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Reactive arthritis and Reiter's syndrome (Pathophysiology (Defect …
Reactive arthritis
and Reiter's syndrome
Definition
Reactive arthritis
Sterile inflammatory arthritis
developing a few weeks after infection
Reiter's syndrome
Triad of arthritis, uveitis and conjunctivitis,
usually associated with bacterial STI
Epidemiology
Reactive arthritis common in children
Reiter's syndrome common in
young adults
Pathophysiology
Defect
Recent infection (GIT, GUT) and Abs
to infectious agent develop over subsequent weeks
Mechanism
Cross reaction of Abs or bacterial antigens in joint
causes joint inflammation (synovitis)
No bacterial infiltration of the joint (sterile)
Agents
GIT: salmonella, shigella, campylobacter
GUT: chlamydia, gonorrhoea
Clinical
presentation
Reiter's syndrome
Joint pain
Red, itchy eyes
Genital lesions
Reactive arthritis
Joint pain mono/oligoarthritis
Fever
Malaise
Diagnosis
Examination
Musculoskeletal exam
Hip/knee/ankle/foot pain, may be swollen/tender,
generally not erythematous
Genital exam
Urethritis, balanitis, vulvovaginitis
Any discharge
History
PMH
Growth and development
Vaccinations
Known medical conditions
DH
Meds, allergies
FH
Orthopedic disorders, cancers
PC/HPC
Insidious/acute onset lower limb mono/oligoarthritis,
recent GI/GU infection, any ocular or genital symptoms
Systemic fever, malaise, fatigue
SH
Living arrangements, school/occupation,
smoking, alcohol, drugs, sexual history
Investigations
Bedside
Obs (fever)
Bloods
FBC (infection), CRP (raised),
U+E, LFTs, blood cultures (if ?sepsis)
Autoimmune screen: RF, CCP (-ve)
STI screen (HBV, HCV, syphilis, HIV)
Joint aspiration
MCS (sterile; r/o septic arthritis)
Swabs
Genital (CT/NG)
Imaging
X-ray joint: often nil
Management
Conservative
Information, advice, support
Self help (rest, fluids)
Splinting of joint
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs
Abx
Indication: continuing GIT/GU disease
E.g. doxycycline for NG
Steroids
Indication: severe pain
E.g. IA dexamethasone