Reactive arthritis

Background

• Associated with bacterial infections
  • Shigella, Salmonella, Campylobacter, Chlamydia, etc.

Clinical Features

Can't see, Can't pee, Can't climb a tree (Classical triad in 1/3 of pts)

• Conjunctivitis or uveitis
• Nongonococcal urethritis
• Asymmetric oligoarthritis

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

• Acute osteoarthritis
• Avascular necrosis
• Crystal-induced (Gout, Pseudogout)
• Gonococcal arthritis, arthritis-dermatitis syndrome
• Nongonococcal septic arthritis
• Lyme disease
• Malignancy (metastases, osteochondroma, osteoid osteoma)
• Reactive poststreptococcal arthritis
• Trauma-induced arthritis
  • Fracture
  • Ligamentous injury
  • Overuse
• Avascular necrosis
• Decompression sickness
• Spontaneous osteonecrosis
• Hemorrhagic (e.g. hemophilia, systemic anticoagulation
• Seronegative spondyloarthropathies (ankylosing spondylitis, IBD, psoriatic arthritis, reactive arthritis
• RA, SLE
• Sarcoidosis, amyloidosis
• Periarticular pathology
  • Cellulitis
  • Tendonitis
  • Bursitis
• Transient (Toxic) Synovitis (Hip)
• Slipped Capital Femoral Epiphysis (SCFE)
• Legg Calve Perthes Disease

Oligoarthritis

• Ankylosing spondylitis
• Gonococcal arthritis
• Lyme disease
• Psoriatic arthritis
• Reactive arthritis
• Rheumatic fever
• Rheumatoid arthritis
• Systemic lupus erythematosus

Polyarthritis

Algorithm for Polyarticular arthralgia

• Fibromyalgia
• Juvenile idiopathic arthritis
• Lyme disease
• Osteoarthritis
• Psoriatic arthritis
• Reactive poststreptococcal arthritis
• Rheumatoid arthritis
• Rheumatic fever
• Serum sickness
• Systemic lupus erythematosus
• Serum sickness–like reactions
• Viral arthritis

Migratory Arthritis

• Gonococcal arthritis
• Lyme disease
• Rheumatic fever
• Systemic lupus erythematosus
• Viral arthritis

Diagnosis

• Clinical diagnosis
• Must exclude gonococcal arthritis and other systemic disease manifestations

Management

• NSAIDs mainstay of treatment
• Typically does not need antibiotics for postdysentery form
• However, consider doxycycline in chlamydia-related to improve arthritis symptoms faster

Disposition

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

See Also

Ankylosing spondylitis

Gonococcal arthritis

References

• Lozada CJ et al. Reactive Arthritis. Oct 31 2015. http://emedicine.medscape.com/article/331347-overview#showall.