Page 368 - Medicine and Surgery

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364 Chapter 8: Musculoskeletal system

Management bacterial DNA and RNA and bacterial macromolecules
Pain and inflammation is treated with nonsteroidal anti- can be detected in the joints.
inflammatory drugs. Specific Cox II inhibitors may be
of value (see indications given in section on Rheuma- Clinical features
toid Arthritis). Second line agents include methotrex- Typically there is an abrupt onset of asymmetrical lower
ate and ciclosporin. Anti-TNF-α monoclonal antibodies limb arthritis, sacroilitis and spondylitis. Achilles ten-
have been shown to be effective in reducing the pro- dinitis and plantar fasciitis may also occur. This may
gression of psoriatic arthritis. Surgical intervention may have been preceded by a clinical urethritis, prostatitis,
prove necessary. cystitis or diarrhoeal disease. Bilateral conjunctivitis and
uveitis may also occur.
Prognosis
It is not clear whether any medical intervention has Investigations
disease-modifying potential. High ESR, anaemia of chronic disease and leucocytosis
occur. The synovial fluid white cell count is high. X-rays
are initially normal but may show erosions and features
Reactive arthritis similar to ankylosing spondylitis.

Definition Management
Acute or chronic synovitis that occurs less than 6 weeks Although unlikely to affect the course of arthritis, an-
following infections with various organisms, including tibiotics are given for ongoing urethritis. Ophthalmol-
Chlamydia, Yersinia, Salmonella, Shigella and Campy- ogy referral is essential for uveitis and the arthritis is
lobacter species. Reiter’s syndrome is a form of reactive usually managed with nonsteroidal anti-inflammatory
arthritis with the triad of arthritis, uveitis, and urethritis. drugs. The few patients who develop a chronic arthritis
are treated as for rheumatoid arthritis.
Incidence
Unknown but not rare.
Inflammatory bowel disease
related arthritis
Age
Peak at 16–35 years.
Definition
An enteropathic arthritis, sacroiliitis, ankylosing
Sex spondylitis or rarely hypertrophic osteoarthritis in as-
M > F sociation with ulcerative colitis or Crohn’s disease.

Aetiology Prevalence
As with other spondylo-arthritides there is a strong 10% of ulcerative colitis patients and 15–20% of Crohn’s
association with HLA B27 (60–80% of patients). In- patients.
flammatory arthritis is precipitated by an environmen-
tal agent, e.g. sexually acquired non-specific urethri- Age
tis caused by Chlamydia trachomatis or Ureaplasma Commonest at 20–45 years.
urealyticum or enteric infections particularly Shigella,
Yersinia or Salmonella. Sex
1:1
Pathophysiology
In early synovitis there is intense hyperaemia with in- Aetiology
flammatory infiltration. The arthritis is said to be ster- The aetiology is unknown but the synovitis may occur in
ile as bacteria cannot be cultured from joints; however, response to bacterial antigens that have passed through