skip to main content

Reactive Arthritis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSpondyloarthropathyReactive ArthritisSCE Rheumatology

A 28-year-old man develops conjunctivitis, sterile urethritis and a painful asymmetric oligoarthritis three weeks after culture-confirmed Campylobacter enteritis, which has now fully resolved. His left knee has a large effusion that substantially limits mobility, and his right ankle is also inflamed. Knee aspiration shows inflammatory synovial fluid with no crystals; Gram stain and culture are negative. He is HLA-B27 positive and has no contraindication to NSAIDs. What is the most appropriate initial management of his joint disease?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Start an NSAID and inject the markedly inflamed knee with intra-articular corticosteroid

This is acute enteric reactive arthritis with sterile asymmetric lower-limb oligoarthritis. Initial joint treatment is an NSAID; intra-articular corticosteroid is appropriate for the prominently inflamed knee once septic and crystal arthritis have been excluded. Sulfasalazine or methotrexate may be considered if substantial peripheral arthritis persists despite initial anti-inflammatory treatment, rather than being started immediately. TNF inhibition is reserved for exceptional refractory chronic disease because supporting evidence in reactive arthritis is limited. Prolonged intravenous antibiotics are not indicated: the enteric infection has resolved, and antibiotics do not generally shorten enteric reactive arthritis. HLA-B27 positivity predicts a greater risk of prolonged or recurrent disease but does not itself justify immediate DMARD or biologic escalation.

Reference: Rihl M, Kuipers JG. Reactive arthritis. Zeitschrift für Rheumatologie. 2025;84(4):259-267. https://pubmed.ncbi.nlm.nih.gov/33815974/