Reactive arthritis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
Can't see, Can't pee, Can't climb a tree | *Can't see, Can't pee, Can't climb a tree | ||
(Classical triad in 1/3 of pts) | **(Classical triad in 1/3 of pts) | ||
*Conjunctivitis or uveitis | **Conjunctivitis or uveitis | ||
*Nongonococcal urethritis | **Nongonococcal urethritis | ||
*Asymmetric oligoarthritis | **Asymmetric oligoarthritis | ||
*Keratoderma blennorrhagicum<ref>Wolff K, Johnson R, Saavedra AP. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw-Hill; 2013.</ref> | |||
**Develops in 15% of pts | |||
**Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular [[psoriasis]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 04:15, 30 January 2016
Background
- Associated with bacterial infections
- Shigella, Salmonella, Campylobacter, Chlamydia, etc.
Clinical Features
- Can't see, Can't pee, Can't climb a tree
- (Classical triad in 1/3 of pts)
- Conjunctivitis or uveitis
- Nongonococcal urethritis
- Asymmetric oligoarthritis
- Keratoderma blennorrhagicum[1]
- Develops in 15% of pts
- Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular psoriasis
Differential Diagnosis
Monoarticular arthritis
- Acute osteoarthritis
- Avascular necrosis
- Crystal-induced (Gout, Pseudogout)
- Gonococcal arthritis, arthritis-dermatitis syndrome
- Nongonococcal septic arthritis
- Lyme disease
- Malignancy (metastases, osteochondroma, osteoid osteoma)
- Reactive poststreptococcal arthritis
- Trauma-induced arthritis
- Fracture
- Ligamentous injury
- Overuse
- Avascular necrosis
- Decompression sickness
- Spontaneous osteonecrosis
- Hemorrhagic (e.g. hemophilia, systemic anticoagulation
- Seronegative spondyloarthropathies (ankylosing spondylitis, IBD, psoriatic arthritis, reactive arthritis
- RA, SLE
- Sarcoidosis, amyloidosis
- Periarticular pathology
- Transient (Toxic) Synovitis (Hip)
- Slipped Capital Femoral Epiphysis (SCFE)
- Legg Calve Perthes Disease
Oligoarthritis
- Ankylosing spondylitis
- Gonococcal arthritis
- Lyme disease
- Psoriatic arthritis
- Reactive arthritis
- Rheumatic fever
- Rheumatoid arthritis
- Systemic lupus erythematosus
Polyarthritis
- Fibromyalgia
- Juvenile idiopathic arthritis
- Lyme disease
- Osteoarthritis
- Psoriatic arthritis
- Reactive poststreptococcal arthritis
- Rheumatoid arthritis
- Rheumatic fever
- Serum sickness
- Systemic lupus erythematosus
- Serum sickness–like reactions
- Viral arthritis
Migratory Arthritis
- Gonococcal arthritis
- Lyme disease
- Rheumatic fever
- Systemic lupus erythematosus
- Viral arthritis
Diagnosis
- Clinical diagnosis
- Must exclude gonococcal arthritis and other mimics
Management
- NSAIDs
- Antibiotics not needed for postdysentery form
- Consider doxycycline in chlamydia
Disposition
- Outpatient follow up, with DMARDs if refractory to NSAIDs
- 70% self-limited disease
See Also
External Links
References
- ↑ Wolff K, Johnson R, Saavedra AP. The Skin in Immune, Autoimmune, and Rheumatic Disorders. In: Wolff K, Johnson R, Saavedra AP. eds. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7e. New York, NY: McGraw-Hill; 2013.
- Lozada CJ et al. Reactive Arthritis. Oct 31 2015. http://emedicine.medscape.com/article/331347-overview#showall.