Reactive arthritis physical examination

Reactive arthritis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

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 (commonly).

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

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)pyelonephritis; bartholinitis
• Bartholinitis

Neuromuscular

• Neuromuscular examination of patients with [disease name] is usually normal.

OR

• Patient is usually oriented to persons, place, and time
• Altered mental status
• Glasgow coma scale is ___ / 15
• Clonus may be present
• Hyperreflexia / hyporeflexia / areflexia
• Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
• Muscle rigidity
• Proximal/distal muscle weakness unilaterally/bilaterally
• ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
• Unilateral/bilateral upper/lower extremity weakness
• Unilateral/bilateral sensory loss in the upper/lower extremity
• Positive straight leg raise test
• Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
• Positive/negative Trendelenburg sign
• Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
• Normal finger-to-nose test / Dysmetria
• Absent/present dysdiadochokinesia (palm tapping test)

Extremities

• Extremities examination of patients with [disease name] is usually normal.

OR

• Clubbing
• Cyanosis
• Pitting/non-pitting edema of the upper/lower extremities
• Muscle atrophy
• Fasciculations in the upper/lower extremity

Physical Examination

There is pain, swelling, redness, and heat in the joints.

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)

Gallery

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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