Reactive arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesReactive arthritisSCE Rheumatology

A 24-year-old man develops an asymmetric swollen right knee and left ankle 3 weeks after diarrhoea during travel. He has conjunctivitis, heel pain and dysuria has resolved. Synovial fluid is inflammatory and culture negative. RF and anti-CCP are negative. What is the most likely diagnosis?

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Correct answer: C — Reactive arthritis

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

Reactive arthritis is best because asymmetric oligoarthritis with enthesitis and conjunctivitis after gastrointestinal infection is typical of reactive arthritis. B is less suitable because osteoarthritis is non-inflammatory and not post-infective; C is less suitable because RA is typically persistent symmetric small-joint disease; D is less suitable because SLE arthritis would require lupus features and serology; E is less suitable because septic arthritis is usually a single infected joint with positive culture or systemic sepsis. Clinical pearl: initial infection may have resolved by the time arthritis presents.

Reference: NICE NG65; Oxford Textbook of Rheumatology