SARA, where does it typically affect?

A

Posterior and plantar aspect of the heels

18
Q

What proportion of patients with SARA get enthesitis or fasciitis?

A

40%

19
Q

What other sites of the body are affected with SARA?

A

Dactylitis - painful swelling of toe or finger
Sacro-iliitis
Irritable eyes

20
Q

What percentage of people with SARA get conjunctivitis?

A

20-50%

21
Q

How does conjunctivitis with SARA typically present?

A

few days before arthritis

bilateral

22
Q

How likely is upper limb involvement in SARA?

A

Rare in the absence of psoriasis

23
Q

What is the potential complication from persistent small joint arthritis in SARA?

A

joint erosion

24
Q

What other eye complications may occur in SARA (5)?

A 
Corneal ulceration
keratitis
intra-ocular haemorrhage
optic neuritis
posterior uveitis
25
Q

What other extra-genital complications can occur with SARA?

A

Skin involvement - psoriasiform was
Cardiac - often asymptomatic tachycardia, LV dilatation
Renal - proteinuria, microhaematuria, aseptic pyuria
Thrombophlebitis

26
Q

What increases the risk of complications from SARA?

A

possession of HLAB27

27
Q

What is the typical course of disease with SARA?

A

4-6 months

self limiting

28
Q

SARA - how to treat?

A 
Rest
regular NSAIDs 
Antimicrobial therapy for STI
Physio
Consider intra-articular corticosteroid
Consider systemic corticosteroid - oral or IM
29
Q

What treatment may be indicated in disabling symptoms that persist or erosive disease?

A

DMARD
sulfasalazine
methotrexate
azathioprine

30
Q

Role of antibiotics in SARA?

A

Short course to treat uro-genital infection

potential anticollagenolytic properties

31
Q

Treatment of skin lesions in SARA?

A

keratinolytic agents - topical salicylic acid or corticosteroid
vitamin D3 - calcitriol ointment
methotrexate
Retinoids

32
Q

If a person has eye symptoms with SARA how should they be managed?

A

Refer ophthalmology

Slip lamp assessment

33
Q

Post-inflammatory pain and fatigue can occur, how to manage?

A

Explanation and patience

Low dose tricyclic - amitriptyline

DipGUM (39 decks)

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