Thursday, 9 September 2010

MRCP revision battle 6.3: Reiters syndrome/Reactive Arthritis

Reactive arthritis is one of the spondyloarthropathies (alongside ankylosing spondylitis, psoriatic arthritis and enteropathic arthritis).  It is characterised by a sterile arthritis which usually affects the lower limb days to weeks following an infection.  It is associated with being HLA B27 positive.

Infections commonly associated with reactive arthritis fall into 2 groups:
  • GI infections 
    • campylobacter
    • salmonella
    • yersinia
    • shigella
  • GU infections
    • chlamydia
    • gonnorhora
    • ureaplasma

The classical triad associated with reactive arthritis is Reiters Syndrome of uveitis/conjunctivitis, urethritis and arthritis ("can't see, can't pee, can't climb a tree")  Apparently in some parts this is becoming a politically incorrect term as Dr Reiter was a member of the Nazi party with a less than perfect record by the 1940s...

Reactive arthritis can also be associated with keratoderma blenorrhagica, which is brown raised plaques on the hands and feet.  Rarely it can cause aortic incompetance.

Treatment is generally resting/splinting the affected joint and NSAIDS.

Now time for some diversification to the liquid world of the pleural effusion....