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Reactive arthritis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesReactive arthritisSCE Rheumatology

Three weeks after untreated urethritis, a man develops asymmetric knee and ankle synovitis, enthesitis, conjunctivitis and keratoderma. He is afebrile, but the knee has a large effusion. What is the best initial strategy?

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

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Correct answer: E — Aspirate the knee, treat the genital infection and start NSAID therapy

Explanation lettering: B = shown as A · C = shown as B · E = shown as C · A = shown as D · D = shown as E

D is correct. The syndrome strongly suggests reactive arthritis, but a large acute effusion still warrants aspiration when sepsis or crystal disease is plausible. The triggering infection is treated for infectious indications; antibiotics do not reliably shorten established arthritis, which initially receives NSAID therapy if safe. A overstates prolonged antibiotics. B risks injecting infection. C escalates immunosuppression before infection control. E misreads keratoderma.

Reference: NICE NG65: spondyloarthritis — recommendations: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations