| Monoarticular arthritis
| Polyarticular arthritis
Reactive arthritis is an infection-induced systemic illness characterized by inflammatory synovitis from which no viable microorganisms can be cultured.
- Seronegative Spondyloarthritis (Rheumatoid factor negative)
- Reiter's syndrome is a sterile reactive synovitis
- Following STD or Genitourinary infection or dysentery
- Joint aspirate is sterile and microorganism cannot be found
- Usually have additional extra articular features
- Gastrointestinal: Salmonella, Yersinia, Campylobacter, Shigella
- STD: Chlamydia trachomatis or Ureaplasma urealyticum
- Usually post-infectious cross-reaction to an antigen in the pathogen
- Causes features seen in some of the spondyloarthropathies
- Seen several weeks after the infection
- Genetically susceptible individual
- Asymmetrical inflammatory oligoarthritis or monoarthritis predominantly affecting the lower limbs with the involvement of knees, feet, toes, hips and ankles.
- MTP joint synovitis, sausage toe Dactylitis, Achilles tendonitis, Plantar fasciitis
- Conjunctivitis, Anterior Uveitis (Like Ankylosing spondylitis)
- Oral ulcers, Circinate balanitis
- Keratoderma Blennorrhagicum - red scaly rash soles of feet with pustules
- Nail dystrophy (psoriasis), Erythema nodosum (inflammatory bowel disease)
- Aortitis (Ankylosing spondylitis) and conduction defects
- Actually well quoted and often asked about but clinically not very useful
- Arthritis, Conjunctivitis, Urethritis/Cervicitis
- Historically came to note in WW1 soldiers with venereal diseases or dysentery
- Elevated CRP or ESR or WCC non specific
- Aspirated synovial fluid is sterile, with a high neutrophil count.
- Stool cultures may identify a triggering pathogen e.g. salmonella, campylobacter, Shigella, Yersinia
- Screening for Chlamydia trachomatis and Gonorrhoea referral to GUM
- Rheumatoid factor usually negative
- Bed rest plus NSAID inadequate dose +/- intra-articular steroid.
- Treat associated/triggering infection. If active arthritis persists consult a Rheumatologist.
- NSAIDs are the main treatment with analgesic and anti-inflammatory properties
- Sulfasalazine may be useful
- Intra articular steroid injections may be tried
- Anti TNF agents have been tried in those non-responsive to other therapies
- Antibiotic therapies for active chlamydia infection