Return to Scenario ListShow Learning Points most relevant to Phase 1:

Reactive arthritis

Clinical Discipline(s)/Organ System(s)
Musculoskeletal System, Rheumatology, Immunology, Infectious Diseases
Progress Test Topic(s)
A 22 year old NZ European man presents to the Emergency Department with knee and ankle pain. He fell down the steps at home during the weekend. Further history reveals he has had burning pain on urination for over a week. On examination he has redness of the eyes, a swollen left knee and tenderness at the heels.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Structure, function and common pathologies of joints and ligaments including the ankle and foot
   - Structure, function and common pathologies of male urethra
   - Pathogenesis of spondyloarthritis
   - Pathophysiology and microbiology of inflammatory conditions of the male urogenital tract
   - Use and mechanism of action of non-steroidal anti-inflammatory drugs
Clinical and Communication Skills 
   - History of symptoms associated with spondyloarthritis including sexual history
   - Perform a
joint examination and a relevant examination of extra-articular manifestations of spondyloarthritis.

   - Differential diagnosis of asymmetric oligoarthritis and enthesitis
   - Differential diagnosis of urethral discharge
   - Apply Ottawa ankle rules (indications for X-rays)
   - Microbiological tests for laboratory evaluation of spondyloarthritis including stool cultures, urine samples and urethral swabs
   - Antibiotic therapy for genitourinary infection
Personal and Professional Skills 
   - Approach to patient with a sexually transmitted infection (STI) and advice regarding protection from STI
   - Contact tracing after diagnosis of STI
   - Understand the good prognosis but varied course of spondyloarthritis.
   - Strategies for dealing with uncertain diagnosis
   - Interaction and boundaries with patient who may be a similar age to yourself
Hauora Māori 
   - Comparative sexual health among Māori - awareness of differential access to services /quality of medical care
   - Self-reflective competencies: awareness of and ability to recognise own assumptions /stereotypes in relation to Māori patients and whanau, or youth
Population Health 
   - Epidemiology of spondyloarthritis.
   - Epidemiology of STIs
   - Prevention: surveillance of STIs, safer sex, current recommendations on Chlamydia screening
Conditions to be considered relating to this scenario
reactive arthritis, gout, trauma, gonococcal arthritis (disseminated gonococcal infection), ankylosing spondylitis, undifferentiated spondyloarthritis, psoriatic arthritis
Less common but 'important not to miss'
enteropathic arthritis (associated with inflammatory bowel disease), septic arthritis
Behçet’s disease, enterovirus infection (Coxsackie virus and Echovirus), intravesical Bacillus Calmette-Guerin