Reactive arthritis

• Reactive arthritis involves synovitis in one or more joints in response to an infective trigger. It is not an infection within the joint like in septic arthritis.
• Typically causes acute mono-arthritis, affecting a single joint

  presents as a warm, swollen and painful joint
• Need to exclude septic arthritis in patients presenting with a monoarticular arthritis
• The most common triggers of reactive arthritis are gastroenteritis or sexually transmitted infections.
• Chlamydia may cause reactive arthritis. Gonorrhoea typically causes septic arthritis rather than reactive arthritis.
• Reactive arthritis is a seronegative spondyloarthropathy - There is a link with the HLA B27 gene (autoimmune diseases)
• Reactive arthritis is more common in patients with HIV - needs to be excluded
• Associations "cant see, cant pee, cant climb a tree"

  • Bilateral conjunctivitis (non infective)
  • Anterior uveitis
  • Urethritis (non-gonococcal)
  • Circinate balanitis (dermatitis of head of the penis)
• Joint aspiration is required. Synovial fluid is sent for microscopy, culture and sensitivity testing for infection, and crystal examination for gout and pseudogout.
• Management of reactive arthritis (after septic arthritis is excluded) involves:

  • Treatment of the triggering infection (e.g., chlamydia) 
  • NSAIDs
  • Steroid injection into the affected joints
  • Systemic steroids may be required, particularly where multiple joints are affected
• Most cases resolve within 6 months