a case presentation by final year med student on reactive arthritis/reiter's syndrome

1. Case Presentation
General Medicine rotation (DEMC)
Tjibaenyana Daman
BY

2. Pt History
● Mr J, 55 y.o man;
– Married with 3 kids
– Security officer
– Islamic background
● 1/7 hx assymtrical joint pain involving:
– R Ankle (9/10)
– L + R knee pain (6/10)
– R shoulder pain (4/10)
– R middle finger MCP joint (8/10)

3. HOPC
● Acute onset
● Arousal from sleep
● Burning + Migratory
● None triggers of note
● Stiffness
● Denies hx of:
– Fever, URTI , bowel/bladder pathology, headache
or visual symptoms

4. Past med+Surg history
● T2DM since 10 years ago
● Hyperlipidaemia
● Denies hx of Rheumatologoical disease-
Gout,SLE,RA,OA
● Anal Fistula repair- 2013

5. Family hx
● Unremarkable- No hx of
cardiac,rheumatological or malignant pathology

6. Drugs/Meds
Medication Dose
Simvastatin 30mg
Gliclazide 120mg BD
Acarbose 5mg
Non-smoker
Non-Alcoholic

7. O/E
Tender.red MCP middle finger
Bilat. Jnt line tenderness.stiffness,No
Redness/bogginess or swelling
Red,hot swollen
Ankle,unable to weigh bear,

8. Ix
Test Result
FBC Hb
12.6
Plt 165 WBC 10.7 Neut 52
LFT AST 14 AST 33 ALP 161 Alb 36
ESR 84
Hep c Reactive
Hep B Non-reactive
Syphilis
Non-reactive
Serology
RF Non-reactive
X-ray Normal
ECG Normal

9. DDx
● Gout
● Rheumatoid arthritis
● Rheumatic fever
● Still's disease
● Psoriatic arthritis

10. Impression
● Reactive polyarthritis

11. Plan
● Conservative treatment:
– Rest and observe
– Anti-inflammatory analgesia
● D/C 2 days post-admission on:
– Celebrex
– Ultracet
● For r/v in 2/52

12. Arthritic pain

13. RA-Overview

14. Seronegative spondyloarthropathies

15. Reactive (Poly) Arthritis
● Def: Painful inflamatory arthritis occurring in reaction to
certain bacterial infections-commonly in the genitals
(Chlamydia trachomatis) or the bowel (Campylobacter,
Salmonella, Shigella and Yersinia)
● Epidemiology:
– young adults
– common in men between ages 20 and 50.

16. Signs and symptoms
arthritic
assymetric
Oligoarticular
Lower extremity
predilection
enthesitis
Keratoderma
blennorhagica
Sacroilitis
Non-specific
urethritis

17. Pathophysiology
Not quite clear- 2o
to infection Over two thirds are HLA-B27
positive.
HLA-B27 antigen has been
found to play an important
role including facilitating
persistence of Chlamydia
infection
altered host response
in regard to enhanced
invasion of microbes in
the gut
molecular
mimicry,

18. Treatment
● Treat Underlying cause (if any)
● Rest
● Symptom relief:
– NSAIDS
– DMARDS(chronic)

19. Prognosis & Complications
● In early phase:
– Pericarditis
– Uveitis
● Progression to chronic ReA:
– lasting greater than six months
– May develop features characteristic of another of the
spondyloarthritides, eg, psoriatic arthritis

20. References
● Kumar P and Clark M (Eds) (2009) Kumar and
Clark’s Clinical Medicine (7th edition). Edinburgh:
Saunders Elsevier.
● http://www.uptodate.com/contents/reactive-arthritis-formerly-
reiter-syndrome
● https://www.rheumatology.org/Practice/Clinical/Patien
ts/Diseases_And_Conditions/Reactive_Arthritis/

21. Terima kasih!