Some great learning points from today's case discussion of Reactive Arthritis:
1. MSK features of reactive arthritis (at least one of the following - asymmetric oligoarthritis typically in the lower extremities, enthesitis, dactylitis, or inflammatory back pain) present 1-4 weeks following a triggering infection.
2. The clinical triad of post-infectious arthritis, urethritis, and conjunctivitis (formerly called Reiter Syndrome), only represent a subset of patients with reactive arthritis. Reactive arthritis is a clinical diagnosis without validated diagnostic criteria, however the diagnosis can generally be made if a patient exhibits all 3 of the following:
- Characterstic MSK findings (as above)
- Preceding extraarticular infection (I.e. urethritis, diarrhea)
- Lack of evidence for another more likely alternate cause of the MSK findings
3. In reactive arthritis, does antibiotic therapy reduce articular symptoms? According to a meta-analysis of 12 RTCs (Barber 2013), despite the offending organism, there was substantial heterogeneity without any significant effects of pain scores or number of joints involved, while there were significantly more GI adverse events. The diversity of study designs in the 12 RTCs likely contributed to the heterogeneous results, and thus the global efficacy of antibiotics in reactive arthritis remains uncertain.