Common findings include oral ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. In the oral cavity, the patients may experience recurrent aphthous stomatitis, geographic tongue and migratory stomatitis in higher prevalence than the general population. Some patients experience serious gastrointestinal problems similar to those of Crohns disease. About 10 percent of people with reactive arthritis, especially those with a prolonged course of the disease, will develop cardiac manifestations, including aortic regurgitation and pericarditis. Reactive arthritis has been described as a precursor of other joint conditions, including ankylosing spondylitis. Causes
Reactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence of enthesitis as the basic pathologic lesion and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis. Other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp. A bout of food poisoning or a gastrointestinal infection may also precede the disease (the last four genera of bacteria mentioned above are enteric bacteria). Shigella is the most common organism causing reactive arthritis following diarrhea. Chlamydia trachomatis is the most common cause of reactive arthritis following urethritis. Ureaplasma and mycoplasma are rare causes. There is some circumstantial evidence for other organisms causing the disease, but the details are unclear.Reactive arthritis usually manifests about 1–3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown.
While early cervical pregnancies may abort spontaneously or can be managed with excision, D&C, suturing, electrocautery, and tamponading, by medication such as methotrexate, and/or by uterine artery embolization, a more advanced pregnancy may require a hysterectomy to control bleeding. The more advanced the pregnancy, the higher the risk for major bleeding necessitating a hysterectomy.On very rare occasions, a cervical pregnancy results in the birth of a live baby; typically, the pregnancy is in the upper part of the cervical canal and manages to extend into the lower part of the uterine cavity. A cervical pregnancy can develop together with a normal intrauterine pregnancy; such a heterotopic pregnancy will call for expert management as to not to endanger the intrauterine pregnancy. Epidemiology
The incidence has been reported to be about 1:1,000 to 1:16,000 pregnancies.Pregnancies involving the isthmus – the segment of the uterus between the cervix and the fundus – are more common than true cervical pregnancies. While in many situations the cause of the abnormal implantation remains unclear, there is evidence to link the development of cervical pregnancy to uterine instrumentation, specifically repeated D&Cs (dilatation and curettage). Cervical pregnancies are to be distinguished from pregnancies that start from an implantation in a scar of a previous cesarean section, so-called scar pregnancies. References


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