Reactive Arthritis

Casebank History
1

Who you are:
You are an FY2 in the Emergency Department

Who your patient is:
25 year old male Peter came to your GP practice because of pain in the knees and ankle.

What you must do:
Take history, assess and discuss management with the patient

Patient Information:

  • You were in south Spain for vacation and developed diarrhea and vomiting 3 weeks ago on his trip
  • On returning you developed aches in your knees and ankles
  • No restriction in movement but feels joint stiffness every time he rest and try to move which last depending on how long he has rested.
  • No issues bearing weight
  • No muscle soreness
  • No joints involved
  • No history of trauma
  • Mild swelling and redness
  • No blurring of vision
  • Occasional alcohol
  • Non smoker
  • No recreational drugs
  • Affected life only when needs to move around at work
  • Office worker
  • Knees examination fine
  • Ankle pain on choking the tone

O/E: Vitals: normal

Investigations: Cp, ESR,CRP.

Set up: Patient wearing shorts and ready for examination.

Questions:

  • What do you think is wrong with me?
  • What are you going to do for me?

Approach:

  • GRIPS
  • How can I help you?
  • History of joint pains.
  • Which joints?
  • Severity?
  • Radiation?
  • Type of pains?
  • Any stiffness?
  • Any swelling?
  • Differential diagnosis:
  • Reactive arthritis
  • Rheumatoid arthritis
  • SLE
  • Trauma
  • Hemophilia
  • Septic Arthritis
  • Gout
  • Reiter’s syndrome
  • PMAFTOSA
  • Systemic review
  • Ideas, concerns.
  • Effects of symptoms on patient’s life.
  • Examinations:
  • Observations (T, BP, HR, Pulse)
  • Knee and ankle examination.
  • Explain examination findings and diagnosis to the patient. It is reactive arthritis. This is an inflammation of the joint. It is a body’s reaction to infection somewhere else.
  • It is an inflammation in the joint as a result of diarrhea and vomiting (Gastroenteritis) you had 3 weeks ago.
  • But you do not have infection in the joints.

Management:

  • Blood tests
  • Ankle X-ray
  • If all tests are normal, can go home with analgesia (Ibuprofen)
  • Warning signs:
  • High fever
  • Not able to bear weight
  • Redness on the joints
  • Offer leaflets to the patient about reactive arthritis.
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