Reactive Arthritis in Emergency Medicine Follow-up

  • Author: Bo Burns, DO, FACEP, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Feb 1, 2010
 

Further Inpatient Care

  • Inpatient care may be considered for patients who are unable to tolerate oral administration of medications, who are unable to ambulate because of significant joint involvement, who have intractable pain, or who have concomitant disease requiring admission.
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Further Outpatient Care

  • Nonweightbearing of an affected joint may be necessary to allow healing.
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Inpatient & Outpatient Medications

  • Nonsteroidal anti-inflammatory agents may control painful arthralgias. Patients must be instructed on compliance and possible need for adjustment to dose or to another agent.
  • Empiric antibiotics may be considered after appropriate cultures have been taken. Treat urethritis or cervicitis but generally not diarrhea.
  • Long-term antibiotic therapy may be warranted in cases of poststreptococcal reactive arthritis. This is currently a controversial topic.[17, 18]
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Complications

  • Recurrent arthritis (15-50%)
  • Chronic arthritis or sacroiliitis (15-30%)
  • Ankylosing spondylitis (30-50% of HLA-B27–positive patients)
  • Urethral stricture
  • Cataracts
  • Aortic root necrosis
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Prognosis

  • Signs and symptoms usually remit within 6 months. However, a significant percentage of patients have recurrent episodes of arthritis (15-50%), and some patients develop chronic arthritis (15-30%).
  • Postdysenteric cases are associated with a better prognosis than postchlamydial cases.
  • Poor prognosis of reactive arthritis is associated with hip arthritis, lumbar-sacral stiffness, sedimentation rate higher than 30, poor efficacy of NSAIDs, oligoarthritis, onset when patients are younger than 16 years, and sausage finger or toe.
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Patient Education

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Contributor Information and Disclosures
Author

Bo Burns, DO, FACEP, FAAEM  Assistant Professor, Associate Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine

Bo Burns, DO, FACEP, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Soliman, MD  Resident Physician, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa

Disclosure: Nothing to disclose.

Specialty Editor Board

Dana A Stearns, MD  Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital

Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Thomas Scoggins, MD, and Igor Boyarsky, DO, to the development and writing of this article.

References

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Circinate balanitis in a patient with reactive arthritis.
Plaques on the soles of a patient with reactive arthritis.
Painful erosions on the fingers in a patient with reactive arthritis.
Plaques and erosions of the tongue in a patient with reactive arthritis.
Radiograph of the feet in a 27-year-old man shows erosions in all the left metatarsophalangeal (MTP) joints with subluxation and valgus deformity of most of the toes. Smaller erosions in the four and fifth MTP joints of the right foot are also shown.
Lateral radiograph of the foot (same patient as in the photo above) reveals a calcaneal spur and enthesitis.
Radiograph of both hands shows small erosive changes in both first metacarpal heads associated with minimal subluxation. Bone density is normal.
Radiography of the pelvis reveals bilateral asymmetric sacroiliitis.
Image in 40-year-old man with nonmarginal syndesmophytes predominantly in the lower thoracic and upper lumbar spine.
 
 
 
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