Tasty Morsels of EM 046 – Reactive vs Gonococcal Arthritis

8 Apr

As always, this is from the ever expanding google doc on bits and bobs I read and learn from and transfer here for all our learning pleasure.

REACTIVE ARTHRITIS

  • You probably used to know this as Reiter’s Syndrome (at least it was when I went to medical school) but it has gone the way of Wegener’s and had its name changed due to the Nazi associations.
  • usually 2-6 weeks following infection
  • GU or enteric infections
    • GU: chlamidiya (remember chlamidiya less likely to have urethritis symptoms than gonococcal)
    • Enteric: Salmonella, Shigella, Yersinia, or Campylobacter
  • both have asymmetric arthritis, knees, ankles feet and heels most often involved.
  • can also have conjunctivitis and even uveitis
  • up to 10% can have painless ulcers of mouth and tongue which can later become painful shallow ulcers, penis can also be involved.
  • look for dactylitis (remember this also occurs in psoriatic arthritis)
  • NSAIDS work well for both
  • antibiotics work for chlamidiya associated cases but not enteric ones

GONOCOCCAL ARTHRITIS

  • gonocoocal arthritis the most common cause of septic arthritis in sexually active population
  • more females than males
  • does not present the same as classic septic arthritis and much less chance of joint destruction
  • can be split into two syndromes that overlap
    • oligoarthritis (usually a couple of joints rather than just one).
    • disseminated gonococcal infection syndrome (migratory polyarthalgias, skin lesions, tenosynovitis)
  • very difficult to grow GC from a joint, but other cultures may well be +ve (e.g. pharyngeal or genital)
  • admission for treatment (ceftriaxone IV/IM daily) recommended

References:

  • Rosen’s 8th Chapter 116

[Featured Image: Wikimedia Commons]

2 Replies to “Tasty Morsels of EM 046 – Reactive vs Gonococcal Arthritis

  1. Find the cell counts on the joint fluid confusing for these. Always have to google it. Plus didn’t know Wegener was a Nazi too. Good work!

    A

    • I suspect the numbers just aren’t good enough to make a solid decision on things. Any number probably created on a logistic regression on a secific population and not valid in the next population

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