A Study on the clinical features of Reactive Arthritis and its Outcome.

Hema, M (2014) A Study on the clinical features of Reactive Arthritis and its Outcome. Masters thesis, Madras Medical College,Chennai.


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INTRODUCTION : Reactive arthritis (ReA) is a spondyloarthropathic group of disorders characterized by inflammation of the joints occurring either after a genitourinary or gastrointestinal infection. Its is a sterile synovitis associated with infection at a distant site without evidence of sepsis at the affected joint and often associated with urethritis, conjunctivitis and occurrence of other extraarticular manifestations. Time interval between the onset of infection and joint symptoms should be between 1 week to a of maximum 4 weeks. Clinical features are classically characterized by axial arthritis, oligoarthritis and enthesitis accompanied by extraarticular manifestations. Musculoskeletal symptoms are often acute associated with systemic features such as fatigue, weight loss and fever. Extraarticular symptoms include mucocutaneous, ocular and cardiac manifestations. Men and women are equally affected and the common age group is 20 to 40. Different bacterial species are associated with reactive arthritis. Commonest enteric pathogens are Salmonella, Shigella, Campylobacter and Yersinia. Chlamydia trachomatis is the commonest genitourinary pathogen. Reactive arthritis is usually a self limiting disorder, however 15-30% may progress to chronic reactive arthritis (>6 months). Prognosis is less favourable in patients with HLA-B27 positivity. AIMS AND OBJECTIVES : 1. To study the clinical features of Reactive arthritis. 2. To study the outcome of Reactive arthritis: a. To study the association of disease activity of Reactive arthritis and its outcome, b. To correlate the association between HLA B27 and the outcome of Reactive arthritis, c. To correlate the serum levels of IL 17A levels and disease activity of Reactive arthritis, d. To study the radiological outcome of Reactive arthritis. MATERIALS AND METHODS : After analyzing 100 patients who attended the Rheumatology OPD with predominant lower limb arthritis,46 patients who satisfied the diagnostic criteria for Reactive arthritis were chosen for the study. Inclusion criteria * Patients satisfying the diagnostic criteria for Reactive arthritis. Exclusion criteria : * JIA * Septic arthritis * Inflammatory polyarthritis of known connective tissue disorders such as Ankylosing spondylitis, Rheumatoid arthritis and Psoriatic arthritis. After thorough clinical examination all these patients underwent routine laboratory investigations such as Haemogram, Liver function tests and Renal function tests. Ultrasound was done in these patients to confirm the arthritis and enthesitis.CT pelvis was done at the onset and after 1 year to look for the radiological evidence of sacroil itis. All patients underwent ECHO and Opthalmological examination. Dermatogical consultation was obtained whenever necessary. Urine culture was done in patients with dysuric symptoms. RESULTS : Total no of patients studied were 46. Among them 58.7% were males and 41.3% were females. Sex has no significant correlation with the outcome. P Value 1.0. Total mean age of the patients is 29.91 years and the mean duration is 4.07 weeks. Mean age among the males is 29.67years and their mean duration is 3.70 weeks. Mean age among the females is 30.26years and their mean duration is 4.58 weeks. Among the 46 patients 45.5% had diarrhea and 43.5% of patients had genitourinary symptoms such as dysuria and white discharge. CONCLUSION : Knees and ankles were the commonly affected joints. * Plantar fascia and Achilles tendon were the commonly affected entheses. * Extraarticular manifestations were not commonly observed in our study. * IBA has significant association with the outcome. * Patients with high mean DAREA score at the onset progressed to chronic reactive arthritis and Spondyloarthropathy. * Persistent disease activity was found in patients with elevated IL17A levels. * HLAB27 was found to be associated with 11/46 patients. Among the HLA B27patients,9patients had spondyloarthropathy. * 11/46 patients had CT evidence of sacroilitis at follow up. * Salmonella is the most common organism associated with reactive arthritis in our study.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Reactive Arthritis ; Clinical Features ; Outcome.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:44
Last Modified: 16 Aug 2017 05:18
URI: http://repository-tnmgrmu.ac.in/id/eprint/1809

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