Reactive Arthritis Flashcards
defined by an episode of peripheral arthritis of > 1 month’s duration occur- ring in association with urethritis and/or cervicitis
Reactive arthritis
Frequently accompanied by keratoderma blennorrhagicum, circinate balanitis, conjunctivitis, and
stomatitis.
Classic triad.
arthritis, urethritis, and conjunctivitis.
Age of onset.
Gender.
Genetic.
Median 22 yo
Male 90%
HLA B27- 75%
Patients who are HLA-B27 negativehaveamildercourse,withsigni - cantly less sacroiliitis, uveitis, and carditis.
Clinical manifestation
Onset 1 to 4 weeks after infection: Enterocolitis, nongonococcal urethritis. Urethritis and/or conjunctivitis usually first to appear, followed by arthritis.
Symptoms consist of malaise, fever,dysuria, and urethral discharge. Eyes: Red, slightly sensitive, and seronegative arthritis.
Skin lesions
Resemble those of psoriasis, espe- cially on the palms/soles, and glans penis.
Keratoderma blennorrhagicum: Brownish- red papules or macules, sometimes topped
by vesicles that enlarge; centers of lesions become pustular and/or hyperkeratotic, crusted, mainly on palms and soles
Circinate balanitis: Shallow erosions with serpiginous, micropustular borders in uncircumcised; crusted and/ or hyperkeratotic plaques in circumcised, i.e., psoriasi orm.
Lesions in nails and mucous membrane
NAILS Small subungual pustules → onycholysis and subungual hyperkeratosis.
MUCOUS MEMBRANES
Urethra- Sterile serous or mucopurulent discharge. Mouth- Erosive lesions on tongue or hard palate, resembling migratory glossitis.
How many percent have the triad of arthritis, urethritis and conjunctivitis.
30%
40% - have only 1 manifestation
Treatment to cutaneous manifestion.
Balanitis: low potency glucocorticoids.
Palmar/plantar: Potent glucocorticoid preparations, which are more effective under plastic occlusion.
Extensive or refractory disease: systemic retinoids (acitretin, 0.5 to 1 mg/kg body weight), photo- therapy, and PUVA. Anti- NF agents.
