Reactive Arthritis: Definition and Epidemiology
- First described in 1969 as “an arthritis which developed soon after or during an infection elsewhere in the body, but in which the microorganisms cannot be recovered from the joint”
- Period of several days to weeks between the infection and arthritis.
- Mono or oligoarticular pattern of the arthritis, often involving the lower extremities, and sometimes associated with dactylitis and enthesitis
- Seen in young adults, men and women
- In a US population-based study in Oregon and Minnesota, the incidence of reactive arthritis following documented enteric bacterial infections ranged from 0.6 to 3.1 cases per 100,000.
Posted 11/01/16 11:44:41 AM by Ying Liu
- Post-infectious arthritis, urethritis, and conjunctivitis “Can’t see, can’t pee, can’t climb a tree”
- Also oral lesions, cutenous erupations, and rarely cardiac complications
- Inflammatory Arthritis
- Elevated CRP/ESR
- Positive HLA B27 seen in 30 to 50 percent in patients with reactive arthritis
Posted 11/01/16 11:45:28 AM by Ying Liu
Posted 11/01/16 11:46:13 AM by Ying Liu
- Antibiotics for enteric or genitourinary infections but not useful for arthritis
- Naproxen 500 mg two to three times daily
- Diclofenac 50 mg three times daily
- Indomethacin 50 mg three to four times daily
- Systemic or Intra-Articular Glucocorticoids
- Refractory Arthritis or Chronic Arthritis (> 6 months) à DMARDs
Posted 11/01/16 11:47:02 AM by Ying Liu
HIV, HLA-B27 and Reactive Arthritis
- HLA-B27 is associated with chronic non-progressors of HIV infection
- HLA-B27 is also more common in Caucasian populations; less common in African populations
- Associated with a spectrum of diseases from reactive arthritis to IBD-associated and psoriatic arthritis to seronegative spondylarthropathies
Posted 11/01/16 11:48:51 AM by Ying Liu
A Word on Shigellosis:
- Fever, abdominal pain, and blood/mucousy diarrhea
- Low infectious dose à 10-100 organisms only needed to cause disease
- Associated with reactive arthritis and HUS
- Those with HIV at increased risk of complications
- High rates of resistance to ampicillin and Bactrim. Growing resistance to azithromycin, ceftriaxone and ciprofloxacin.
- First-line empiric therapy is with a fluoroquinolone
- Can use ceftriaxone if MDR organism suspected
- Duration of therapy is 3 days, 5-7 days in those with HIV
Posted 11/01/16 11:49:28 AM by Ying Liu
Created by Christopher Kelly
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