Reactive arthritis

Reactive arthritis is non-infectious inflammation of the joints that develops in response to an infectious disease located outside the joint within a few days/weeks. We classify it among the group of spondyloarthritis, therefore also reactive arthritis has a common manifestations, which are typical for this group of diseases:


 * bond to positivity HLA-B27
 * more frequent eye damage (uveitis, conjunctivitis)
 * more frequent enthesitis
 * skin and mucose membrane damage (aphthae, erythema nodosum,...)
 * changes in the axial skeleton are only a late consequence
 * increased sedimentation and CRP

Etiology and Pathogensis
Genetic factors play a role (96 % pac. HLA-B27 pozitivních) + infections of the gastrointestinal tract: (salmonella, shigella, yersinie, Campylobacter jejuni), urogenital infection: (Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum) and infections of the respiratory system. Sometimes without a previous detectable infection.

General manifestations
Leakage, fatigue, temperature.

Musculoskeletal manifestations
thumb|300px|Keratoderma blenorrhagicum


 * Asymetric mono- / oligoartritis (max. 4 joints) with predilection localization of the supporting joints; affected joints reddish + warmer;
 * enthesopathy, which can lead to movement provision interfusion of the tendon insertion on a bone (tendon Achilli, plantar fascitis).

Skin manifestations
Keratoderma blenorrhagicum (peeling skin of the palms or soles similar psoriasis) a balanitis.

Syndroms in the UGT area
Sterile urethritis – Reiter's syndrom – (arthritis, urethritis, conjunctivitis aj.); Eye findings may progress to episcleritis, corneal ulceration and mainly anterior uveitis.

Diagnostics

 * Oligoarthritis of the supporting joints is affecting younger individuals following an underwent infection in the UGT/GIT.
 * lab examination:unspecified markers of inflammation in the acute phase are high( FW,CRP,mucoproteins,ELFO proteins), serology (detection of antibodies against certain mircoorganisms.), height of effusion (differetiation from septic arthritis);
 * RTG: often negative, sometimes in chronic phase, sacroileitis;
 * complete Reiter's syndrom: arthritis + urethritis + conjunctivitis (the complete triad is rather rare);
 * incomplete Reiter's syndrom: arthritis + another symptoms; there may also be enthesitis, skin and mucosal ulceration, periostitis.

Differential diagnostics

 * Arthritis uratica;
 * Rheumatoid arthritis;
 * Infectious purulent arthritis.

Therapy
Individual, basis NSA, for heavier forms glucocorticoids (initial dose 30–50 mg with a gradual decrease; for recurrent joint effusions intraarticulary); ATB (for isolating infection agents / sometimes also with positive serology); basal medicamentations (in chronic course with higher activity; sulfasalazin 2–3 g, MTX 10–20 mg/week).

Prognosis
Mostly good in a small part of patients the transition leads to chronicity. (imminent m. Bechtěrev).

Související články

 * Chlamydiové infekce genitálu
 * Psoriatická artritida
 * Ankylozující spondylartritida