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arthritis_reactive

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reactive arthritis (Reiter's syndrome)

introduction

  • reactive arthritis refers to an acute inflammatory aseptic arthritis complicating an infection elsewhere in the body.
  • 60-85% of patients are HLA-B27 positive
  • Reiter's syndrome was a term used to describe a subset of these patients who developed:
    • reactive arthritis
    • nonspecific urethritis
    • and conjunctivitis, often accompanied by iritis
  • the main bacteria implicated, and the two main sources of the precipitant infection:
    • enteric infections
      • Shigella flexneri
      • several Salmonella species
      • Yersinia enterocolitica
      • Campylobacter jejuni
      • Clostridium difficile
    • sexually transmitted infections
      • Chlamydia trachomatis
      • Chlamydia pneumoniae
      • Ureaplasma urealyticum

clinical features

  • usually begins with urethritis or diarrhoeal episode followed by conjunctivitis and then the reactive arthritis
  • arthritis begins within 1 month of infection in 80% of patients.
    • it is usually acute, asymmetric, and oligoarticular and predominantly involves the joints of the lower extremities (eg, knees, ankles, feet, wrists).
    • dactylitis or sausage digit is a diffuse swelling of a solitary finger or toe and is a distinct feature of both reactive arthritis and psoriatic arthritis.
    • plantar fasciitis and Achilles tendonitis also are common.
    • up to 70% develop sacroiliitis

Mx

Systemic corticosteroids should be avoided because they can aggravate the cutaneous manifestations of the disease.
arthritis_reactive.txt · Last modified: 2013/10/10 13:50 (external edit)