Reactive arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesReactive arthritisSCE Rheumatology

A 29-year-old woman has reactive arthritis after documented Campylobacter enteritis 4 weeks ago. She has two swollen joints, Achilles enthesitis and no ongoing diarrhoea or fever. Synovial fluid cultures are negative. NSAIDs provide partial relief. What is the most appropriate management?

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Correct answer: A — Add local corticosteroid injection for persistent synovitis

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

Add local corticosteroid injection for persistent synovitis is best because after treating any active infection, NSAIDs and local corticosteroid injection are appropriate for persistent reactive arthritis synovitis. A is less suitable because joint replacement is inappropriate for an acute inflammatory episode; B is less suitable because urate-lowering therapy treats gout, not reactive arthritis; D is less suitable because long-term antibiotics do not treat post-enteric reactive arthritis once infection has cleared; E is less suitable because rituximab is not used for reactive arthritis. Clinical pearl: antibiotics are for active infection, not for established sterile reactive arthritis.

Reference: NICE NG65