Diagnosis of Reactive ArthritisDon Jayric DepalobosMayene Echave

Tests for Reactive Arthritis

•History & Physical Examination•Diagnostic Criteria •Synovial Fluid Analysis•Radiography

Test for Reactive Arthritis

•History> Antecedent infection (1-4 weeks)>Diarrhea or Dysuria>Constitutional symptoms: fatigue, malaise, fever, and weight loss.>The diagnosis should be entertained in any patient with an acute inflammatory, asymmetric, additive arthritis or tendinitis.

• Physical Eamination>Attention must be paid to the distribution of the joint and tendon involvement and to possible sites of extraarticular involvement, such as the eyes, mucous membranes, skin, nails, and genitalia.

• Diagnostic Criteria of the Third International Workshop on Reactive Arthritis. [Evidence-based]

1. The arthritis should predominantly involve the lower limb, involve one or a few joints and not equally involve both sides of the body. (Asymmetric)

2. There should be evidence or a history of preceding infection.

3. If no clear clinical infection, then laboratory confirmation is essential.

4. No evidence of joint infection. Causes of monoarthritis or oligoarthritis should be ruled out.

Tests for Reactive Arthritis

•Synovial Fluid Analysis

Expected Result:Non-specifically Inflammatory

Synovial Fluid Analysis is also used to exclude septic or crystal-induced arthritis.

Tests for Reactive Arthritis

•Synovial Fluid Analysis

Tests for Reactive Arthritis• Radiography

Early or mild disease: >radiographic changes may be absent or confined to juxtaarticular osteoporosis.

With long-standing persistent disease, >marginal erosions and loss of joint space can be seen in affected joints.

Periostitis with reactive new bone formation is characteristic, as in all the SpA.

Spurs at the insertion of the plantar fascia are common.

Sacroiliitis and spondylitis may be seen as late sequelae. Sacroiliitis is more commonly asymmetric than in AS, and spondylitis, rather than ascending symmetrically, can begin anywhere along the lumbar spine.

The syndesmophytes may be asymmetric, coarse and nonmarginal, arising from the middle of a vertebral body, a pattern less commonly seen in primary AS. Progression to spinal fusion is uncommon.

References1. Harrison’s Principle of Internal Medicine, 18th

Edition

2. Goldman's Cecil Textbook of Medicine, 24th Edition

3. Henry's Clinical Diagnosis and Management by Laboratory Methods, 22nd Edition

4. Third and Fourth International Workshop on Reactive Arthritis – American Journal of Rheumatology, American College of Rheumatology