Reactive Arthritis
Print Friendly, PDF & Email

almostadoctor app banner for android and iOSalmostadoctor iPhone, iPad and android appsalmostadoctor iOS appalmostadoctor android app

Introduction

Reactive arthritis is an acute form of spondyloarthritis associated with STI’s and acute diarrhoea. Usually occurs shortly after the initial infection, although the reactive arthritis itself is an autoimmune reaction.

Aetiology

  • Associated with STI – most 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 arthritis – can’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

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

Read more about our sources

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply