Reactive Arthritis

Reactive Arthritis
Presentation by: Walter Eisenhauer MMS, PA-C

Reactive Arthritis

* Also known as Reiter’s syndrome
o Named after Hans Reiter, a German Physician in 1916
o Symptoms of Arthritis, Conjunctivitis, Non Gonococcal Urethritis following bouts of bloody dysentery
o > 75% HLA B27 positive
* Secondary immune reaction, in susceptible individuals, to primary infection:
o Yersinia
o Campylobacter
o Shigella
o Salmonella
o Chlamydia
* Classified as a seronegative spondyloarthropathy
* Occurs 2-4 weeks after inciting infection
* Most responsible organisms have an affinity for mucous membranes
* Terms Reactive Arthritis & Reiter’s Syndrome Synonamous
* First manifestation usually non gonococcal Urethritis
o occurs in both venereal and non venereal forms of the disease
o Mucopurulent discharge
o Dysuria
o Prostatitis
o Epididymitis
* Females
o Dysuria
o Vaginal discharge
o Purulent cervicitis
* Conjunctivitis
o follows urethritis by several days
o Sx often mild and transient
o acute anterior Uveitis possible
* Articular symptoms typically appear last
* additive
* oligoarticular
* lower limbs most common
* Keratoderma blennorrhagicum
* Circinate Balanitis

Glossitis/ Mucocutaneous Lesions
* Aortic Valve involvement 1-2% of cases
* Amyloidosis
* Neurologic complications
o peripheral neuropathies
o encephalopathy
o transverse myelitis

* Clinical course
o Normally limited course running 3-12 months
o 15% with prolonged relapsing arthritis
+ ? Relapse
+ ?Reinfection
o Ankylosing Spondylitis in 10% of cases
o Relation to HIV- probably due to increased risk of concurrent infection not HIV as initiator
* Laboratory findings
o Normochromic, normocytic anemia
o Leukocytosis
o Acute phase reactants:
+ ESR
+ C-reactive Protein
* HLA-B27 positive 75%
* Synovial fluid- highly inflammatory
* Sterile cultures- negative gram stain
* X-Ray reveals periostitis with eventual new bone growth
* Treatment:
Idiopathic Inflammatory Bowel Disease
Whipple’s Disease
Ankylosing Spondylitis
Ankylosing Spondylitis
Clinical Picture
Syndosmophytes
Patient Instructions

* No cure but can be well managed
* Education of patients =increased compliance
* Early diagnosis important
* NSAIDS Vocational support
* Exercise Screen first degree relatives
* Surgical measures
Treatment

Reactive Arthritis.ppt