Reactive arthritis

Question 1

What is the definition of ReA?

Answer 1

Sterile inflammatory synovitis occurring within 4 weeks of an infection elsewhere in the body (distant), primarily urogenital or enteric/GI infections

Question 2

What are the 2 types of infection that usually are followed by ReA?

Answer 2

Urogenital
Enteric/GI

Question 3

What term was ReA previously referred to as, when was this term discovered, and what were the classic clinical features?

Answer 3

Reiter’s syndrome

discovered in 1916

presents with classic triad of conjunctivitis, arthritis, nongonococcal (not caused by gonorrhoea) urethritis

Question 4

Why is the term Reiter’s syndrome no longer used?

Answer 4

Not referred to as Reiter’s syndrome anymore due to Hans Reiter’s participation in Nazi medical experimentation during WW2

Question 5

How many new cases of ReA develop per year?

Answer 5

30-40/100000 cases per year

Question 6

What is the ratio of men to women affected by ReA?

Answer 6

1:1

Question 7

What age range has the highest prevalence of ReA overall, and how can this different types of ReA affect prevalence in this age range?

Answer 7

Overall most prevalent in young adults aged 20-40

Higher risk for women of enteric/GI form

Higher risk for men of urogenital form

Question 8

What percentage of individuals with ReA are HLA-B27 positive, and does this affect the extent of ReA?

Answer 8

65-96% are HLA B27 positive cases, tend to be more chronic and severe

Question 9

Is the infection that is followed by sterile joint inflammation distant or localised, in ReA?

Answer 9

Distant infection initially occurs then is followed by sterile joint inflammation

Question 10

Give 2 ways in which an individual can get an urogenital infection, and give 2 common examples of urogenital infections that can lead to ReA?

Answer 10

Occurs after sexual exposure/STI or UTl

chlamydia, neisseria causes gonorrhoea

Question 11

Give 4 examples of enteric/GI infections that can lead to ReA?

Answer 11

Salmonella (raw/undercooked meat, poultry, eggs)

Shigella (type of food poisoning) causes shigellosis

Yersinia (in raw/undercooked pork) causes yersiniosis

Campylobacter (in raw/undercooked poultry) causes campylobacteriosis

Question 12

What are the 3 most common situations in which an individual can get an infection that leads to ReA?

Answer 12

After sexual exposure to STI

UTI

Food poisoning

Question 13

Other than urogenital and GI infections, give 4 examples of infections that can lead to ReA?

Answer 13

Streptococcal sore throat

meningococci

borrelia

viral infection

Question 14

Are the hallmarks for Reiter’s syndrome the same as the hallmarks for ReA?

Answer 14

Hallmarks of Reiter’s syndrome are acute onset of complete triad of arthritis, conjunctivitis, urethritis, but in ReA most patients don’t have complete classic triad

Question 15

What is usually the initial clinical feature that presents in ReA?

Answer 15

Urethritis

Question 16

After initial infection, when does urethritis occur and what are the 2 common presenting features?

Answer 16

Begins up to 1 week after infection

Presents as dysuria, pyuria (high WBC count/pus in urine)

Question 17

After initial infection, when does conjunctivitis occur and what are the 4 common presenting features?

Answer 17

Develops weeks after infection

Presents as red, watery, sticky eyes and discharge from eyes

Question 18

After initial infection, when does arthritis occur, and describe the arthritis in terms of symmetry and number of joints involved?

Answer 18

Typically asymmetrical oligoarthritis in lower limbs

Question 19

Apart from joint inflammation, what other structure can become inflamed in ReA?

Answer 19

Enthesitis occurs due to inflammation of entheses

Question 20

Is there spine involvement in ReA?

Answer 20

Inflammation and arthritis in lumbosacral area (lower back) and sacroiliac joints

Question 21

What 2 conditions can occur in feet due to inflammation, in ReA?

Answer 21

Plantar fasciitis

Achilles tendonitis

Question 22

Describe the 2 characteristic skin lesions of ReA, and what form are these predominantly associated with?

Answer 22

Circinate balanitis: pink-red ulcers (often painless) on the prepuce and glans penis

Keratoderma blennorrhagia: waxy yellow–brown skin lesions, particularly affecting the palms and soles

Associated with urogenital form

Question 23

What clinical feature of ReA involves the mouth, and how does it commonly present?

Answer 23

Buccal erosion, presents as mouth ulcers

Question 24

How does the nail dystrophy (abnormal changes) in ReA compare to in PsA?

Answer 24

Identical in both conditions

nail pitting, cracking, onycholysis, accompanying nail disease

Question 25

Give 4 examples of common systemic features of ReA?

Answer 25

Malaise Weight loss Fever Fatigue

Question 26

Give 2 examples of GI symptoms of ReA?

Answer 26

Diarrhoea Abdominal pain

Question 27

In lab investigations of ReA, which 3 inflammatory markers are seronegative, and which 2 markers are elevated?

Answer 27

Seronegative RF, ANA, Anti-Citrullinated Peptide Antibody (ACPA) Elevated ESR and CRP

Question 28

In lab investigations of ReA, what 2 conditions can be ruled out by aspirating affecting joints and testing a culture?

Answer 28

Septic arthritis Crystal arthritis

Question 29

Why is a high vaginal swab performed on individuals with ReA or suspected ReA?

Answer 29

High vaginal swab can test for presence of chlamydia, which indicates urogenital infection

Question 30

What 4 lab investigations can be done to identify signs of bacterial infection that has led to ReA?

Answer 30

Gram staining, polarised light microscopy, PCR, culture

Question 31

Give 6 examples of where a culture can be obtained from to test for bacterial infection, in ReA?

Answer 31

Stool, urethral, cervical, throat, blood, urine (urinalysis)

Question 32

How does radiographic sacroiliitis appear on X-ray in ReA?

Answer 32

asymmetrical and unilateral

Question 33

Are bone erosions seen on X-ray if the ReA is acute or chronic?

Answer 33

Chronic ReA, as erosions occur in recurrent disease activity

Question 34

What 3 radiological features of ReA can be seen on X-ray?

Answer 34

soft tissue swelling, joint space narrowing and erosions

Question 35

In acute ReA, what 3 management modalities can be given to provide symptomatic relief?

Answer 35

Rest, analgesics and NSAIDs

Question 36

If ReA causes severe synovitis, what type of injection can be given?

Answer 36

Intra-articular corticosteroid injections

Question 37

What are the 2 ways of treating nonspecific chlamydial urethritis?

Answer 37

short course of doxycycline or single dose of azithromycin

Question 38

What 2 clinical features of ReA can occasionally require use of DMARDs?

Answer 38

Severe, progressive arthritis and keratoderma blennorrhagica

Question 39

Why does anterior uveitis need urgent referral, and how is it treated in ReA?

Answer 39

Anterior uveitis is a medical emergency that needs urgent referral Requires topical or systemic glucocorticoids.

Question 40

What guides how skin conditions caused by ReA are treated?

Answer 40

Treated as psoriasis