6- REACTIVE ARTHRITIS

• Sterile synovitis


  Persistent bacterial antigen in inflamed synovium
• Occurs following


  1. GI infection: shigella, salmonella, yersinia, campylobacter

  2. STD: chlamydia, trachomatis, ureaplasma, urealyticum (nonspecific urethritis, cervicitis)
• Presentation


  • Young man, acute arthritis within 4 weeks after mild or asymptomatic GI/sexual infection, lower limbs affected asymmetrically (knees, ankles, feet)
  • Circinate balanitis (superficial ulcers around penile meatus)
  • Keratoderma blennorrhagia: red plaques & pustules resembling psoriasis on palms & soles of feet
  • Nail dystrophy
  • Enthesitis à Plantar fasciitis & Achilles tendonitis, acute anterior uveitis
• Reiter's syndrome


  Conjunctivitis, urethritis, reactive arthritis
• Mnemonic: can't see, can't pee, can't climb a tree
• Diagnosis is clinical
• Treatment


  1. NSAIDs, local corticosteroid injections, treatment of underlying cause

  2. If not controlled by NSAIDs à sulfasalazine (DMARD)