Reactive arthritis: Difference between revisions

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==Background==
==Background==
*Historically also known as "Reiter syndrome"
*Seronegative spondyloarthropathy that manifests as an acute, asymmetric, oligoarthritis (LE>UE) that occurs 2-6 weeks after infection
*Patients often positive for HLA-B27
*Associated with bacterial infections
*Associated with bacterial infections
**Shigella, Salmonella, Campylobacter, Chlamydia, etc.
**[[Shigella]], [[Salmonella]], [[Campylobacter]], [[Chlamydia]], etc.
*Classic triad: [[urethritis]], [[conjunctivitis]], and [[arthritis]] ("Can't pee, can't see, can't climb a tree")


==Clinical Features==
==Clinical Features==
*Can't see, Can't pee, Can't climb a tree
*Preceding Infection
**(Classical triad in 1/3 of pts)
**[[Urethritis]]: generally caused by Chlamydia or Ureaplasma
**Conjunctivitis or uveitis
**Enteritis: generally caused by Salmonella or Shigella
**Nongonococcal urethritis
**Respiratory tract infections, both bacterial and viral (case reports have been written about COVID-19 associated reactive arthritis)
**Asymmetric oligoarthritis
**Preceding infection may be clinically silent
*Musculoskeletal symptoms
**[[Arthritis]]: oligoarthritis, usually in the lower extremities
**Enthesitis (pain at insertion sites)
**[[Dactylitis]] (sausage digits)
**[[Low back pain]]
*Extra-articular symptoms
**[[Conjunctivitis]] (less frequently [[uveitis]], [[keratitis]])
**GU symptoms
**Oral lesions
**Cutaneous and nail changes
*Keratoderma blennorrhagicum<ref>Wolff K, Johnson R, Saavedra AP. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw-Hill; 2013.</ref>
*Keratoderma blennorrhagicum<ref>Wolff K, Johnson R, Saavedra AP. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw-Hill; 2013.</ref>
**Develops in 15% of pts
**Develops in 15% of patients
**Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular [[psoriasis]]
**Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular [[psoriasis]]


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{{Differencial Diagnosis Migratory Arthritis}}
{{Differencial Diagnosis Migratory Arthritis}}
==Diagnosis==
 
==Evaluation==
*Clinical diagnosis
*Clinical diagnosis
*Must exclude [[Gonococcal septic arthritis|gonococcal arthritis]] and other mimics
*Must exclude [[Gonococcal arthritis|gonococcal arthritis]] and other mimics


==Management==
==Management==
*NSAIDs
*Treat inciting infection
*Antibiotics not needed for postdysentery form
*Symptomatic treatment of arthritis
*Consider doxycycline in chlamydia
**[[NSAIDs]] are first line ([[naproxen]], [[diclofenac]], [[indomethacin]])
**Intraarticular and systemic [[steroids]] for NSAID refractory


==Disposition==
==Disposition==
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<references/>
<references/>


[[Category:Rheum]]
[[Category:Rheumatology]]

Latest revision as of 00:31, 13 August 2021

Background

  • Historically also known as "Reiter syndrome"
  • Seronegative spondyloarthropathy that manifests as an acute, asymmetric, oligoarthritis (LE>UE) that occurs 2-6 weeks after infection
  • Patients often positive for HLA-B27
  • Associated with bacterial infections
  • Classic triad: urethritis, conjunctivitis, and arthritis ("Can't pee, can't see, can't climb a tree")

Clinical Features

  • Preceding Infection
    • Urethritis: generally caused by Chlamydia or Ureaplasma
    • Enteritis: generally caused by Salmonella or Shigella
    • Respiratory tract infections, both bacterial and viral (case reports have been written about COVID-19 associated reactive arthritis)
    • Preceding infection may be clinically silent
  • Musculoskeletal symptoms
  • Extra-articular symptoms
  • Keratoderma blennorrhagicum[1]
    • Develops in 15% of patients
    • Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular psoriasis

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

Oligoarthritis

Polyarthritis

Algorithm for Polyarticular arthralgia

Migratory Arthritis

Evaluation

Management

Disposition

  • Outpatient follow up, with DMARDs if refractory to NSAIDs
  • 70% self-limited disease

See Also

External Links

References

  1. ↑ Wolff K, Johnson R, Saavedra AP. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw-Hill; 2013.
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