Reactive arthritis physical examination
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Physical examination of patients with reactive arthritis is usually remarkable for arthritis (lower extremity; weight bearing), conjunctivitis, and urethritis. As the duration and severity of reactive arthritis increases other signs include dactylitis (sausage-shaped fingers), enthesopathy, sacroiliitis, keratoderma blennorrhagicum, circinate balanitis, myocarditis, and pericarditis.
Appearance of the Patient
- Patients with reactive arthritis usually appear fatigued.
- Skin examination of patients with reactive arthritis presents with onychodystrophy and keratoderma blennorrhagicum (characteristic but seen only in 5-10%).
- Ophthalmoscopic exam may be abnormal with findings of conjunctivitis.
- As the disease progresses other findings such as scleritis, episcleritis, and corneal ulceration may be present.
Involvement of the heart is rare in reactive arthritis. Cardiovascular examination of patients with severe reactive arthritis may have:
- Urethritis with erythema, edema and clear mucoid discharge.
- Spread of infection may further lead to prostatitis (males) or cervicitis, cystitis, salpingo-oophoritis and vulvovaginitis (females).
- Circinate balanitis (balanitis circinata)
- Mono- or oligoarthritis
- Dactylitis (sausage-shaped finger)
- Enthesopathy (Achilles tendon)
- Picture - Conjunctivitis in reactive arthritis (Chlamydia)
- Picture - Psoriasiform skin changes in reactive arthritis (Chlamydia)
- Picture - arm lesions in reactive arthritis (Chlamydia)
- Picture - hand lesions in reactive arthritis (Chlamydia)