Reactive Arthritis

INTRODUCTION:
  • Reactive arthritis is a systemic disorder, defined by the development of conjunctivitis, urethritis, arthritis, and mucocutaneous lesions following an episode of infection elsewhere in the body.
  • Most common among young men(except after Yersinia infection)
  • Associated with HLA-B27
ETIOPATHOGENESIS:
  • Most common organism associated with reactive arthritis is chlamydia trachomatis.
  • HLA B 27 associated reactive arthritis, urethri­tis and conjunctivitis is associated with Ureaplasma urealyticum infection
  • Of the four Shigella species S. sonnei, S. boydii, S. flexneri, and S. dysenteriae, S. flexneri has most often been implicated. 
  • Other bacteria identified definitively as triggers of ReA include several Salmonella spp., Yersinia enterocolitica, pseudotuberculosis, Campylobacter jejuni, and Chlamydia trachomatis.
PATHOPHYSIOLOGY:
  • The etiology of reactive arthritis remains uncertain. The most accepted theory is, initial activation by a microbial antigen, followed by an autoimmune reaction that involves the skin, eyes, and joints. Human leukocyte antigen B27 (HLA-B27) haplotype is frequently associated.
PREVELANCE:
  • The prevalence of ractive arthritis is estimated to be 30-40 cases per 100,000 adults;
  • The annual, incidence is estimated to be 4.6/100,000 for Chlamydia-induced arthritis and 5/100,000for enterobacteria-induced reactive arthritis."
TYPES:
  • Two forms are recognized: a sexually transmitted form and a dysenteric form.
  • Gastrointestinal infections with Shigella, Salmonella, and Campylobacter species and other microorganisms.Young children tend to have the post dysenteric form.
  • Genitourinary infections especially with Chlamydia trachomatis have been found to trigger reactive arthritis.Adolescents and young men are most likely to acquire reactive arthritis after they have urethritis
. CLINICAL FEATURES:
TRIAD:
  1. The classic triad of the disease, namely
  2. Arthritis
  3. Urethritis
  4. Conjunctivitis
  • The arthritis is most commonly asymmetric & painful oligoarthritis and frequently involves the large weight-bearing joints (chiefly the knee and ankle & sacroilitis); Dactylitis, or "sausage digit," a diffuse swelling of a solitary finger or toe, is a distinctive feature of ReA. Enthisistis ,Tendinitis and fasciitis are particularly characteristic lesions.
  •  Systemic symptoms including fever and weight loss are common at the onset of disease. 
  • The mucocutaneous lesions may include balanitis, stomatitis, and keratoderma blennorrhagicum( consist of vesicles that become hyperkeratotic)ultimately forming a crust before disappearing. They are most common on the palms and soles, Lesions on the glans penis, termed circinate balanitis, are common, indistinguishable from pustular psoriasis. 
  •  Urogenital lesions: In males: urethritis may be marked or relatively asymptomatic. Prostatitis is also common. In Females: cervicitis or salpingitis
  •  Ocular: transient, asymptomatic conjunctivitis, anterior uveitis
  • Signs of the disease disappear within days or weeks, the arthritis may persist for several months or become chronic.
INVESTIGATIONS:
  • Sacroiliac as well as the peripheral joints may show progressive joint disease in radiograph.Synovial fluid from affected joints is culture-negative.
TREATMENT:
  • NSAIDs have been the mainstay of therapy. Antibiotics do not alleviate symptoms. Patients who do not respond to NSAIDs may respond to sulfasalazine, 1000 mg orally twice daily, or to methotrexate, 7.5–20 mg orally per week.
Exam Question
  • Keratoderma blennorrhagica is seen in reactive arthritis.
  • Most common organism associated with reactive arthritis is chlamydia trachomatis. 
  • HLA B 27 associated reactive arthritis, urethri­tis and conjunctivitis is associated with Ureaplasma S. dysenteriae, S. flexneri,chlamydia trachomatis,Ureaplasma urealyticum, Campylobacter jejuni, Salmonella enteritidis, and Yersinia.
  • Asymmetric & painful oligoarthritis is a feature of reactive arthritis
  • Reactive arthritis Most common among young men
  • Asymmetrical Enthisistis, sacroilitis,Dactylitis & anterior uveitis are associated with reactive arthritis
  • HLA B27 & HIV affects severity of reactive arthritis urealyticum infection
  • Reactive arthritis is a result of exposure to four Shigella species S. sonnei, S. boydii, S. flexneri, and

Don't Forget to Solve all the previous Year Question asked on Reactive Arthritis