RHEUMATOLOGY

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Reactive Arthritis
Reiter's disease is the classical triad:1. Non specific urethritis.
2. Conjuctivitis.
3. Periphral arthritis, after 1-3/52 of Genitourinary or Gastrointestinal
Tracts infection.
Cases reported following outbreak (epidemic or sporadic) of diarrhoeal
illness caused by Shigella, Salmonella and Campylobacter microorganisms as well as by venerably acquired genitourinary infections,
usually Chlamydia.
Reactive Arthritis is a disease of young men, with male to female
ratio of (15:1).
20% of HLA-B27 positive men will develop Reactive Arthritis if
they are exposed to an epidemic of Shigella dysentery.

Clinical Features of Reactive Arthritis:

Reactive Arthritis characteristically involves the lower limbs,
asymmetrical oligoarthritis, the pattern may be additive.
Hip disease is uncommon.
Exclusively upper extremities involvement is extremely rare.
Dactylitis pattern in the feet uncommon.
Arthritis is sterile synovitis.
Enthesitis is a characteristic of Reactive Arthritis, Achilles'
Tendonitis and Plantar Fasciitis are most common sites of
involvement, but pain in the iliac crest and Ischial Tuberosities is
also detected.
Low back pain and buttock pain reflecting Saccroiliac Jt.
Inflammation, which occurs in up to 50%, but progression to AS is
uncommon and later event, is strongly associated with HLA-B27.

Extra-articular Features of Reactive Arthritis:

Extra-articular features can be helpful in establishing the diagnosis
particularly in circumstances when it is difficult to identify a triggering
infection.
Keratoderma blenorrhagicum (15%).is papulosequamous rash
most commonly affecting the palms and soles. The lesions can be
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indistinguishable clinically and histopathologically from pustular

psoriasis.
Nail Dystrophy can occur with ReA (Reactive Arthritis), further
high lightening the clinical overlap of some features with Psoriatic
Arthritis.
Circinate Balanitis, it occurs in (20-50%) of patients and usually
painless.
Buccal Erosions it occurs in (10%) and usually painless red
patches.
Oral Ulcers on the hard palate or tongue, typically painless.
Dysuria and Pyuria present clinical features of urethritis.
Acute Anterior Uveitis occurs in 20% of ReA.

Prognosis:
The first attacking arthritis is self limiting with spontaneous remission
within 2-4/12 of onset, represent (60%) of patients.
15% of patients of ReA relapse.
15% of patients of ReA continue to chronic state.
10% of patients develop Ankylosing Spondylosis.
Mortality in ReA results from cardiac complication Amyloidosis.

Uncommon Complications:

Aortic Incompetence.
Conductive Defect.
Pleuro-pericarditis
Periphral Neuropathy.
Seizures.

Investigations:
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ESR and CRP are raised.

RF and ANA are negative.
Normochromic normocytic anaemia.
Sterile and inflammatory synovitis.
Stool culture.
Urine culture.
Urethral culture.
High vaginal swab.
Radiological, the most important findings are:
Fluffy calcaneal spur.
Asymmetrical and unilateral sacroiliac joint
involvement.

Treatment:

NSAIDS.
Local, intra-articular, steroid injection.
Topical and systemic steroids for Anterior Uveitis.
ReA after 4/52 of treatment without improvement, persistent
synovitis, Sulfasalazine and Mehtotrexate are used.
Antibiotics for infections.