hi this is tom from zero defiance calm in this video i'm going to be going through reactive arthritis and you can find written notes on this topic at zero finals comm slash reactive arthritis or in the Rheumatology section at the zero finals medicine book let's jump straight in reactive arthritis is where synovitis occurs in joints as a reaction to a recent infective trigger and remember synovitis is inflammation of the synovium which is inside the joints and acts like a cushion to keep the joints from wearing out reactive arthritis used to be known as Reiter syndrome so you might still see that appearing in older textbooks or potentially in your exams typically it causes an acute mono arthritis and a mono arthritis is a single joint and it's acute because it comes on fairly quickly and often this is a single joint in the lower limb most often than me and it presents with a warm swollen and painful joints the obvious differential diagnosis is septic arthritis which is infection in the joint but in reactive arthritis there is no joint infection the most common infective triggers for reactive arthritis are gastroenteritis or sexually transmitted infections chlamydia is the most common sexually transmitted infection that causes reactive arthritis corneria commonly causes a gonna cockle septic arthritis so if somebody's got a recent sexually transmitted infection you need to think about both reactive arthritis but also septic arthritis as far as pathophysiology is concerned essentially what is happening is that the immune system is responding to the recent infection whether that's a gastroenteritis or sexually transmitted infection or and other infection and the immune system response also causes antibodies or inflammation that affects joints there's a link with the hla b27 gene and it's considered part of the seronegative spondyloarthropathies of conditions that remember also consists of psoriatic arthritis and ankylosing spondylitis there's a few associations to be aware of bilateral conjunctivitis and this is a non infective conjunctivitis also anterior uveitis and also circa nate balanitis and circulate balanitis is dermatitis of the head of the penis so a quick tom tip for you these features of reactive arthritis eye problems balanitis and arthritis lead to the typical saying which you'll hear quite a lot which is can't see pee or climb a tree and that saying is quite a good way and a catchy way for you to remember the features of reactive arthritis so what's the management of reactive arthritis well anytime a patient is presenting with an acute warm swollen and painful joint you need to treat them according to the local hot joint policy and this involves treating as presumed septic arthritis until you've excluded that condition because that's the most dangerous potential cause of this presentation and this will involve giving antibiotics until the possibility of septic arthritis is excluded it's important to aspirate the joint so take a sample of the fluid from within the joint and send this sample to the lab for gram staining culture and sensitivities to look for bugs that could be causing septic arthritis the aspirated fluid can also be sent for crystal examination to look for things like gout and pseudogout management of reactive arthritis after you've excluded septic arthritis is with non-steroidal anti-inflammatories steroid injections into the affected joint and potentially even systemic steroids like oral prednisone may be required particularly where multiple joints are affected most cases of reactive arthritis resolved within six months and they don't react a but if you have recurrent cases they may require disease-modifying antirheumatic drugs or anti TNF medications thanks for watching this video if you found it helpful please consider giving it a thumbs up and subscribing to follow the channel and find out as more videos come out you can also find written notes with illustrations on the zero to finals website at zero de finals comm and on the website you can also find a podcast that can help you learn on the go questions to test your knowledge and the zero to finals books follow the link in the description to pick up a copy of the Z road finals Medicine book it contains detailed and concise notes on 10 specialties in medicine and it's designed specifically to contain the key facts and guidelines you need to know for your medical exams with mnemonics and tom tips to help you learn exactly what you need to know for your exams without all the hassle follow the links to find out more