Reactive arthritis

Question 1

Define reactive arthritis

Answer 1

Characterised by sterile arthritis occurring after an extra articular infection (commonly GI or urogenital)

Question 2

Define reiter’s syndrome

3

Answer 2

TRIAD of:

• reactive arthritis
• urethritis
• conjunctivitis

Question 3

Aetiology of reactive arthritis

2

Answer 3

Thought that initial activation of immune system by microbial antigen is followed by autoimmune reaction that involves skin, eyes & joints

HLA-B27 allele is identified in 70-80% of patients

Question 4

Associated infections of reactive arthritis

4 + 1

Answer 4

GI
Salmonella
Shigella
Yersinia
Campylobacter

Urogenital
Chlamydia trachomatis (60%)

Question 5

Epidemiology of reactive arthritis

gender, age, association

Answer 5

20x more common in MALES
Age of onset 20-40 yrs
Seen in 2% of patients w/ non specific urethritis

Question 6

Presenting symptoms of reactive arthritis

6

Answer 6

Symptoms can develop 3-30 days after infection
Burning or stinging when passing urine (due to urethritis)
Arthritis
Low back pain (due to sacroiliitis)
Painful heels (due to enthesitis & plantar fasciitis)
Conjunctivitis

Question 7

Signs of reactive arthritis on physical examination

6 groups

Answer 7

Arthritis
Conjunctivitis
Oral ulceration  
Circinate balanitis
Keratoderma blenorrhagica
Others

Question 8

Signs of reactive arthritis on physical examination - arthritis
(3)

Answer 8

Asymmetrical oligoarthritis
Often affects lower extremities
Sausage shaped digits

Question 9

Signs of reactive arthritis on physical examination - conjunctivitis

Answer 9

Anterior uveitis - painful red eye

Question 10

Signs of reactive arthritis on physical examination - circinate balanitis

Answer 10

Scaling red patches on the glans of penis

Question 11

Signs of reactive arthritis on physical examination - keratoderma blenorrhagica
(4)

Answer 11

Brownish-red macules
Vesicopustules
Yellowish-brown scales
Found on SOLES & PALMS

Question 12

Signs of reactive arthritis on physical examination - others

3

Answer 12

Nail dystrophy
Hyperkeratosis
Onycholysis

Question 13

Investigations for reactive arthritis

5 types

Answer 13

Bloods
Stool or urethral swabs & cultures
Urine
Plain X-rays
Joint aspiration

Question 14

Investigations for reactive arthritis - bloods

3

Answer 14

FBC
High ESR/CRP
HLA-B27 testing

Question 15

Investigations for reactive arthritis -

Answer 15

May be negative by the time arthritis develops (occurs post-infection)

Question 16

Investigations for reactive arthritis - urine

Answer 16

Screen for Chlamydia trachomatis

Question 17

Investigations for reactive arthritis - plain X-rays

2

Answer 17

Useful in chronic cases

Erosions seen at entheses (insertion of tendons into bone)

Question 18

Investigations for reactive arthritis - joint aspiration

Answer 18

To exclude septic or crystal arthritis