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Reiters arthritis
It is a clinical syndrome triggered by a specific etiological agent in a susceptible host following enteric or urogenital ...
It is a triad of Arthritis ,urethritis,and uveitis plus mucocutaneous lesions
History Described by Hans Reiter in 1916
Epidemiology <ul><li>Prevalence world wide </li></ul><ul><li>Incidence 30-40 /one lack </li></ul><ul><li>More common in 18...
Association of HLA B 27 and Spondyloarthropathies(in whites) -8% General healthy  population  -50% Acute iritis -70% UnspA...
Pathology <ul><li>Synovial histolgy is similar to inflammatory arthropathies. </li></ul><ul><li>Enthesitis is very common ...
Etiology and pathogenesis <ul><li>Bacteria responsible for triggering disease are </li></ul><ul><ul><li>Shigella </li></ul...
 
Isolated  reports  of acute arthritis preceded by even viral and parasitic infection
Immune response inYersinia triggered arthritis <ul><li>Initial, weak IgM-class antibody production </li></ul><ul><li>Later...
In  summery advance in molecular research have revealed that an imbalance in inflammation cytokines is central in there pa...
Clinical Features <ul><ul><li>History </li></ul></ul><ul><li>A vast majority of cases of reactive arthritis are oligosympt...
Symptoms of triggering infection would be mild in 9-10 % cases may go unnoticed
 
Manifestations of the urogenital system   Circinate balanitis is characteristic. Circinate balanitis is defined by circina...
Conjunctivitis  Eye involvement is common.   Conjunctivitis appears in approximately 50% of patients with reactive arthrit...
Other ocular manifestations   Iritis, iridocyclitis, and uveitis are seldom reported.  Iritis is more common in late recur...
<ul><li>Asymmetric Mono or oligoarthritis .  Mostly knees,ankles and hips. </li></ul><ul><li>Shoulders elbow,wrist,and sma...
Enthesopathy  (ie, inflammation at the tendinous insertion into bone) is common in reactive arthritis and in other seroneg...
Cutaneous and mucus membrane involvement  <ul><li>Erythema nodosum </li></ul><ul><li>Keratoderma blenorrhagicum indistingu...
GIT <ul><li>Abd. Pain diarrhoea, iliocolonoscopic picture like U.C. or Crohns both micro and macroscopically. </li></ul>
Investigations <ul><li>ESR </li></ul><ul><li>CRP </li></ul><ul><li>CBC </li></ul><ul><li>LFT </li></ul><ul><li>RFT </li></...
AIM of treatment <ul><li>Rapid control of inflammation </li></ul><ul><li>Prevent tissue damage </li></ul><ul><li>Improve Q...
Treatment  <ul><li>Antibodies if infections still persist </li></ul><ul><li>Rest </li></ul><ul><li>NSAIDs </li></ul><ul><l...
 
 
Summery box <ul><li>Biologic agents are highly effective-modifying medications. </li></ul><ul><li>currently licenced biolo...
Prognosis <ul><li>Generally good </li></ul><ul><li>Urogenital and Eye symptoms can recure </li></ul><ul><li>Severe destruc...
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physicians' forum bhopal

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physicians' forum bhopal

  1. 1. Reiters arthritis
  2. 2. It is a clinical syndrome triggered by a specific etiological agent in a susceptible host following enteric or urogenital infections targeting predominantly HLA-B27 +ve person
  3. 3. It is a triad of Arthritis ,urethritis,and uveitis plus mucocutaneous lesions
  4. 4. History Described by Hans Reiter in 1916
  5. 5. Epidemiology <ul><li>Prevalence world wide </li></ul><ul><li>Incidence 30-40 /one lack </li></ul><ul><li>More common in 18-40 yrs of age </li></ul><ul><li>But all age group can suffer </li></ul><ul><li>both sex equally affected slightly more common in males. </li></ul><ul><li>Very severe form seen in patient of AIDS. </li></ul><ul><li>Family clustering </li></ul><ul><li>Strongly associated with HLA B27 </li></ul>
  6. 6. Association of HLA B 27 and Spondyloarthropathies(in whites) -8% General healthy population -50% Acute iritis -70% UnspA -40-50% Psoriatic spA -35-75% Enteropathic spA -70% Juvenile spondyloarthropathy 40-80% ReA -90% Ankylosing spondylitis HLA B 27 prevalence Disease
  7. 7. Pathology <ul><li>Synovial histolgy is similar to inflammatory arthropathies. </li></ul><ul><li>Enthesitis is very common </li></ul><ul><li>Microscopic evidence of inflammation is seen colon and Ilium lesion </li></ul><ul><li>Skin lesions similar to Psoriatic lesions </li></ul>
  8. 8. Etiology and pathogenesis <ul><li>Bacteria responsible for triggering disease are </li></ul><ul><ul><li>Shigella </li></ul></ul><ul><ul><ul><li>Sonnei </li></ul></ul></ul><ul><ul><ul><li>Boyedii </li></ul></ul></ul><ul><ul><ul><li>Flexneri </li></ul></ul></ul><ul><ul><ul><li>dysenterioe </li></ul></ul></ul><ul><ul><li>Solmonella </li></ul></ul><ul><ul><li>Y. Enterocolitica </li></ul></ul><ul><ul><li>C.Trachomatis </li></ul></ul><ul><ul><li>Closridium difficle </li></ul></ul><ul><ul><li>Nesseria Gonorrhoea </li></ul></ul>
  9. 10. Isolated reports of acute arthritis preceded by even viral and parasitic infection
  10. 11. Immune response inYersinia triggered arthritis <ul><li>Initial, weak IgM-class antibody production </li></ul><ul><li>Later,strong and persisting IgG and IgA antibody production </li></ul><ul><li>IgA ab.increases in avidity with time </li></ul><ul><li>Ab. Are directd against several antigenic epitopes ofYersinia </li></ul><ul><li>Nonspecific immune complex are always found in serum </li></ul><ul><li>Specific Ic. Containing Yersinia and anti-Yersinia ab. May be found in se rum and synovial fluid </li></ul><ul><li>Peripheral T cells shows weak response to Yersinia </li></ul><ul><li>Tcells in synovial fluid shows vigrous but somewhat nonspecific response </li></ul>
  11. 12. In summery advance in molecular research have revealed that an imbalance in inflammation cytokines is central in there pathogenesis
  12. 13. Clinical Features <ul><ul><li>History </li></ul></ul><ul><li>A vast majority of cases of reactive arthritis are oligosymptomatic, and conjunctivitis or urethritis are present weeks before the patient's first visit </li></ul><ul><ul><ul><li>A syndrome, with malaise, low-grade fever, and generalized myalgia or headache can be present </li></ul></ul></ul>
  13. 14. Symptoms of triggering infection would be mild in 9-10 % cases may go unnoticed
  14. 16. Manifestations of the urogenital system Circinate balanitis is characteristic. Circinate balanitis is defined by circinate or gyrate white plaques that grow centrifugally and eventually cover the entire surface of the glans penis. The penile shaft and scrotum can be involved. The lesions become rapidly keratotic in a circumcised penis. Circinate vulvitis is reported in women. Prostatitis, cystitis, and pyelonephritis are rare but possible urogenital manifestations of reactive arthritis. Bartholinitis can be present in women. Proctitis caused by Chlamydia species can occur in both sexes after anal intercourse.
  15. 17. Conjunctivitis Eye involvement is common. Conjunctivitis appears in approximately 50% of patients with reactive arthritis. Conjunctivitis is often bilateral, and it may be overlooked because of its transitory course. An intense red, velvetlike conjunctival injection characterizes the conjunctivitis. Edema and a purulent discharge are not rare in reactive arthritis–associated conjunctivitis.
  16. 18. Other ocular manifestations Iritis, iridocyclitis, and uveitis are seldom reported. Iritis is more common in late recurrent episodes, and it only occurs in 3-8% of patients in the first attack. At clinical examination, redness, pain, impaired vision, and exudation with hypopyon can suggest iritis. Recurrent episodes can lead to pupillary synechia and glaucoma. Keratitis rarely is reported.
  17. 19. <ul><li>Asymmetric Mono or oligoarthritis . Mostly knees,ankles and hips. </li></ul><ul><li>Shoulders elbow,wrist,and small joints of hands and feet can also get involved </li></ul><ul><li>Dactilitis is not uncommon </li></ul><ul><li>Pain in sacroiliac region in late stage. </li></ul>
  18. 20. Enthesopathy (ie, inflammation at the tendinous insertion into bone) is common in reactive arthritis and in other seronegative arthritides (eg, plantar fasciitis, digital periostitis, Achilles tendinitis).
  19. 21. Cutaneous and mucus membrane involvement <ul><li>Erythema nodosum </li></ul><ul><li>Keratoderma blenorrhagicum indistinguisible from psoariasis both clinically and histopathologically. </li></ul><ul><li>Circinate balanitis ,cystitis and prostatitis </li></ul>
  20. 22. GIT <ul><li>Abd. Pain diarrhoea, iliocolonoscopic picture like U.C. or Crohns both micro and macroscopically. </li></ul>
  21. 23. Investigations <ul><li>ESR </li></ul><ul><li>CRP </li></ul><ul><li>CBC </li></ul><ul><li>LFT </li></ul><ul><li>RFT </li></ul><ul><li>RAFactor </li></ul><ul><li>Urine analysis </li></ul><ul><li>ECG </li></ul><ul><li>Joint fluid analysis </li></ul><ul><ul><li>Cellcount </li></ul></ul><ul><ul><li>Crystals exlusion </li></ul></ul><ul><ul><li>Gram stain </li></ul></ul><ul><ul><li>Bact. Culture </li></ul></ul><ul><li>Bacterialculture </li></ul><ul><ul><li>Feces </li></ul></ul><ul><ul><li>Urine or urethralswab </li></ul></ul><ul><ul><li>Cervical sample </li></ul></ul><ul><ul><li>throat </li></ul></ul><ul><li>Antibody determination at admission </li></ul><ul><li>HLA B27 After 2-4 weeks </li></ul><ul><li>Radiographs of affected joints </li></ul><ul><li>ophthalmologicalexamination </li></ul>
  22. 24. AIM of treatment <ul><li>Rapid control of inflammation </li></ul><ul><li>Prevent tissue damage </li></ul><ul><li>Improve QOL </li></ul><ul><li>Try to achieve long term remission </li></ul>
  23. 25. Treatment <ul><li>Antibodies if infections still persist </li></ul><ul><li>Rest </li></ul><ul><li>NSAIDs </li></ul><ul><li>Intra-articular corticosteroids </li></ul><ul><li>Systemic corticosteroids </li></ul><ul><li>Rarely DMARDs </li></ul>
  24. 28. Summery box <ul><li>Biologic agents are highly effective-modifying medications. </li></ul><ul><li>currently licenced biologics target TNF α,interleukin-1,Tcell activation and Bcells. </li></ul><ul><li>Biologic agents improve the s/s and QOL with RA,Crohn’s disease psoriasis and many orphan conditions. </li></ul><ul><li>Needs vigilance for side effects. </li></ul><ul><li>Treatment should be commenced early for ultimate outcome. </li></ul>
  25. 29. Prognosis <ul><li>Generally good </li></ul><ul><li>Urogenital and Eye symptoms can recure </li></ul><ul><li>Severe destructive disease is rare </li></ul>

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