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Chapter 161: Reactive Arthritis

Barbara Kiersz-Mueller; Heidi S. Chumley; Angela D. Shedd; Suraj G. Reddy; Richard P. Usatine

PATIENT STORY

A 29-year-old man presented with concerns about an extensive rash that had developed over the previous month. The rash was reported to involve the scalp, abdomen, penis, hands, and feet (Figures 161-1, 161-2, 161-3, 161-4, 161-5). He also complained of severe joint pain, involving the back, knees, and feet. He denied ocular, GI, or genitourinary complaints, but was prescribed a course of antibiotics last month when his partner was diagnosed with Chlamydia.

FIGURE 161-1

Reactive arthritis in a young man showing annular scalp lesions (circinate plaques). (Reproduced with permission from Shedd AD, Reddy SG, Meffert JJ, Kraus EW. Acute onset of rash and oligoarthritis, J Fam Pract. 2007;56(10):811-814. Frontline Medical Communications. Inc..)

A photo shows reddish ring-like lesions in the scalp of a child.
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FIGURE 161-2

Keratoderma blennorrhagicum with hyperkeratotic papules, plaques, and pustules that have coalesced to form circular borders. (Reproduced with permission from Shedd AD, Reddy SG, Meffert JJ, Kraus EW. Acute onset of rash and oligoarthritis. J Fam Pract. 2007;56(10):811-814. Frontline Medical Communications.)

A photo shows reddish lesions in the sole. The lesions comprise of papules, pus-filled blisters, and pinkish plaques with scaly borders.
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FIGURE 161-3

Erythema and scale seen on the toes of the patient in Figure 161-1. Note the nail involvement with subungual keratosis and onycholysis. The fourth toe is red and swollen; this is called dactylitis. (Reproduced with permission from Shedd AD, Reddy SG, Meffert JJ, Kraus EW. Acute onset of rash and oligoarthritis. J Fam Pract. 2007;56(10):811-814. Frontline Medical Communications.)

A photo shows redness in the toes, around the nail bed. The nails appear yellowish, dry, and brittle.
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FIGURE 161-4

The patient in Figure 161-1 with psoriasiform lesions on the corona and glans. The patient also has erythema in the inguinal area that resembles inverse psoriasis. This particular case does not exemplify classic balanitis circinata, which is characterized by annular or arcuate thin scaly plaques, as opposed to the nonspecific scaly plaques found on this patient. (Reproduced with permission from Suraj Reddy, MD.)

A photo shows redness and dry scaly lesions in the penis and along the inguinal folds.
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FIGURE 161-5

psoriatic-appearing plaque on the leg in the same patient with reactive arthritis in Figure 161-1. (Reproduced with permission from Shedd AD, Reddy SG, Meffert JJ, Kraus EW. Acute onset of rash and oligoarthritis, J Fam Pract. 2007;56(10):811-814. Frontline Medical Communications. Inc.)

A photo shows a large reddish plaque with white scaly surface.
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The patient's young age, rapid onset of symptoms, dermatologic findings, and arthritis were suggestive of reactive arthritis. The patient's joint pain was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and skin lesions were treated with topical corticosteroids. No antibiotics were prescribed because no current infectious agent was identified. In conjunction with a dermatologist, acitretin 25 mg daily was started to treat his psoriasiform lesions.

INTRODUCTION

Reactive arthritis is a noninfectious acute oligoarthritis that occurs ...

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