Clinical features of reactive arthritis

Kwiatkowska, 2009Zochling, 2010

Arthritis is the hallmark feature of reactive arthritis; however, the clinical presentation may also include conjunctivitis and urethritis.

The arthritis is typically an inflammatory peripheral arthropathy with an asymmetrical oligoarticular distribution, predominantly affecting the lower limbs. Dactylitis (inflammation of a whole finger or toe) is a common feature, and enthesitis (inflammation at the sites of tendon and ligament attachment to bone) can occur. The articular symptoms typically develop at least one week after an infective illness; this temporal relationship may help to distinguish reactive arthritis from joint infection (see Septic arthritis or Viral arthritis). While Streptococcus pyogenes infection does not cause reactive arthritis, it may cause rheumatic fever, which is a postinfective arthritis and should be considered in high-risk populations (see Acute rheumatic fever).

Extra-articular features of reactive arthritis include:

• conjunctivitis in up to 33% of cases. Acute anterior uveitis can occur, although less commonly than with axial spondyloarthritis
• genitourinary inflammation, including urethritis, prostatitis and balanitis
• keratoderma blennorrhagica. This is a pustular hyperkeratotic rash typically affecting the palms and soles of the feet, which is histologically identical to pustular psoriasis.