A. Reactive arthritis secondary to Salmonella spp. – Explanation

Urethritis + arthritis + conjunctivitis = reactive arthritis

Two of the classic three features of reactive arthritis (urethritis, arthritis and conjunctivitis) are
present in this patient. The family history of colorectal cancer is of no particular significance.
Symptoms of reactive arthritis typically appear 1-4 weeks following the initial infection, in this case a
diarrhoeal illness.
Reactive arthritis
Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It
encompasses Reiter’s syndrome, a term which described a classic triad of urethritis, conjunctivitis
and arthritis following a dysenteric illness during the Second World War. Later studies identified
patients who developed symptoms following a sexually transmitted infection (post-STI, now
sometimes referred to as sexually acquired reactive arthritis,
SARA).

Reactive arthritis is defined as an arthritis that develops following an infection where the organism
cannot be recovered from the joint.
Epidemiology

• post-STI form much more common in men (e.g. 10:1)
• post-dysenteric form equal sex incidence

The table below shows the organisms that are most commonly associated with reactive arthritis:

Management

• symptomatic: analgesia, NSAIDS, intra-articular steroids
• sulfasalazine and methotrexate are sometimes used for persistent disease
• symptoms rarely last more than 12 months