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Updated: Nov 1 2018

Reactive Arthritis

Images
https://upload.medbullets.com/topic/107049/images/soa-arthritis.jpg
https://upload.medbullets.com/topic/107049/images/feet-reiters_syndrome.jpg
  • Snapshot
    • A 22-year-old man presents to his primary care physician's office due to pain in his knee, dysuria, and eye discomfort and discharge. Medical history is significant for a sexually transmitted infection due to Chlamydia approximately 1 month ago. On physical exam, there is conjunctivitis, left-knee swelling and tenderness, and urethral discharge.
  • Introduction
    • Clinical definition
      • a systemic inflammatory disorder that results from following an extra-articular infection (e.g., sexually transmitted infection and gastroenteritis)
        • typically results after 1-6 weeks after the infection
        • formerly known as Reiter syndrome
        • classic triad is
          • urethritis
          • conjunctivitis
          • arthritis
    • Epidemiology
      • demographics
        • age
          • 20-40 years of age
        • sex
          • following a genitourinary infection, it is more common to develop reactive arthritis in men
          • affects men and women equally a gastrointestinal infection
      • risk factors
        • HLA-B27 positivity
    • Etiology
      • genitourinary pathogens
        • Chlamydia trachomatis
      • gastrointestinal pathogens
        • Salmonella enteritidis and typhimurium
        • Shigella
        • Yersinia
        • Campylobacter
    • Pathogenesis
      • unclear
    • Prognosis
      • most cases spontaneously recover
  • Presentation
    • Symptoms
      • asymmetric joint pain
        • e.g., knee, ankle, and heel
      • eye discomfort
        • in cases of conjunctivitis
    • Physical exam
      • conjunctivitis
      • arthritis
        • typically an acute and asymmetric oligoarthritis
      • genital involvement
        • circinate balanitis
        • urethritis
        • cervicitis
      • keratoderma blennorrhagicum
  • Studies
    • Labs
      • complete blood count
        • may demonstrate
          • neutrophillic leukocytosis
      • ↑ C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
    • Diagnostic criteria
      • a clinical diagnosis
  • Differential
    • Ankylosing spondylitis
    • Enteropathic arthritis
    • Septic arthritis
    • Gonococcal arthritis
    • Gout
    • Pseudogout
    • Rheumatoid arthritis
  • Treatment
    • Medical
      • nonsteroidal antiinflammatory drugs (NSAIDs)
        • indication
          • drug of choice for acute phase of reactive arthritis
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