Systemic Infection

Question 1

What is SARA?

Answer 1

Sexually acquired Reactive Arthritis - Inflammatory arthritis occurs after exposure to infection; sterile
Occurs 1-4 weeks after infection

Question 2

Most common cause of SARA?

Answer 2

CT and (chlamydia pnemoniae)

Question 3

Are bacteria found in joint?

Answer 3

Bacterial degradation products are. CT is found in a metabolically active state BUT aberrant unclear what significance this is.

Question 4

Risk factors for SARA and RR?

Answer 4

Men 10x
HLAB27 x 50
Precedding GI or CT infection
New Sexual partner past 3 months (88% have had SI in past 30 days)

Question 5

SARA arthritic clinical signs

Answer 5

Arthritis 14 days after clinical signs (latency after CT longer than enteric infections)
Asymetrical oligoarthritis
Red swollen painful joint, worse in morning
Axial arthritis

Question 6

Other clinical findings

Answer 6

Enthesitis 40% (Achilles and plantar fascia, = heel pain)
16% dactylitis
10% constitutional symptoms
Mucus membrane - ulcers, cystitis, prostatitis
Keratoderma blennorhagicum - pustular usually on feet
Circanate balanitis - painless ulcers, plaque like lesions
Ocular - conjunctivitis 20-50% iritis 2-10%
Aortitis (abnormal ECG in 5-14%)
50% abnomral urine dip

Question 7

What % have recurrent symptoms?

Answer 7

50%

Question 8

Investigation s

Answer 8

Raised ESR and CRP
Negative ANA and RF
Xrays - sacroileotis

Question 9

management

Answer 9

1. NSAIDS
2. Steroids
3. DMARDS - sulphasalazine only one properly evaluated if ineffective MTX
4. Biologics