Reactive Arthritis

Original article by Tom Leach | Last updated on 2/6/2014
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Reiter’s Syndrome aka Reactive arthritis

This acute form of spondyloarthritis is associated with STI’s and acute diarrhoea. Usually occurs shortly after the initial infection, although it is still an autoimmune reaction.
 

Aetiology

  • Associated with STImost commonly chlamydiaand typically affects men aged 20-40.
  • Associated with GI infection:
    • Less common than STI involvement
    • Could be salmonella, shingella, Yersinia, or campylobacter
 

Presentation

  • Acute, asymmetrical, polyarthritis
  • The classic triad of:
    • Conjunctivitis – can’t see
    • Non specific urethritis – can’t pee
    • Acute arthritiscan’t bend the knee
  • May be an oligoarthritis
  • Tends to affect the large joints, particularly the ankle and knee. May sometimes involve the feet.
  • May sometimes involve:
    • Keratinous brown plaques on soles and palms
    • Mouth ulcers
    • Fever
    • Fatigue
    • Weight loss
    • Pustular vesicles (rare) – sometimes look like those seen in psoriasis
    • CNS involvement (rare)
    • Cardiovascular involvement (rare)
  • Can vary from a very mild arthritis, to a serious multi-systemic condition.
  • Presents 1-4 weeks after the initial infection
 

Pathology

Not fully understood. It is thought that there is probably some sort of joint infection, or infection related inflammation, but aspirate is always aseptic. Those with HLA-B27 have predisposition.
 

Diagnosis

  • High degree of clinical suspiscion:
    • STI / GI infection
    • Acute onset polyarthritis of lower limbs and feet
  • Bloods:
    • ↑ESR
    • ↑CRP
  • Consider:
    • Stool sample / culture
    • Test for chlamydial / other STI infection
 

Treatment

Treating the original infection (although useful!) will rarely affect the symptoms of arthritis
  • Rest / splint affected joints
    • Up to 50% will resolve within 4 months
  • Use NSAID’s and Steroid injections if necessary
    • These only provide symptomatic releif
  • In some cases, may be chronic. This can result in deformity. In some patients, it may also relapse and remit. In these individuals, consider:
    • Sulfasalazine
    • Methotrexate
 
Anterior uveitis – may be treated with steroid eye drops