1. Reactive arthritis (ReA): Articular manifestations
ReA-Iraj Salehi-Abari
Reactive arthritis (ReA): Articular manifestations
Iraj Salehi-Abari MD.,
Internist
Rheumatologist

2. 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

3. 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

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

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

6. 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

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

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

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

10. 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

11. ReA-Iraj Salehi-Abari
Arthritis
Typical picture

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

13. ReA-Iraj Salehi-Abari
Enthesitis
Plantar fasciitis

14. ReA-Iraj Salehi-Abari
Enthesitis
Achille tendinitis

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

16. PsA-Iraj Salehi-Abari
Dactylitis:

17. PsA-Iraj Salehi-Abari
Dactylitis:

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

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

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

21. ReA-Iraj Salehi-Abari

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

23. PsA-Iraj Salehi-Abari