Reactive arthritis Reactive arthritis may represent an autoimmune response of molecular mimicry involving T lymphocytes that cross react

t with antigens (synovial, cartilaginous, glycosoaminoglycan) in the joints. Usually associated with GI or GU infections Transient (toxic) synovitis may follow an URTI and usually presents with hip pain which on radiology will show widening of space from suppuration (aspirate to relieve pain), ESR and WBC usually normal GI infections usually salmonella, shigella, Yersinia and campylobacter GU infecions usually chlamydia trachomatis, Viruses such as varicella, parvovirus, hepatitis B also possible, rarely EBV Those with GI infections may develop inflammatory bowel disease in the future Bacterial enteritis: o Although the erythrocyte sedimentation rate (ESR) may be elevated, fever and leukocytosis are often absent. o Urethritis and conjunctivitis occur occasionally in these syndromes. o Postinfectious arthritis may follow by 12 mo less apparent illness, such as viral upper respiratory tract infections. o The pain or joint swelling is usually transient, lasting <6 wk. Infective endocarditis can be associated with arthralgia, arthritis, or signs suggestive of vasculitis, such as Osler nodes, Janeway lesions, and Roth spots. Reactive arthritis perhaps due to immune complexes, also occurs in children with Neisseria gonorrhoeae, Neisseria meningitidis, Haemophilus influenzae type b, and Mycoplasma pneumoniae infections. Certain viruses associated with arthritis may result in particular patterns of joint involvement. o Rubella and hepatitis B virus typically affect the small joints; mumps and varicella often involve large joints, especially the knees. o The hepatitis B arthritis-dermatitis syndrome is characterized by rash and an arthritis resembling that of serum sickness. o Rubella-associated arthropathy follows natural rubella infection and, infrequently, rubella immunization. It typically occurs in young women, with an increased frequency with advancing age, and is uncommon in preadolescent children and in males. Arthralgias of the knees and hands usually begin within 7 days of onset of the rash or 1028 days after immunization. o Parvovirus B19, responsible for erythema infectiosum (fifth disease), can cause arthralgia, symmetric joint swelling, and morning stiffness in adults, particularly women, and less frequently in children.