Reactive arthritis: Difference between revisions

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** Chlamydia trachomatis
** Chlamydia trachomatis


== Clinical Presentation ==
== Clinical Manifestations ==


* Classic triad of arthritis, urethritis, and conjunctivitis only seen in about a third of patients
* Classic triad of arthritis, urethritis, and conjunctivitis only seen in about a third of patients

Revision as of 22:56, 14 July 2020

Definition

  • A syndrome cause by specific infections in a genetically susceptible host that is characterized by conjunctivitis, urethritis, and seronegative arthritis

Associated Infections

  • Enteric infections
    • Shigella spp.
    • Salmonella spp.
    • Yersinia enterocolitica and Y. pseudotuberculosis
    • Campylobacter jejuni
  • Genitourinary infections
    • Chlamydia trachomatis

Clinical Manifestations

  • Classic triad of arthritis, urethritis, and conjunctivitis only seen in about a third of patients
  • Onset 1-4 weeks after infection
  • May present with constitutional symptoms (fever, malaise, weight loss)
  • Arthritis is usually peripheral and axial, symmetric and additive evolving over 1-2 weeks
  • Can have dactylitis, enthesistis, tendinitis, and fasciitis
  • Oral ulcers are common but often asymptomatic
  • Keratoderma blennorhagica, a palmoplantar pustular disease
  • Circinate balanitis, painless erosions from ruptured vesicles on the glans

Investigations

  • ESR/CRP and acute-phase reactants
  • CBC may show mild anemia
  • Synovial fluid non-specific inflammation
  • X-rays can show justaarticular osteoporosis
    • Later findings include marginal erosions, loss of joint space, periostitis, reactive born formation, and plantar spurs

Management

  • NSAIDs for symptom relief, though often not helpful
    • Indomethacin 75-150mg/d in divided doses

Prognosis

  • Symptoms typically resolve over 3-5 months
  • Can be chronic (about 15%)