Reactive Arthritis - PowerPoint PPT Presentation

1 / 32
About This Presentation
Title:

Reactive Arthritis

Description:

Salmonella. Chlamydia. Reactive Arthritis. Classified as a seronegative spondyloarthropathy. Occurs 2-4 weeks after inciting infection ... – PowerPoint PPT presentation

Number of Views:3064
Avg rating:3.0/5.0
Slides: 33
Provided by: walterei
Category:

less

Transcript and Presenter's Notes

Title: Reactive Arthritis


1
Reactive Arthritis
  • Walter Eisenhauer MMS, PA-C

2
Reactive Arthritis
  • Also known as Reiters syndrome
  • Named after Hans Reiter, a German Physician in
    1916
  • Symptoms of Arthritis, Conjunctivitis, Non
    Gonococcal Urethritis following bouts of bloody
    dysentery
  • gt 75 HLA B27 positive

3
Reactive Arthritis
  • Secondary immune reaction, in susceptible
    individuals, to primary infection
  • Yersinia
  • Campylobacter
  • Shigella
  • Salmonella
  • Chlamydia

4
Reactive Arthritis
  • Classified as a seronegative spondyloarthropathy
  • Occurs 2-4 weeks after inciting infection
  • Most responsible organisms have an affinity for
    mucous membranes
  • Terms Reactive Arthritis Reiters Syndrome
    Synonamous

5
Reactive Arthritis
  • First manifestation usually non gonococcal
    Urethritis
  • occurs in both venereal and non venereal forms of
    the disease
  • Mucopurulent discharge
  • Dysuria
  • Prostatitis
  • Epididymitis

6
Reactive Arthritis
  • Females
  • Dysuria
  • Vaginal discharge
  • Purulent cervicitis

7
Reactive Arthritis
  • Conjunctivitis
  • follows urethritis by several days
  • Sx often mild and transient
  • acute anterior Uveitis possible

8
Reactive Arthritis
  • Articular symptoms typically appear last
  • additive
  • oligoarticular
  • lower limbs most common

9
Reactive Arthritis
  • Keratoderma blennorrhagicum

10
Reactive Arthritis
  • Circinate Balanitis

11
Glossitis/ Mucocutaneous Lesions
12
Reactive Arthritis
  • Aortic Valve involvement 1-2 of cases
  • Amyloidosis
  • Neurologic complications
  • peripheral neuropathies
  • encephalopathy
  • transverse myelitis

13
Reactive Arthritis
  • Clinical course
  • Normally limited course running 3-12 months
  • 15 with prolonged relapsing arthritis
  • ? Relapse
  • ?Reinfection
  • Ankylosing Spondylitis in 10 of cases
  • Relation to HIV- probably due to increased risk
    of concurrent infection not HIV as initiator

14
Reactive Arthritis
  • Laboratory findings
  • Normochromic, normocytic anemia
  • Leukocytosis
  • Acute phase reactants
  • ESR
  • C-reactive Protein

15
Reactive Arthritis
  • HLA-B27 positive 75
  • Synovial fluid- highly inflammatory
  • Sterile cultures- negative gram stain
  • X-Ray reveals periostitis with eventual new bone
    growth

16
Reactive Arthritis
  • Treatment
  • NS AIDS
  • Phenylbutazone
  • Methotrexate
  • Intralesional glucocorticoids
  • Uveitis-glucocorticoids

17
Idiopathic Inflammatory Bowel Disease
  • 10-20 of all patients with Crohns disease or
    Ulcerative Colitis have peripheral arthritis
  • Migratory arthralgias
  • Additive arthritis
  • Predominately lower extremities
  • HLA-B27 not implicated here

18
Idiopathic Inflammatory Bowel Disease
  • 10 of Patients with UC/Crohns develop spinal
    arthritis
  • Anemia common in IBD
  • Acute phase reactants

19
Whipples Disease
  • Multisystem disease usually affecting Men
    characterized by
  • Fever diarrhea steatorrhea profound weight
    loss arthritis (spondylitis)
  • Serositis (pleural effusions) lymphadenopathy,
    cutaneous hypopigmentation, uveitis
  • Tropheryma whippelii

20
Ankylosing Spondylitis
  • Chronic, systemic inflammatory disorder of the
    axial skeleton
  • Sacroiliitis is hallmark of the disease
  • Angkylos-bent (Greek)
  • Spondylous-spine
  • Strong genetic predisposition
  • HLA-B27

21
Ankylosing Spondylitis
  • Inflammation originates in ligamentous and
    capsular sites of attachment to bones
    (enesthitis)
  • Inflammatory process results in gradual fibrosis
    and bony ankylosis

22
Ankylosing Spondylitis
  • Clinical Features
  • Begins in late adolescence or early adulthood
  • MaleFemale 31
  • Divided into skeletal and extraskeletal
    manifestations
  • Primary-no evidence of Reiters, Psoriasis, IBD,
  • Secondary-evidence of above

23
Ankylosing Spondylitis
  • Back pain insidious in onset
  • first clinical manifestation in 75

24
Ankylosing Spondylitis
  • Pain early is quite severe and aggravated by
    coughing, sneezing or sudden twisting
  • Felt deep in gluteal region and hard to localize
  • Sx worsen after prolonged periods of inactivity

25
Ankylosing Spondylitis
  • Enthesitis can result in tenderness
  • Achilles insertion
  • Costochondral junctions
  • Ischial tuberosities
  • Extra skeletal manifestations includeIritis
  • Cardiac abnormalities

26
Ankylosing Spondylitis
  • Pulmonary apical fibrosis
  • Cauda equina syndrome
  • Amyloidosis

27
Clinical Picture
28
Syndosmophytes
29
Syndosmophytes
30
Ankylosing Spondylitis
  • Lab
  • HLA B-27 in majority of patients
  • Acute phase reactants
  • Mild increase Alk Phos
  • Mild anemia

31
Patient Instructions
  • No cure but can be well managed
  • Education of patients increased compliance
  • Early diagnosis important
  • NSAIDS Vocational support
  • Exercise Screen first degree relatives
  • Surgical measures

32
Treatment
  • First Line
  • NSAIDs
  • Second Line
  • Sulfasalazine
  • Methotrexate
  • ?? Antibiotics
Write a Comment
User Comments (0)
About PowerShow.com