Septic & Reactive Arthritis

Question 1

What is reactive arthritis?

(Reiter syndrome)

Answer 1

• synovitis occurs in the joints as a reaction to a recent infective trigger
• unlike septic arthritis, there is NOT an infection in the joint

previously known as Reiter Syndrome

Question 2

What is the typical presentation of reactive arthritis?

Answer 2

• it typically causes an acute monoarthritis (single joint affected, symptoms develop rapidly)
• it most commonly affects the lower limb, in particular the knee joint
• the joint is warm, swollen & painful

Question 3

What is the most important differential to exclude when diagnosing reactive arthritis?

Answer 3

septic arthritis

• they can present similarly
• in reactive arthritis, the infective organism cannot be isolated from the joint

Question 4

What are the most common infective triggers for reactive arthritis?

Answer 4

• gastroenteritis
• sexually transmitted infection - particularly chlamydia

gonorrhoea commonly causes a gonococcal septic arthritis

Question 5

What gene is associated with reactive arthritis?

Answer 5

HLA B27 gene

• it is part of the seronegative spondyloarthropathy group of conditions
• this includes ankylosing spondylitis & psoriatic arthritis

Question 6

What is the time course of symptom development for reactive arthritis?

Answer 6

• symptoms typically develop within 4 weeks of initial infection
• symptoms tend to last for around 4-6 months

Question 7

What other symptoms are associated with reactive arthritis and how can they be remembered?

Answer 7

• non-infective bilateral conjunctivitis
• anterior uveitis
• circinate balanitis (dermatitis of the head of the penis)
• keratoderma blenorrhagica

keratoderma blenorrhagica = waxy yellow/brown papules on the palms & soles

remember the features by “can’t see, pee or climb a tree”

Question 8

What is involved in the initial investigations for reactive arthritis?

Answer 8

!! it must be treated as septic arthritis until proven otherwise !!

• treat via the local “hot joint” policy
• antibiotics are given until septic arthritis is excluded
• a joint aspirate is sent for gram staining / culture & sensitivity testing

the joint aspirate can also be sent for crystal examination to look for gout / pseudogout

Question 9

What is involved in the management of reactive arthritis?

Answer 9

• NSAIDs
• steroid injections into the affected joint
• systemic steroids (e.g. oral prednisolone) typically when multiple joints are affected

septic arthritis must be excluded first !!

Question 10

Can reactive arthritis recur?

Answer 10

• most cases resolve within 6 months and DO NOT recur
• recurrent cases may require DMARDs or anti-TNF medications

sulfasalazine & methotrexate used in persistent disease