Reactive Arthritis
Title
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Reactive Arthritis (Reiter’s
Syndrome)
Definition
Reactive arthritis refers
to:
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Non-septic arthritis
That occurs after a:
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Genito-urinary or
gastrointestinal infection
Pathogenesis
Causes
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Genital infection:
Chlamydia trachomatis
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Dysenteric illness:
Shigella
Salmonella
Yersinia
Campylobacter
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Increased prevalence of HLA-B 27
Pathological Process
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Sterile synovitis
Clinical Features
History
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Symptoms begin 7-14 days after
sexual contact or dysentery
E&M
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Low-grade fever
LMS
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Pain and swelling of joints
Examination
IS
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Keratoderma blenorrhagica
CVS
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Aortitis
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Aortic regurgitation
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Conduction defects
GIT
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Small painless superficial
ulcers on oral mucosa, tongue
RAG
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Urethritis
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Balanitis
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Cervicitis
LMS
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Spondyloarthropathy
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Asymmetric oligo or
polyarthropathy:
Affecting large joints of the lower limbs and
toes
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Enthesopathy:
Plantar fasciitis
Achilles tendonitis
CNS
Eyes
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Conjunctivitis
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Uveitis
Investigations
Fluids
Blood
Haematology
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ESR:
Elevated
Imaging
X-ray
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Juxta-articular osteoporosis
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Periostitis
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Plantar spurs
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Sacroiliitis
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Changes of ankylosing
spondylitis
Management
Control
Drugs
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Genital infection with
Chlamydia:
Tetracycline, doxycycline
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NSAIDs
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Enthesopathy or oligoarthritis:
Local steroid
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Severe protracted illness:
Methotrexate, azathioprine
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Relapsing
disease:
Sulphasalazine
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Uveitis:
Steroid eye drops
Ophthalmological opinion
Prognosis
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80 % disease persists
