Updated: 11/1/2018

Reactive Arthritis

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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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