Reactive arthritis

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Background

  • Seronegative spondyloarthropathy that manifests as an acute, asymmetric, oligoarthritis (LE>UE) that occurs 2-6 weeks after infection
  • Associated with bacterial infections
    • Shigella, Salmonella, Campylobacter, Chlamydia, etc.
  • Classic triad: urethritis, conjunctivitis, and arthritis ("Can't pee, can't see, can't climb a tree")

Clinical Features

  • Preceding Infection
    • Urethritis: generally caused by Chlamydia or Ureaplasma
    • Enteritis: generally caused by Salmonella or Shigella
    • Preceding infection may be clinically silent
  • Musculoskeletal symptoms
  • Extraarticular symptoms
  • Keratoderma blennorrhagicum[1]
    • Develops in 15% of patients
    • Found on palm/soles. Vesicles/pustules with yellow/brown color. Appears similar to pustular psoriasis

Differential Diagnosis

Monoarticular arthritis

Algorithm for Monoarticular arthralgia

Oligoarthritis

Polyarthritis

Algorithm for Polyarticular arthralgia

Migratory Arthritis

Evaluation

Management

Disposition

  • Outpatient follow up, with DMARDs if refractory to NSAIDs
  • 70% self-limited disease

See Also

External Links

References

  1. 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.