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Sexually Acquired Reactive Arthritis

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WHAT IS IT?

Abstract

VOL: 99, ISSUE: 45, PAGE NO: 27

 

WHAT IS IT?
- Sexually acquired reactive arthritis (SARA) is an inflammation of the synovial membranes, tendons and fasciae, triggered by genital infection.

 


 

CAUSES
- The precise mechanisms are not clearly understood, but SARA appears to involve an immune response. A number of micro-organisms have been implicated: Chlamydia trachomatis; Neisseria gonorrhoea; Ureaplasma urealyticum and Shigella sonnei.

 


 

- It is 10 times more frequent in men than in women, although it may be under-recognised in women.

 


 

SIGNS AND SYMPTOMS
History includes possible previous or family history of spondyloarthritis or iritis; sexual intercourse, usually with a new partner, within three months prior to onset. Symptoms include:

 


 

- Genital infection;

 


 

- Pain, with or without swelling and stiffness, at one or more joints; especially knees and feet;

 


 

- Tenosynovitis;

 


 

- Dactylitis;

 


 

- Pain and redness of the eye - usually due to conjunctivitis; other conditions such as posterior uveitis should be investigated;

 


 

- Low back pain and stiffness;

 


 

- Malaise, fatigue and fever;

 


 

- Psoriasis.

 


 

COMPLICATIONS
- Heart lesions - usually asymptomatic although tachycardia and rarely pericarditis and aortic valve disease may occur.

 


 

- Renal pathology, such as proteinuria, microhaematuria and aseptic pyuria - usually asymptomatic.

 


 

- Rarely, thrombophlebitis of the lower limbs, subcutaneous nodules, nervous system involvement.

 


 

- Erosive joint damage, especially in the small joints of the feet, with 12 per cent exhibiting foot deformities, although severe deformity is rare.

 


 

- Fever and weight loss.

 


 

- Inadequately treated or recurrent uveitis may result in cataracts and blindness.

 


 

DIAGNOSIS
Diagnosis involves three components:

 


 

- Recognition of the typical clinical features of spondyloarthropathy;

 


 

- Demonstration of evidence of genitourinary infection;

 


 

- Investigation of specificity and activity of arthritis.

 


 

TREATMENT
Treatment is directed at presenting symptoms, by relevant specialists.

 


 

- Antimicrobial therapy for occurrence of genital infections.

 


 

- Rest with the restriction of physical activity, especially weight-bearing activity where leg joints are involved.

 


 

- Physiotherapy in order to prevent muscle wasting.

 


 

- Cold pads to alleviate joint pain and oedema.

 


 

- Administration of intra-articular corticosteroid injections, for single troublesome joints.

 


 

- Administration of systemic corticosteroids for severe arthritis.

 


 

- Sulphasalazine, methotrexate and/ or azathioprine where disabling symptoms persist for three or more months, or where there is evidence of erosive joint damage.

 


 

- Gold salts and D-penicillamine are occasionally used when persistent polyarthritis is present.

 


 

- Topical salicylate, corticosteroids and/or calcipotriol, for mild-to-moderate skin lesions.

 


 

- Methotrexate and/or retinoids, for severe skin lesions.

 


 

- Referral to an ophthalmologist for eye lesions.

 


 

- Low-dose tricyclic drugs at night, if post-inflammatory pain and fatigue are severe.

 


 

PROGNOSIS
- In most cases SARA is self-limiting with the first episode lasting four to six months. About 50 per cent of patients have recurrent episodes.

 


 

- Symptoms persist for more than one year in 17 per cent of patients.

 


 

- Persistent disability occurs in 15 per cent of patients, mainly due to erosive damage

 


 

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