Differentiating reactive arthritis from other diseases
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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 | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
History of Psoriasis | 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 | |
Psoriatic arthritis | + | + | ++ | + | + | + | + | +++ (DIP/PIP) | +++ | ++ (Unilateral) | ++ | - | ++ (Widening) | ++ | +++ (Fluffy) | ++ | + | - | 30-75% |
Rheumatoid arthritis | - | ++ | + | - | - | - | - | +++ | +++ | + (Unilateral) | ++(Cervical) | +++ | +++ (Narrowing) | + | + (Linear) | +++ | +++ | +++ | 6-8% |
Ankylosing spondylitis | - | +++ | - | + | - | - | - | + | + | +++ (Bilateral) | +++ | +++ | ++ (Narrowing) | +++ | +++ (Fluffy) | + | +++ | - | 90% |
Reactive arthritis (Reiter's syndrome) | - | +++ | - | + | + | - | - | ++ | +++ | ++ (Unilateral) | + | + | + (Narrowing) | - | +++ (Fluffy) | ++ | ++ | - | 75% |
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent