Reactive arthritis

Question 1

Define

Answer 1

Inflammation of joints/skin following a gastric or genitourinary infection 1-4 weeks previously

Question 2

Aetiology

Answer 2

Gastric or genitourinary infection

HLA-B27

Question 3

Epidemiology

Answer 3

Mainly in adults

More in males

Question 4

Symptoms

Answer 4

In joints/entheses:
Pain
Swelling
Redness
Warmth  
STIFFNESS IN MORNING

Question 5

What is the pattern of arthritis?

Answer 5

Asymmetrical oligoarthritis (2-4 joints affected) or axial arthritis

However, polyarticular and monoarticular arthritis can occur.

Question 6

Which bones are most commonly affected?

Answer 6

Large joints of lower extremities

Question 7

List some constitutional symptoms

Answer 7

Fever
Fatigue
Weight loss

Question 8

What is enthesitis and where does it commonly occur in ReA?

Answer 8

Inflammation of joint where tendon meets bone; plantar fasciitis

Question 9

List some other uncommon symptoms

Answer 9

Keratoderma blennorhagicum (skin rashes on palms and feet soles)
Circinate blantis (around glans of penis)
Mucous membrane involvement e.g. PAINLESS oral ulcers, urethritis, cystitis, prostatitis, sterile dysuria
Eye and cardiac manifestations (uveitis, conjunctivitis, aortitis)

Question 10

Investigations

Answer 10

Raised ESR and CRP
Negative ANA, RA
XR
Arthrocentesis to rule out gout

Urogenital/stool cultures

Question 11

Treatment

Answer 11

First line: NSAIDS
Second line: DMARDS

NOTE: Abx have not been proven to be effective

Question 12

Complications

Answer 12

Secondary osteoarthritis due to joint destruction
Keratoderma blennorhagicum
Uveitis

Question 13

Prognosis

Answer 13

30-50% will develop chronic reactive arthritis…

Question 14

What is the class triad of symptoms seen with Chlamydia-induced ReA?

Answer 14

Can’t see, can’t pee, can’t climb a tree

Conjunctivitis, oligoarthritis, urethritis