Reactive arthritis

Question 1

What is reactive arthritis?

Answer 1

A sterile arthritis following a remote infection

Question 2

What are the most common causative organisms?

Answer 2

GU
- chlamydia

GIT

• Shigella
• Salmonella
• Campylobacter
• Yersinia

Other
- E coli

Question 3

How long between infection and arthritis

Answer 3

1-4 weeks

Question 4

What is hte pattern of the arthritis?

Answer 4

Asymmetric, oligoarticular and lower limb
Enthesitis
Dactylitis
Sacro-iliitis

Question 5

What is the triad of Reiter’s syndrome?

Answer 5

Arthritis
Urethritis
Conjunctivitis

Question 6

What are some extra-articular manifestations

Answer 6

Skin - balanitis, mouth ulcers
Ocular - conjunctivitis
GU - Prostatitis, urethritis, cervicitis
Constitutional symptoms

Question 7

How do you investigate?

Answer 7

Inflam markers
Identify preceding infection - urinary PCR
HLA-B27
Synovial fluid analysis

Question 8

How do you treat?

Answer 8

Rx precipitating infection
NSAIDs
Intra-articular steroid
Systemic glucocortiocoid if unwell

DMARD if chronic disease

Question 9

What is the natural history?

Answer 9

Median disease duration 3-5 months

~15-20% persist for >12months