musculoskeletal and connective tissue disorders
Reactive Arthritis
Symptoms and Signs of Reactive Arthritis
Reactive arthritis can range from transient monarticular arthritis to a severe, multisystem disorder. Constitutional symptoms may include fever, fatigue, and weight loss. Arthritis may be mild or severe. Joint involvement is generally asymmetric and oligoarticular or polyarticular, occurring predominantly in the toes and large joints of the lower extremities and may include large knee effusions. Back pain may occur, usually with severe disease. Joint damage occurs rarely. Axial involvement is more often reported in patients with positive HLA-B27 and usually is asymmetric with large and bulky syndesmophytes. (inflammation at tendinous insertion into bone—eg, Plantar Fasciitis , digital periostitis, —small, transient, relatively painless, superficial ulcers—commonly occur on the oral mucosa, tongue, and glans penis (balanitis circinata). Particularly characteristic are vesicles (sometimes identical to Psoriasis ) of the palms and soles and around the nails that become hyperkeratotic and form crusts The ulcers in this photo are shallow and relatively painless. © Springer Science+Business Media This photo shows extensive psoriatic plaques, generalized erythema, and marked scaling on the palms in a patient with reactive arthritis. © Springer Science+Business Media This photo shows plaques, marked erythema, and scaling of the skin in a patient with reactive arthritis. © Springer Science+Business Media This image shows dystrophic nail changes resulting from reactive arthritis. Image courtesy of Karen McKoy, MD. Urethritismay develop 7 to 14 days after sexual contact (or occasionally after dysentery); low-grade fever, conjunctivitis, and arthritis develop over the next few weeks. Not all features may occur, so incomplete forms need to be considered. In men, the urethritis is less painful and productive of purulent discharge than acute gonococcal urethritis and may be associated with hemorrhagic cystitis or prostatitis. In women, urethritis and cervicitis may be mild (with dysuria or slight vaginal discharge) or asymptomatic. Conjunctivitisis the most common eye lesion. It usually causes mild eye redness and grittiness, but keratitis and anterior uveitis can develop also, causing eye pain, photophobia, and tearing. Rarely, cardiovascular complications (eg, aortitis, aortic insufficiency, cardiac conduction defects), pleuritis, and central nervous system or peripheral nervous system symptoms develop. 