Reactive arthritis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

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.

Physical Examination

Physical examination of patients with reactive arthritis is usually remarkable for arthritis, conjunctivitis, and urethritis.

Appearance of the Patient

• Patients with reactive arthritis usually appear fatigued.

Vital Signs

• Low-grade fever

Skin

• Skin examination of patients with reactive arthritis presents with onychodystrophy and keratoderma blennorrhagicum (characteristic but seen only in 5-10%).

HEENT

• 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.

Heart

Involvement of the heart is rare in reactive arthritis. Cardiovascular examination of patients with severe reactive arthritis may have:

• Myocarditis
• Pericarditis
• Aortitis
• Aortic regurgitation
• Transient conduction abnormalities

Abdomen

• Diarrhea
• Abdominal pain

Genitourinary

• 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)
• Bartholinitis

Extremities

Lower extremities (weight bearing joints, metatarsophalangeal joints >> calcaneus > ankle > knee) are commonly affected in reactive arthritis. Signs include:

• Mono- or oligoarthritis
• Dactylitis (sausage-shaped finger)
• Enthesopathy (Achilles tendon)
• Sacroiliitis

Gallery

Images

• 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)

Skin

Extremities

• 
  Patient’s hands exhibited severe sloughing of the skin, which is a symptom of his diagnosed “Reiter’s syndrome”. From Public Health Image Library (PHIL).
• 
  Patient’s right hand exhibited pustules on the palm and fingers, which is a symptom of his diagnosed “Reiter’s syndrome”. From Public Health Image Library (PHIL).
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.

Genitalia

• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.
• 
  Reiter's syndrome. Adapted from Dermatology Atlas.

Eye

• 
  Reiter's syndrome. Adapted from Dermatology Atlas.

References

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