Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Psoriatic arthritis affects approximately 10% of those with psoriasis, and can present in a number of forms. Most commonly, psoriatic arthritis affects the distal interphalangeal joints. Dactylitis, inflammation of an entire digit, is a feature of this, and gives rise to the ‘sausage finger’ seen in these patients. Other forms include a symmetrical arthritis that presents in a similar fashion to rheumatoid arthritis, and arthritis mutilans. In this severe form of the condition, the appearances are often more severe than the symptoms experienced by the patient. Reactive arthritis is a sterile arthritis that is typically seen soon after urethritis or a diarrhoeal infection. The commonest organisms that cause this have been listed above. Reiter’s syndrome is a form of reactive arthritis. The features of this can be rememberd by the rhyme ‘Can’t see (conjunctivitis), can’t pee (urethritis) and can’t climb up a tree (arthritis)’.
Practice Paper 9: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Reiter’s syndrome, or reactive arthritis, is a triad of urethritis, seronegative (i.e. rheumatoid factor–negative) arthritis and conjunctivitis resulting from a pathological immune response to an infectious agent (‘can’t see, can’t pee, can’t climb a tree!’). Two other associated features of Reiter’s syndrome are circinate balanitis (erythematous lesions on the penis) and keratoderma blenorrhagicum (hard nodules on the soles of the feet that are clinically and histologically indistinguishable from plantar psoriasis). There are two main causes of Reiter’s syndrome: genitourinary infection (Chlamydia or Neisseria gonorrhoeae) or gastrointestinal infection (Salmonella, Shigella, Yersinia or Campylobacter). Reiter’s syndrome is much more common in males (25:1). Diagnosis is normally clinical, although the erythrocyte sedimentation rate is raised and HLA-B27 is often present.
Infection and sexual health
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
One of the immediate complications is developing PID. In chlamydial PID, perihepatitis can also occur; this is known as Fitz-Hugh-Curtis syndrome. As with other types of PID, the long-term sequelae include tubal damage resulting in an increased risk of infertility and ectopic pregnancy and chronic pelvic pain. Less common outcomes include adult conjunctivitis and sexually acquired reactive arthritis or Reiter’s syndrome. This is more common in men who have chronic chlamydial infection.
Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid
Published in Journal of Dermatological Treatment, 2019
Sarah Madeline Brown, Khadija Aljefri, Rachel Waas, Philip Hampton
There is little in the literature regarding teratogenicity following paternal methotrexate exposure (35). There is one case report of a man with Reiters syndrome who was treated with methotrexate for 5 months prior to conception and fathered a normal child (31). Methotrexate can cause chromosomal abnormalities and point mutations. In animal studies, it has previously been found to result in degeneration of spermatocytes, Leydig cells and Sertoli cells in the testes of rats (36). In humans, reversible oligospermia has been reported (31). A case of a patient with severe psoriasis treated with methotrexate showed a low-sperm count of 0.8–3.1 million/mL at 16–20 days following discontinuation. Following 4 months without treatment his sperm count rose to 44–51 million/mL. His sperm count dropped again on restarting methotrexate treatment (35). It is recommended that methotrexate should be discontinued in men for at least 3 months and up to 6 months prior to conception (10).
Relapsing polychondritis in children: A review
Published in Modern Rheumatology, 2020
Jubran T. Alqanatish, Jawaher R. Alshanwani
Relapsing polychondritis (RP) is a rare auto-immune disease that was first described in 1923 by Jaksch Wartenhorst [1]. It is even more limited in children than adult and is characterized by a systemic inflammatory disease with recurrent, progressive inflammation and cartilage degeneration, which commonly affects the cartilages of the ears, eyes, nose, trachea, larynx, and joints and results in pain and deformities [2]. The involvement of a major airway is more common and more serious in young patients than in adults. An RP study conducted in the United Kingdom estimated the prevalence of RP to be nine cases per million people [3]. RP occurs in individuals of all races and age groups with no differences in gender [4,5]. However, it seems that there is variability in clinical presentation between Caucasian and Asian populations [4]. It appears to be more common in middle-aged Caucasians, and the age of onset in children is variable (1.7 months to 17 years) [6]. Most cases of pediatric-onset RP have been published as a single case report or hand-full case series although the prevalence of RP is unknown. In children, the diagnosis is either delayed or overlooked due to low incidence. Concomitant presentation of other autoimmune diseases and myelodysplastic syndromes, such as rheumatoid arthritis, juvenile idiopathic arthritis, spondyloarthropathies, reactive arthritis, systemic vasculitis, Sjögren’s syndrome, systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease, and myelodysplastic leukemia, are seen with RP in one-third of cases [7–12].
Behcet disease: an undifferentiating and complex vasculitis
Published in Postgraduate Medicine, 2023
Daniel Pak, Hyon Ju Park
Other diseases to evaluate for include systemic lupus erythematosus, reactive arthritis, and spondyloarthropathy. Accompanying symptoms and axial inflammatory arthritis, serologies, and HLAB27 status can help differentiate between BD from these diseases. As mentioned above, when intestinal BD is present, endoscopic exams can help differentiate between IBD and BD based on presence of granulomas in intestinal BD. Celiac disease can also present with aphthous ulcers, abdominal bloating/cramping, and diarrhea. Although BD is highly inflammatory in nature, the lack of fevers tend to help separate this disease out from other autoinflammatory conditions like hyperimmunoglobulin D and A20 haploinsufficiency syndromes [84]. Age of onset and other clinical manifestations can help differentiate it from periodic fever, aphthous stomatitis, pharyngitis, and cervical adenopathy (PFAPA).
Related Knowledge Centers
- Cervicitis
- Conjunctivitis
- Inflammation
- Urethritis
- Uveitis
- Arthritis
- Psoriasis
- Balanitis Circinata
- Keratoderma Blennorrhagicum
- Enthesitis