Spondyloarthropathies - Reactive Arthritis/REITERS SYNDROME

Question 1

Definition

Answer 1

REITER’S SYNDROME = Inflammatory arthritis = synovitis in the joints as a reaction to a recent infection triggers. Typically causing an acute monoarthritic In the lower limb (MC = the knee) presenting with a warm, swollen + painful joint
DEFINED AS: Arthritis that occurs as a result of an infection whereby the organism cannot be isolated from the affected joints

Question 2

Epidemiology

Answer 2

MALE
Young adults = 20-40

Question 3

Risk factors

Answer 3

Sexual intercourse: usually with a new partner, within three months prior to the onset of arthritis
Genetic susceptibility: HLA-B27 positive
HIV positivity

Question 4

Aetiology

Answer 4

Post-STI organisms
- Chlamydia trachomatis
- Neisseria gonorrhoea
Post-gastroenteritis organisms
- Shigella
- Salmonella (typhimurium and enteritidis)
- Yersinia enterocolitica
- Campylobacter

Question 5

Pathophysiology

Answer 5

Mechanism remains unknown but thought to involve cross-reactivity between the original bacterial antigens and the synovium of affected joints.
- Reactive arthritis encompasses a clinical syndrome formerly termed Reiter’s syndrome, which describes a triad of urethritis, conjunctivitis and arthritis.
- Reactive arthritis is classed as an HLA-B27, seronegative spondyloarthropathy due to its association with the HLA-B27 gene and absence of rheumatoid factor.

Question 6

Signs

Answer 6

CANT SEE, CANT PEE, CANT CLIMB UP A TREE:
- Uveitis
- Urethritis/Balanitis
- Arthritis + Enthesitis
Asymmetrical oligoarthritis:
- Painful swollen joint
- Classically affecting > 5 joints
- The knee is the most likely joint to be affected
Cutaneous lesions - Keratoderma = red brown papules on the soles of the feet
Rectal discharge = Proctitis or anal discharge

Question 7

Symptoms

Answer 7

HOT, SWOLLEN JOINT
Urethral discharge or dysuria
Painful red eyes
Rash
Rectal discharge

Question 8

Diagnosis

Answer 8

FIRST LINE =
Joint Aspiration = rule out septic arthritis
Stool sample = history consistent with infective gastroenteritis
Swab from infected site = urethral, cervical or rectal swab to demonstrate evidence of an STI

Question 9

Treatment

Answer 9

FIRST LINE =
- NSAIDS
- Intra-articular steroid injections = single swollen joint
- Antibiotic therapy = can be used if an active STI is identified, but little evidence exists for improving arthritis symptoms
* Mostly single attack - if have 6+ months of recurrence = CHRONIC *
- DMARDS = Methotrexate
- Anti-TNF a = INFLIXIMAB = If MT ineffective

Question 10

Complications

Answer 10

Chronic relapsing arthritis
Fatigue