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== Overview ==
 
==Overview==
Obtaining history is an important aspect in making a [[diagnosis]] of reactive arthritis. The areas of focus should be on onset, duration, and progression of [[symptoms]] with special focus on past [[medical history]] and current medications. Previous history of [[Gastrointestinal tract|gastrointestinal]] or [[Genitourinary system|genitourinary]] [[infections]] may predispose an individual to develop reactive arthritis. [[Symptoms]] start to appear after days to weeks of initial [[Gastrointestinal tract|gastrointestinal]] or [[genitourinary]] [[infection]]. Common [[symptoms]] of reactive arthritis include [[Urinary system|urinary]] changes (increased [[frequency]], [[dysuria]]/burning micturation and [[urgency]]), irritation and redness of eyes, and [[joint]] pain ([[arthralgia]]-commonly of [[lower limbs]]). Less common [[symptoms]] include [[inflammation]] of [[soft tissue]], swollen toes, and [[skin rash]]. If [[symptoms]] are present for more than six months, it is termed as chronic reactive arthritis.


==History and Symptoms==
==History and Symptoms==
[[Image:Feet-Reiters syndrome.jpg|thumb|left|200px|Diagnosis revealed that the rash on the bottom of this individual’s feet, known as ''keratoderma blennorrhagica'', was due to Reiter's syndrome' <small>Dr. MF Rein</small>.]]
===History===
Symptoms generally appear within 1-3 weeks but can range from 4-35 days from the onset of the inciting episode of the disease.
Obtaining history is an important aspect in making a [[diagnosis]] of reactive arthritis. It provides insight into cause, precipitating factors and associated [[Comorbidity|comorbid]] conditions. Complete history will help determine the correct therapy and helps in determining the [[prognosis]]. Specific histories about the [[symptoms]] (duration, onset, progression), associated [[symptoms]], drug usage have to be obtained. Specific areas of focus when obtaining the history, are outlined below:
 
*Past medical history (recent [[Gastrointestinal tract|GI]] or [[Genitourinary system|GU]] [[infection]])
The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination ([[dysuria]]) or an increased need to urinate ([[polyuria]] or [[frequency]]). Other urogenital problems may arise such as [[prostatitis]] in men, and [[cervicitis]], [[salpingitis]] and/or [[vulvovaginitis]] in women.
*[[Joint pain]] ([[arthralgia]])
 
*[[Back pain]]
The [[arthritis]] that follows usually affects the large joints such as the [[knee]]s causing [[Pain and nociception|pain]] and [[swelling]] with relative sparing of small joints such as the wrist and hand.
*Urinary changes ([[frequency]], urgency, dysuria or burning micturation)
*Visual disturbance
*[[Fatigue]]
*[[Fever]]


Eye involvement occurs in about 50% of men with urogenital reactive arthritis and about 75% of men with enteric reactive arthritis. [[Conjunctivitis]] and [[uveitis]] can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.
===Common Symptoms===
 
Common [[symptoms]] of reactive arthritis include:<ref name="pmid8129453">{{cite journal |vauthors=Braun J, Laitko S, Treharne J, Eggens U, Wu P, Distler A, Sieper J |title=Chlamydia pneumoniae--a new causative agent of reactive arthritis and undifferentiated oligoarthritis |journal=Ann. Rheum. Dis. |volume=53 |issue=2 |pages=100–5 |date=February 1994 |pmid=8129453 |pmc=1005260 |doi= |url=}}</ref><ref name="pmid18436339">{{cite journal |vauthors=Wu IB, Schwartz RA |title=Reiter's syndrome: the classic triad and more |journal=J. Am. Acad. Dermatol. |volume=59 |issue=1 |pages=113–21 |date=July 2008 |pmid=18436339 |doi=10.1016/j.jaad.2008.02.047 |url=}}</ref><ref name="pmid23673301">{{cite journal |vauthors=Kanwar AJ, Mahajan R |title=Reactive arthritis in India: a dermatologists' perspective |journal=J Cutan Med Surg |volume=17 |issue=3 |pages=180–8 |date=2013 |pmid=23673301 |doi=10.2310/7750.2012.12048 |url=}}</ref>
Roughly 20 to 40 percent of men with reactive arthritis develop penile lesions called [[balanitis circinata]] (circinate balanitis) on the end of the penis. A small percentage of men and women develop small hard nodules called [[keratoderma blennorrhagica]] on the soles of the feet, and less often on the palms of the hands or elsewhere. In addition, some people with Reactive Arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some people suffer serious gastrointestinal problems similar to those of Crohn's Disease.
*Urinary changes (increased [[frequency]], burning and [[urgency]])
 
*Irritation and redness of eyes
About 10 percent of people with Reactive Arthritis, especially those with prolonged disease, will develop cardiac manifestations including [[aortic regurgitation]] and [[pericarditis]].
*[[Joint pain]] ([[arthralgia]]-commonly of [[lower limbs]])


===Less Common Symptoms===
Less common [[symptoms]] of reactive arthritis include:<ref name="pmid22795425">{{cite journal |vauthors=Ngaruiya CM, Martin IB |title=A case of reactive arthritis: a great masquerader |journal=Am J Emerg Med |volume=31 |issue=1 |pages=266.e5–7 |date=January 2013 |pmid=22795425 |doi=10.1016/j.ajem.2012.04.019 |url=}}</ref>
*[[Inflammation]] of [[soft tissue]]
*Swollen toes
*[[Skin rash]]
<br style="clear:left">
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Rheumatology]]
[[Category:Rheumatology]]
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Latest revision as of 19:48, 6 June 2018

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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

Obtaining history is an important aspect in making a diagnosis of reactive arthritis. The areas of focus should be on onset, duration, and progression of symptoms with special focus on past medical history and current medications. Previous history of gastrointestinal or genitourinary infections may predispose an individual to develop reactive arthritis. Symptoms start to appear after days to weeks of initial gastrointestinal or genitourinary infection. Common symptoms of reactive arthritis include urinary changes (increased frequency, dysuria/burning micturation and urgency), irritation and redness of eyes, and joint pain (arthralgia-commonly of lower limbs). Less common symptoms include inflammation of soft tissue, swollen toes, and skin rash. If symptoms are present for more than six months, it is termed as chronic reactive arthritis.

History and Symptoms

History

Obtaining history is an important aspect in making a diagnosis of reactive arthritis. It provides insight into cause, precipitating factors and associated comorbid conditions. Complete history will help determine the correct therapy and helps in determining the prognosis. Specific histories about the symptoms (duration, onset, progression), associated symptoms, drug usage have to be obtained. Specific areas of focus when obtaining the history, are outlined below:

Common Symptoms

Common symptoms of reactive arthritis include:[1][2][3]

Less Common Symptoms

Less common symptoms of reactive arthritis include:[4]


References

  1. ↑ Braun J, Laitko S, Treharne J, Eggens U, Wu P, Distler A, Sieper J (February 1994). "Chlamydia pneumoniae--a new causative agent of reactive arthritis and undifferentiated oligoarthritis". Ann. Rheum. Dis. 53 (2): 100–5. PMC 1005260. PMID 8129453.
  2. ↑ Wu IB, Schwartz RA (July 2008). "Reiter's syndrome: the classic triad and more". J. Am. Acad. Dermatol. 59 (1): 113–21. doi:10.1016/j.jaad.2008.02.047. PMID 18436339.
  3. ↑ Kanwar AJ, Mahajan R (2013). "Reactive arthritis in India: a dermatologists' perspective". J Cutan Med Surg. 17 (3): 180–8. doi:10.2310/7750.2012.12048. PMID 23673301.
  4. ↑ Ngaruiya CM, Martin IB (January 2013). "A case of reactive arthritis: a great masquerader". Am J Emerg Med. 31 (1): 266.e5–7. doi:10.1016/j.ajem.2012.04.019. PMID 22795425.

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