Management of sexually acquired reactive arthritis in 19 North Thames GUM clinics.
Our objective was to describe how genitourinary medicine (GUM) clinics in the North Thames region manage sexually acquired reactive arthritis (SARA), and to compare management with national guidelines. A self-completed questionnaire survey and retrospective case note review was conducted between September and October 2001. Clinicians in 33 clinics were asked to describe their clinic's policy on the management of SARA, and to review the last five cases seen or the last cases seen in the preceding two years, if less than five. Nineteen (58%) clinics took part. There were inter-clinic variations in the investigation and management of patients, with only 63% (12/19) of clinics offering non-steroidal anti-inflammatory drugs (NSAIDs) and 58% (11/19) giving doxycycline 1001mg. twice daily for two weeks for urethritis - the rest using any of three other antibiotic regimens. There was no consistent policy of referral between other specialties and GUM for genital screening and partner notification. A total of 36 male and female case notes were reviewed. Patients without arthritis or joint swelling (5/38, 13%), or with non-typical symptoms such as diarrhoea (5/38, 13%) were diagnosed inappropriately with SARA. Only 33 (87%) had evidence of a sexually transmitted infection (STI) with at least two (5%) of patients being treated with antibiotics despite no apparent indication being present. Only 21 (55%) had documented NSAID therapy. Case identification was difficult due to the lack of a national disease code (KC60) for SARA. The data suggest that a diagnosis of SARA is sometimes being made with no identifiable STI, or where symptoms are more suggestive that another route of infection is likely. A clear guideline within clinics to standardize prescribing of antibiotics is needed and collaborative policies with GUM are needed for other specialties to use when investigating and managing patients with seronegative arthritis. GUM should consider re-introducing a KC60 code for SARA for better case identification.
Bell
Charlotte
C
Patrick Clements Clinic, The Central Middlesex Hospital, Acton Lane, Park Royal, London NW10 7NS, UK. charlotte.bell@st-marys.nhs.uk
Brook
Gary
G
Jones
Karen
K
Carlin
Elizabeth
E
Daniels
David
D
Forster
Greta
G
Miller
Robert
R
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D016918:Arthritis, Reactive / Q000175:diagnosis / Q000188:drug therapy*; D016358:Contact Tracing / Q000706:statistics & numerical data; D003951:Diagnostic Errors; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D006113:United Kingdom
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal