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Reactive Arthritis

Reiter Syndrome


Presentation

  • Because the standard constellation of symptoms in Reiter syndrome (arthritis, conjunctivitis, and urethritis) is not typically present in all patients, the disease can be easily overlooked if clinical suspicion is not high upon presentation.[ncbi.nlm.nih.gov]
  • Here, we report an unusual clinical presentation of HOA. A 77-year-old man presented with fever, diarrhea, and an oligoarthritis involving the left knee and the ankles.[ncbi.nlm.nih.gov]
  • We present a comparison of the clinical manifestations, radiographic features and treatment regimens of these cases.[ncbi.nlm.nih.gov]
  • Both presented patients and the review of the literature demonstrate that active TB may be complicated by ReA known as Poncet's disease.[ncbi.nlm.nih.gov]
  • A definite linkage to HLA B27 is present, although without prognostic value.[ncbi.nlm.nih.gov]
Trismus
  • We present a case report of a four-year-old boy with torcicollis and trismus after acute otitis media. Grisel Syndrome diagnosis in association with temporo-mandibular reactive arthritis was admitted, leading to early conservative treatment.[ncbi.nlm.nih.gov]
Ciliary Injection
  • The 28-year-old man visited the authors' hospital due to ciliary injection and hypopyon over left eye. On examination, Behcet-mimicking symptoms were observed, such as genital and oral ulcers and arthritis.[ncbi.nlm.nih.gov]
Arthritis
  • How is reactive arthritis treated? The type of treatment for reactive arthritis depends on the stage of reactive arthritis. The early stage of reactive arthritis is considered acute (early).[rheumatology.org]
  • Women with reactive arthritis often have milder symptoms than men. What are the symptoms? What are the symptoms of reactive arthritis? Symptoms of reactive arthritis may be so mild that you do not notice them.[niams.nih.gov]
  • Gonococcal arthritis. Gout. Inflammatory bowel disease. Psoriatic arthritis. Rheumatic fever. Rheumatoid arthritis. Septic arthritis.[patient.info]
  • CONCLUSIONS AND RELEVANCE: C difficile infection-associated reactive arthritis is an underdiagnosed, potentially morbid reactive arthritis associated with C difficile infection occasionally misdiagnosed as septic arthritis.[ncbi.nlm.nih.gov]
  • Reactive arthritis belongs to the group of arthritidies known as the spondyloarthritides. There are two main types of reactive arthritis: post-venereal and post-enteric.[ncbi.nlm.nih.gov]
Arthralgia
  • Staphylococcal septicemia, while frequently associated with arthralgia, has rarely been associated with a sterile arthritis, although it infrequently results in septic arthritis.[ncbi.nlm.nih.gov]
  • Arthralgia and/or arthritis is one of the rare severe complications following intravesical BCG immunotherapy.[ncbi.nlm.nih.gov]
  • ReA was diagnosed in 21, postinfectious arthralgia in 13, and other musculoskeletal conditions in 11 patients. HLA-B27 was positive in five out of 44 patients (11%).[ncbi.nlm.nih.gov]
  • Left ankle arthralgia persisted for about 5-6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml.[ncbi.nlm.nih.gov]
  • ReA as observed in our study was overall fairly mild, but in many individuals, postinfectious arthralgia and DMARD use continued at least up to 1 year.[ncbi.nlm.nih.gov]
Joint Swelling
  • Reactive arthritis occurs when the body’s immune system reacts to a recent infection, usually within the past four to six weeks, with joint swelling and pain.[rileychildrens.org]
  • It can make your joints swell and hurt, similar to arthritis. Reactive arthritis may be called Reiter’s syndrome or Fiessinger-Leroy’s disease.[familydoctor.org]
  • Reactive arthritis is a relatively short-lived condition causing painful joint swelling. It develops in response to and occurs shortly after an infection, usually of the bowel, genital tract or throat.[dundeemedstudentnotes.wordpress.com]
Joint Effusion
  • It is important to consider reactive arthritis, rather than solely an infectious cause of joint effusions, and arthropathy in a patient with a preceding or ongoing Staphylococcal infection.[ncbi.nlm.nih.gov]
  • effusions) Tendonitis/enthesitis of the lower limbs (achilles’ tendonitis/ plantar fasciitis) is also relatively common.[dundeemedstudentnotes.wordpress.com]
Torticollis
  • GS should be suspected in a child presenting with torticollis after an upper respiratory tract infection or an ENT surgical procedure.[ncbi.nlm.nih.gov]
Cloudy Urine
  • The patient subsequently developed a fever over 38 C, pain on micturition, and cloudy urine 3 days following PCI. Urine cultures were positive for Escherichia coli and Enterococcus faecalis, whereas blood cultures were negative.[ncbi.nlm.nih.gov]

Workup

  • Reactive Arthritis Workup. Available online at . Accessed July 23, 2017. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2016. Questions and Answers about Reactive Arthritis. Available online at . Accessed July 23, 2017.[labtestsonline.org]
  • […] infectious process, especially in monoarticular arthritis with constitutional symptoms) Antistreptolysin O (ASO) or anti-DNase B testing (if poststreptococcal infection is suspected) Electrocardiography (ECG; in patients with a prolonged course of ReA) See Workup[emedicine.medscape.com]

Treatment

  • OBJECTIVE: To examine the efficacy and safety of antibiotic treatments for reactive arthritis (ReA). METHODS: We did a systematic review and metaanalysis of randomized controlled trials of antibiotics for treatment of ReA.[ncbi.nlm.nih.gov]
  • Complete resolution of ocular and systemic symptoms was achieved after 2 months of treatment. Streptococcus viridans is potential microorganisms of ReA. Careful survey and prompt treatment is necessary.[ncbi.nlm.nih.gov]
  • An emphasis is placed on disease awareness since viable treatment options are emerging. Copyright 2011 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Early recognition and adequate treatment for gastrointestinal infections and infestations before complications is important.[ncbi.nlm.nih.gov]
  • OBJECTIVE: There are few treatments for reactive arthritis (ReA).[ncbi.nlm.nih.gov]

Prognosis

  • The influence of new drugs on the short and long term prognosis of the patients with ReA remains to be evaluated.[ncbi.nlm.nih.gov]
  • The outcome and prognosis of ReA are best known for enteric ReA, whereas studies dealing with the long-term outcome of ReA attributable to Chlamydia trachomatis are lacking. Copyright 2011 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Prognosis Prognosis is variable. Two-thirds of patients develop prolonged joint discomfort, lower back pain or an enthesopathy after acute ReA. Severe chronic sequelae may develop in up to 30% of cases.[orpha.net]
  • […] risk factors for poor prognosis: nature of the infection, persistent infection with Chlamydia, the presence of HLA-B27 (axial involvement, ocular), male gender, recurrent arthritis and a family history of the disease Reference: Dumond DC.[gpnotebook.co.uk]

Etiology

  • Chlamydia trachomatis and Chlamydophila pneumoniae are human pathogens; the former being the etiologic agent for trachoma as well as a prevalent sexually transmitted bacterium, while C. pneumoniae is a respiratory pathogen responsible for community-acquired[ncbi.nlm.nih.gov]
  • The clinical syndrome of reactive arthritis can be easily remembered with the mnemonic: Can't see, can't pee, can't climb a tree Etiology and Pathogenesis Although the etiology of Reactive Arthritis is incompletely understood, it appears to be the result[pathwaymedicine.org]
  • Current theories suggest the persistent presence of non-culturable bacteria and bacterial antigens residing in the joint synovia as the etiology of the disease state.[ncbi.nlm.nih.gov]
  • Post-streptococcal syndrome should be considered in the etiology of acute bilateral granulomatous uveitis in children, and anti-streptococcal lysine O titer should be considered in serodiagnostic testing.[ncbi.nlm.nih.gov]
  • The primary etiologic agent for post-venereal ReA is the bacterium Chlamydia trachomatis; its relative, C pneumoniae, has also been implicated in disease induction although to a lesser degree.[ncbi.nlm.nih.gov]

Epidemiology

  • Prospective epidemiologic data suggest that Chlamydia-induced reactive arthritis is underdiagnosed.[ncbi.nlm.nih.gov]
  • Our epidemiological study confirms suggested high incidence rates of reactive arthritides. Reactive arthritides must be considered in early arthritis, even without symptoms of triggering infections.[ncbi.nlm.nih.gov]
  • OBJECTIVE: We describe the epidemiological and microbiological process in the clearing of a foodborne outbreak of Yersinia pseudotuberculosis O:1 linked to raw carrots and frequency of the associated reactive extra-gastrointestinal manifestations.[ncbi.nlm.nih.gov]
  • An invaluable tool for differential diagnosis of STDs, the atlas features one to two color photograph for each disorder and accompanies those with the salient points of epidemiology, clinical signs, physical exam, diagnosis, and management.[books.google.com]
  • Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • We further discuss the context of pathophysiology of the arthritis in these patients, with an emphasis on the immunomodulatory properties of these two pathogens.[ncbi.nlm.nih.gov]
  • In this report, a case diagnosed with both reactive arthritis and osteopoikilosis will be presented and current arguments about its differential diagnosis and pathophysiology and concomitant disorders shall be discussed.[ncbi.nlm.nih.gov]
  • In recent years, a great deal has been learnt about the epidemiology, pathophysiology and treatment of reactive arthritis and Chlamydia-induced reactive arthritis, specifically.[ncbi.nlm.nih.gov]
  • The pathophysiology of all the seronegative reactive arthritis syndromes and the immunologic role of infectious diseases as precipitants for clinical illness are incompletely understood.[unboundmedicine.com]
  • Around 1-4% of patients get ReA after enteric infection Around 0.5-1% of patients with urethritis develop ReA Pathophysiology As with other seronegative arthropathies, there is an association with HLA-B27 allele of the MHC-class I protein.[dundeemedstudentnotes.wordpress.com]

Prevention

  • CONCLUSION: These data are consistent with prior studies and highlight the need for continued primary prevention efforts.[ncbi.nlm.nih.gov]
  • The patient was treated with topical steroids, cycloplegics, high-dose oral steroids and preventive course of penicillin with total improvement and no recurrence.[ncbi.nlm.nih.gov]
  • Rheumatic fever is an important health problem in certain areas of the world, but it can be prevented by treating streptococcal pharyngitis as soon as it is recognized (i.e. primary prevention).[printo.it]
  • Physicians should be aware of this rare complication associated with a common disease to prevent delay in diagnosis and initiation of appropriate treatment.[ncbi.nlm.nih.gov]
  • Clinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.[ncbi.nlm.nih.gov]

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