BOF: 22
A 28-year-old male presents with a painful swollen knee.
He feels generally unwell and has fever. He has a psoriasiform rash on his glans
penis and he also complains
of low backache.
Six weeks previously he has had a self-limiting episode
of diarrhoea.
In this patient
a)
Prompt treatment will reduce the chance of recurrence
b)
High dose steroids should be used without delay
c)
Prolonged antibiotic treatment will prevent the disease becoming chronic
d)
If the disease becomes chronic sulphasalazine and methotrexate are useful
second line agents
e)
He has a greater than 50 % chance of developing erosive disease or
spondylitis
Answer:
d)
This patient has developed reactive arthritis. If
possible athrocenetesis should be preformed to exclude septic arthritis.
Prednisolone does help to control symptoms in active disease but is not the drug
of first choice. Non-steroidal anti-inflammatory drugs should be used.
Antibiotics should be used if active infection is demonstrated but prolonged
therapy is of no benefit. More than 50 % of patients will experience further episodes. Sulphasalazine and methotrexate are useful
second line agents if the disease becomes chronic. About 15 % of patients go on
to develop erosive disease or spondylitis.
