Diagnosis of Joint Pain Following UTI
Patient Presentation Summary
A 31-year-old male presents with fever, weight loss, knee joint pain and swelling, and low backache with stiffness.
Crucially, he had symptoms of a urinary tract infection (UTI) approximately three weeks earlier.
Key Investigations
- Joint fluid analysis reveals leukocytes (indicating inflammation) and multinucleated macrophages.
- Urine culture results are sterile.
Reasoning for Diagnosis
The clinical picture, particularly the history of a preceding UTI and the subsequent development of arthritis and back stiffness, strongly suggests Reactive Arthritis.
- Reactive Arthritis: This diagnosis aligns with arthritis developing weeks after a genitourinary (like the UTI) or gastrointestinal infection. The patient's symptoms (fever, weight loss, knee arthritis, low back stiffness possibly indicating sacroiliitis) are characteristic. The sterile urine culture confirms the arthritis is a reactive phenomenon, not an active infection. Inflammatory synovial fluid is typical.
- Septic Arthritis: Considered less likely due to the sterile urine culture and the clear preceding infection history pointing towards a reactive process rather than direct joint seeding.
- Crystal Arthritis: Typically presents with acute flares and is not usually associated with a prior UTI or the specific pattern of back stiffness seen here.
- Still Disease: While possible, the direct link to a recent UTI makes Reactive Arthritis the more probable diagnosis.
Given the preceding UTI, the symptom latency, the specific clinical findings, and the laboratory results, Reactive Arthritis is the most probable diagnosis.
Important Questions from Arthritis
- Which of the following statements regarding Ankylosing spondylitis (AS) are true?
1. AS occurs in about 10 % of Inflammatory Bowel Disease(IBD) patients
2. The AS activity is related to Bowel activity in IBD patients
3. The AS activity does remit with glucocorticoids or colectomy in IBD patients
Select the correct answer using the code given below: - Which of the following statements about “Early onset Osteoarthritis” are true?
1. Onset is usually before the age of 55 years
2. There is clear history of previous trauma
3. In most cases, single joint is affected
Select the correct answer using the code given below: - Consider the following statements regarding Gout in old age.
1. Most of older patients have gout secondary to diuretic use and chronic kidney disease
2. Joints of the upper limbs are more frequently affected
3. Presentation is typical with acute attack of gout
Which of the statements given above are correct? - A 28-year old woman complains of arthritis involving bilateral metacarpophalangeal, proximal interphalangeal and wrist joints of one year duration. The most likely disease entity is:
- Which of the following are the complications of Rheumatoid arthritis?
1. Peripheral entrapment neuropathies
2. Subluxation of the cervical spine at the atlanto-axial joint
3. Primary amyloidosis
4. Lymphoma
Select the correct answer using the code given below:
