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Clinical lectures > Reactive arthritis > Flashcards

Reactive arthritis Flashcards

1
Q

What is the definition of ReA?

A

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

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2
Q

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

A

Urogenital
Enteric/GI

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3
Q

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

A

Reiter’s syndrome

discovered in 1916

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

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4
Q

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

A

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

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5
Q

How many new cases of ReA develop per year?

A

30-40/100000 cases per year

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6
Q

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

A

1:1

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7
Q

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

A

Overall most prevalent in young adults aged 20-40

Higher risk for women of enteric/GI form

Higher risk for men of urogenital form

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8
Q

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

A

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

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9
Q

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

A

Distant infection initially occurs then is followed by sterile joint inflammation

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10
Q

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?

A

Occurs after sexual exposure/STI or UTl

chlamydia, neisseria causes gonorrhoea

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11
Q

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

A

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

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12
Q

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

A

After sexual exposure to STI

UTI

Food poisoning

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13
Q

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

A

Streptococcal sore throat

meningococci

borrelia

viral infection

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14
Q

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

A

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

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15
Q

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

A

Urethritis

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16
Q

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

A

Begins up to 1 week after infection

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

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17
Q

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

A

Develops weeks after infection

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

18
Q

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

A

Typically asymmetrical oligoarthritis in lower limbs

19
Q

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

A

Enthesitis occurs due to inflammation of entheses

20
Q

Is there spine involvement in ReA?

A

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

21
Q

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

A

Plantar fasciitis

Achilles tendonitis

22
Q

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

A

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

23
Q

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

A

Buccal erosion, presents as mouth ulcers

24
Q

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

A

Identical in both conditions

nail pitting, cracking, onycholysis, accompanying nail disease

25
Q

Give 4 examples of common systemic features of ReA?

A

Malaise
Weight loss
Fever
Fatigue

26
Q

Give 2 examples of GI symptoms of ReA?

A

Diarrhoea

Abdominal pain

27
Q

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

A

Seronegative RF, ANA, Anti-Citrullinated Peptide Antibody (ACPA)

Elevated ESR and CRP

28
Q

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

A

Septic arthritis

Crystal arthritis

29
Q

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

A

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

30
Q

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

A

Gram staining, polarised light microscopy, PCR, culture

31
Q

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

A

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

32
Q

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

A

asymmetrical and unilateral

33
Q

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

A

Chronic ReA, as erosions occur in recurrent disease activity

34
Q

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

A

soft tissue swelling, joint space narrowing and erosions

35
Q

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

A

Rest, analgesics and NSAIDs

36
Q

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

A

Intra-articular corticosteroid injections

37
Q

What are the 2 ways of treating nonspecific chlamydial urethritis?

A

short course of doxycycline or single dose of azithromycin

38
Q

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

A

Severe, progressive arthritis and keratoderma blennorrhagica

39
Q

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

A

Anterior uveitis is a medical emergency that needs urgent referral

Requires topical or systemic glucocorticoids.

40
Q

What guides how skin conditions caused by ReA are treated?

A

Treated as psoriasis

Clinical lectures (29 decks)

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