Date:
Patient:
Reason for Visit:
Follow-up for reactive arthritis (ReA)
Assessment of joint pain, inflammation, and functional limitations
Evaluation of response to treatment and potential complications
History:
Presenting Illness:
Onset, duration, and location of joint pain and stiffness (typically asymmetric and involving large joints like knees, ankles, hips, or sacroiliac joints)
Presence of morning stiffness (lasting >30 minutes)
History of a preceding triggering event (typically a gastrointestinal or genitourinary infection) within the past few weeks or months
Severity of symptoms and impact on daily activities
Any associated symptoms (e.g., fever, fatigue, uveitis – eye inflammation, urethritis – urinary tract inflammation)
Past Medical History (PMH):
Prior history of ReA or other inflammatory arthritis (e.g., rheumatoid arthritis)
Underlying conditions associated with ReA (e.g., inflammatory bowel disease, ankylosing spondylitis, Reiter’s syndrome)
Past infections (e.g., Chlamydia, Salmonella, Yersinia)
Physical Exam:
General: Assess for signs of fever, fatigue, or systemic inflammation.
Musculoskeletal:
Evaluate for joint tenderness, swelling, warmth, and range of motion limitations in affected joints.
Look for signs of enthesitis (inflammation at the attachment points of tendons, ligaments to bone) at bony prominences (e.g., heels, knees).
Diagnostic Tests (may be ordered depending on clinical presentation):
Laboratory Tests:
Complete blood count (CBC) – may show elevated white blood cells suggestive of inflammation.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) – elevated levels indicate inflammation, but not specific for ReA.
HLA-B27 typing – positive test can be suggestive of ReA, but not diagnostic (present in healthy individuals as well).
Synovial fluid analysis (if joint aspiration performed) – can help differentiate ReA from other inflammatory arthropathies.
Imaging Tests (may be used to assess joint damage):
X-rays – may show erosions or joint space narrowing in later stages of ReA.
Magnetic resonance imaging (MRI) – can detect early joint inflammation and bone marrow edema.
Assessment:
Confirmation of ReA: Based on clinical presentation (joint symptoms following an infection), HLA-B27 status (if positive), and exclusion of other inflammatory arthritides.
Severity of joint involvement: Number of affected joints, degree of pain and inflammation, functional limitations.
Presence of extra-articular manifestations: Uveitis, urethritis, or other complications.
Plan:
Non-pharmacological interventions:
Rest and joint protection
Physical therapy to maintain joint mobility and muscle strength
Patient education on disease management and lifestyle modifications (e.g., smoking cessation)
Pharmacological therapy:
Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation control.
Disease-modifying antirheumatic drugs (DMARDs) like methotrexate or sulfasalazine may be considered in severe cases or those with persistent symptoms.
Corticosteroid injections into inflamed joints for short-term relief.
Referral to a rheumatologist: For complex cases, severe disease, or consideration of DMARD therapy.
Referral to an ophthalmologist: If uveitis is present.
Referral to a urologist: If urethritis is present.
Patient education: Provide information about ReA, the link to preceding infections, treatment options, importance of self-care strategies, and potential complications.
Discuss the chronic nature of ReA and the importance of ongoing management to control symptoms and prevent joint damage.
Follow-up:
Schedule for follow-up appointments based on disease severity:
More frequent visits for patients with active disease.
Less frequent visits for patients with well-controlled symptoms.
Monitor response to treatment, adjust medications as needed, and assess for potential complications.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of reactive arthritis