Differentiating reactive arthritis from other diseases: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="7" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! colspan="6" |Clinical Features
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Body Distribution
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Key Signs
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Laboratory Abnormalities
|-
|-
|
|'''History of Psoriasis'''
|'''Symmetric [[joint]] involvement'''
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
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|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|'''[[HLA-B27]]'''
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|-
|-
|'''[[Psoriatic arthritis]]'''
|'''[[Psoriatic arthritis]]'''
| +
| +
| +
| ++
| ++
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|-
|-
|'''[[Rheumatoid arthritis]]'''
|'''[[Rheumatoid arthritis]]'''
| -
| ++
| ++
| +
| +
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|-
|-
|'''[[Ankylosing spondylitis]]'''
|'''[[Ankylosing spondylitis]]'''
| -
| +++
| +++
| -
| -
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| -
| -
|90%
|90%
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| -
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|}
|}


Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
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Reactive arthritis must be differentiated from other causes of rash and arthritis<ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959  }} </ref>
Reactive arthritis must be differentiated from other causes of rash and arthritis<ref name="pmid3101626">{{cite journal| author=Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK| title=The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis. | journal=Arch Intern Med | year= 1987 | volume= 147 | issue= 2 | pages= 281-3 | pmid=3101626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3101626  }} </ref><ref name="pmid16297736">{{cite journal| author=Rice PA| title=Gonococcal arthritis (disseminated gonococcal infection). | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 853-61 | pmid=16297736 | doi=10.1016/j.idc.2005.07.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297736  }} </ref><ref name="pmid22353959">{{cite journal| author=Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG| title=Disseminated gonococcal infection in women. | journal=Obstet Gynecol | year= 2012 | volume= 119 | issue= 3 | pages= 597-602 | pmid=22353959 | doi=10.1097/AOG.0b013e318244eda9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22353959  }} </ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Musculoskeletal manifestation include [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain.
*Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions.
*Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Nongonococcal [[septic arthritis]]'''
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with polyarthritis and rash (rare presentation) in young adults. Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
*Presents with polyarthritis and rash (rare presentation) in young adults.  
*Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
|-
|-
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| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
*Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with [[lymphadenopathy|generalized lymphadenopathy]]
*Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS) tests confirm the presence of the causative agent.
*Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS)  
|-
tests confirm the presence of the causative agent.
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Reactive arthritis]] (Reiter syndrome)'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Musculoskeletal manifestation include [[arthritis]], [[tenosynovitis]], [[dactylitis]], and low back pain.
*Extraarticular manifestation include [[conjunctivitis]], [[urethritis]], and genital and oral lesions.
*Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''

Revision as of 13:28, 5 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Reactive Arthritis from other Diseases

Reactive arthritis should be distinguished from other diseases causing arthritis of the peripheral skeleton, which present as arthralgia. The differentials include:

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Reactive arthritis (Reiter's syndrome) +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%
Psoriatic arthritis + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Ankylosing spondylitis +++ - + - - - + + +++ (Bilateral) +++ +++ ++ (Narrowing) +++ +++ (Fluffy) + +++ - 90%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

Reactive arthritis must be differentiated from other causes of rash and arthritis[1][2][3]

Disease Findings
Reactive arthritis (Reiter syndrome)
  • Musculoskeletal manifestation include arthritis, tenosynovitis, dactylitis, and low back pain.
  • Extraarticular manifestation include conjunctivitis, urethritis, and genital and oral lesions.
  • Reactive arthritis is a clinical diagnosis based upon the pattern of findings and there is no definitive diagnostic test
Nongonococcal septic arthritis
  • Presents with an acute onset of joint swelling and pain (usually monoarticular)
  • Culture of joint fluid reveals organisms
Acute rheumatic fever
  • Presents with polyarthritis and rash (rare presentation) in young adults.
  • Microbiologic or serologic evidence of a recent streptococcal infection confirm the diagnosis.
  • Poststreptococcal arthritis have a rapid response to salicylates or other antiinflammatory drugs.
Syphilis
  • Presents with acute secondary syphilis usually presents with generalized, pustular lesions at the palms and soles with generalized lymphadenopathy
  • Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) and Fluorescent treponemal antibody absorption (FTA-ABS)

tests confirm the presence of the causative agent.

Hepatitis B virus (HBV) infection
  • Presents with fever, chills, polyarthritis, tenosynovitis, and urticarial rash
  • Synovial fluid analysis usually shows noninflammatory fluid
  • Elevated serum aminotransaminases and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
Herpes simplex virus (HSV)
  • Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
  • Viral culture, polymerase chain reaction (PCR), and direct fluorescence antibody confirm the presence of the causative agent.
HIV infection
  • Present with generalized rash with mucus membrane involvement, fever, chills, and arthralgia. Joint effusions are uncommon
Gout and other crystal-induced arthritis
  • Presents with acute monoarthritis with fever and chills
  • Synovial fluid analysis confirm the diagnosis.
Lyme disease
  • Present with erythema chronicum migrans rash and monoarthritis as a later presentation.
  • Clinical characteristics of the rash and and serologic testing confirm the diagnosis.

References

  1. ↑ Rompalo AM, Hook EW, Roberts PL, Ramsey PG, Handsfield HH, Holmes KK (1987). "The acute arthritis-dermatitis syndrome. The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis". Arch Intern Med. 147 (2): 281–3. PMID 3101626.
  2. ↑ Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
  3. ↑ Bleich AT, Sheffield JS, Wendel GD, Sigman A, Cunningham FG (2012). "Disseminated gonococcal infection in women". Obstet Gynecol. 119 (3): 597–602. doi:10.1097/AOG.0b013e318244eda9. PMID 22353959.


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