Differentiating reactive arthritis from other diseases: Difference between revisions

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{{Reactive arthritis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Reactive_arthritis]]
{{CMG}}
{{CMG}}


==Overview==
==Overview==
Reactive arthritis should be distinguished from other [[HLA-B27]] diseases causing arthritis of the peripheral skeleton, which present as [[arthralgia]]. The differentials include [[psoriatic arthritis]], [[rheumatoid arthritis]] and [[ankylosing spondylitis]].


==Differentiating Reactive Arthritis from other Diseases==
==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:
{| class="wikitable"
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Arthritis Type
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" ! + |Clinical Features
! 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;" ! + |Laboratory Abnormalities
|-
|'''Symmetric [[joint]] involvement'''
|'''Asymmetric [[joint]] involvement'''
|[[Enthesopathy|'''Enthesopathy''']]
|'''[[Dactylitis]]'''
|'''[[Nail (anatomy)|Nail]] [[Dystrophy]]'''
|'''[[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] association'''
|'''[[Upper extremity]]-hands'''
|'''[[Lower extremity]]'''
|'''[[Sacroiliac joint|Sacroiliac joints]]'''
|'''[[Spine]]'''
|'''[[Osteopenia]]'''
|'''[[Joint]] Space'''
|'''[[Ankylosis]]'''
|'''[[Periostitis]]'''
|'''[[Soft tissue]] swelling'''
|'''[[ESR]]'''
|'''[[Rheumatoid factor]] ([[Rheumatoid factor|RF]])'''
|'''[[HLA-B27]]'''
|-
|'''[[Reactive arthritis]] ([[Reiter's syndrome]])'''
| +++
| -
| +
| +
| -
| -
| ++
| +++
| ++ (Unilateral)
| +
| +
| + (Narrowing)
| -
| +++ (Fluffy)
| ++
| ++
| -
|75%
|-
|'''[[Psoriatic arthritis]]'''
| +
| ++
| +
| +
| +
| +
| +++ ([[Distal interphalangeal joints|DIP]]/[[Proximal interphalangeal joints|PIP]])
| +++
| ++ (Unilateral)
| ++
| -
| ++ (Widening)
| ++
| +++ (Fluffy)
| ++
| +
| -
|30-75%
|-
|'''[[Rheumatoid arthritis]]'''
| ++
| +
| -
| -
| -
| -
| +++
([[MCP joints|MCP]]/[[wrist]])
| +++
| + (Unilateral)
| ++([[Cervical spine|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<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="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! 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: #F5F5F5;" |
*Presents with an acute onset of joint swelling and pain (usually monoarticular)
*Culture of joint fluid reveals organisms
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute rheumatic fever]]'''
| 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.
*Poststreptococcal arthritis have a rapid response to [[salicylate]]s or other [[antiinflammatory drugs]].
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Syphilis]]'''
| 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]]
*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;" | '''[[Hepatitis B virus|Hepatitis B virus (HBV) infection]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with fever, chills, polyarthritis, [[tenosynovitis]], and [[urticarial|urticarial rash]]
*Synovial fluid analysis usually shows noninflammatory fluid
*Elevated [[aminotransaminases|serum aminotransaminases]] and evidence of acute HBV infection on serologic testing confirm the presence of the HBV.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Herpes simplex virus|Herpes simplex virus (HSV)]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Genital and extragenital lesions can mimic the skin lesions that occur in disseminated gonococcal infection
*Viral culture,  [[polymerase chain reaction|polymerase chain reaction (PCR)]], and direct fluorescence antibody confirm the presence of the causative agent.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[HIV infection]] '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Present with generalized rash with mucus membrane involvement, fever, chills, and [[arthralgia]]. Joint effusions are uncommon
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Gout|Gout and other crystal-induced arthritis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presents with acute monoarthritis with fever and chills
*Synovial fluid analysis confirm the diagnosis.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lyme disease]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*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==
==References==

Latest revision as of 20:13, 20 February 2019

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

Overview

Reactive arthritis should be distinguished from other HLA-B27 diseases causing arthritis of the peripheral skeleton, which present as arthralgia. The differentials include psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis.

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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