Reactive arthritis (ReA): Articular manifestations ReA-Iraj Salehi-Abari Reactive arthritis (ReA): Articular manifestations Iraj Salehi-Abari MD., Internist Rheumatologist Salehiabari@sina.tums.ac.ir

Reactive arthritis (ReA): ReA-Iraj Salehi-Abari Reactive arthritis (ReA): . Introduction: . During World War II . Reiter’s syndrome: with triad of . Arthritis . Urethritis . Conjunctivitis . Reactive arthritis: A member of SpA

ReA-Iraj Salehi-Abari Definition: . A systemic disease with arthritis: .After or during an infection elsewhere in the body: . Gastrointestinal infection or . Genitourinary infection and .Bacteria cannot be cultured from the joints: . Noninfectious (inflammatory) arthritis

ReA-Iraj Salehi-Abari Epidemiology: Prevalence: 30-40/100,000 Annual incidece: 5-30/100,000 Age: Young adults, 20-40 years Rare in children Sex: Male predominancy Post GI infection: M = F Post GU infection: M >>> F (10/1 ?) Race: Caucasians, Uncommon in blacks

ReA-Iraj Salehi-Abari Preceding infection: . Gastrointestinal: . Salmonella . Shigella (f, d, s) . Yersinia (e, pt) . Campylobacter (j) . Closridium difficile . Genitourinary: . Chlamydia trachomatis

ReA-Iraj Salehi-Abari Attention please: Post Mycoplasma genitalium, Ureoplasma urealyticum, Chlamydia pneumonia, BH Strep , N. gonorrhea and live vaccination arthritis are not Reactive arthritis as a member of SpA

Clinical manifestations: ReA-Iraj Salehi-Abari Clinical manifestations: Preceding infection Systemic findings: Constitutional: fever, weight loss Articular Extra-Articular

ReA-Iraj Salehi-Abari Preceding infection: GI: Dysentery GU: Infectious Urethritis, Cystitis, Salpingitis Mild or inapparent: 10%

ReA-Iraj Salehi-Abari Articular findings: Arthritis Enthesitis Dactylitis Axial involvement

ReA-Iraj Salehi-Abari Arthritis: . Typical picture: . Acute asymmetric oligoarthritis of large joints in lower limb: Knee, Ankle, Feet, Hip . Above picture along with arthritis in upper limb: 50% . Polyarthritis of small joints: sometimes

ReA-Iraj Salehi-Abari Arthritis Typical picture

ReA-Iraj Salehi-Abari Enthesitis: Plantar fasciitis: Subcalcaneal heel pain Metatarsalgia Achille tendinitis: Retrocalcaneal heel pain & swelling Others

ReA-Iraj Salehi-Abari Enthesitis Plantar fasciitis

ReA-Iraj Salehi-Abari Enthesitis Achille tendinitis

ReA-Iraj Salehi-Abari Dactylitis: Sausage digits: Arthritis + Enthesitis in a toe or finger Toe: ReA Finger: PsA

PsA-Iraj Salehi-Abari Dactylitis:

PsA-Iraj Salehi-Abari Dactylitis:

ReA-Iraj Salehi-Abari Axial involvement: Inflammatory LBP: up to 50% Sacroiliitis: 20-25% Spondylitis: sometimes Secondary Ankylosing spondylitis: 10%

ReA-Iraj Salehi-Abari Axial involvement: Sacroiliitis: 20-25% Unilateral: common Bilateral; asymmetric

ReA-Iraj Salehi-Abari Axial involvement: Spondylitis: sometimes Syndesmophytes Spotty, asymmetric Paramarginal “Jug-handle”

ReA-Iraj Salehi-Abari

ReA-Iraj Salehi-Abari Axial involvement: Ankylosing spondylitis: 10% Chronic (> 6 months) (+) HLA-B27 Bilateral symmetric sacroiliitis

PsA-Iraj Salehi-Abari