Reiter’s Disease (Reactive Arthritis)

Figure 3.9 A: Circinate balanitis (Reprint from Burgdorf WH, Plewig G Wolff HH, Landthaler M, eds. Braun- Falco’s Dermatology. 3rd ed. Heidelberg: Springer; 2009)

• Seronegative arthropathy with constellation of symptoms
• Linked to two factors
  • Genetic factor: HLA-B27
  • Exposure to pathogen
• May follow urethritis after exposure to GU pathogens (likely Chlamydia trachomatis)
• May follow GI infection after exposure to enteric pathogens such as Campylobacter spp., Shigella flexneri, Ureaplasma urealyticum, Salmonella spp., or Yersinia spp.
• Bacterial antigen mimics portion of HLA molecule with subsequent dysregulation of immune control mechanism
• More common and severe in HIV patients; may be presenting sign of HIV
• Presentation
  • Peripheral arthritis ≥1 month duration, with
  • Associated urethritis or cervicitis
  • Other findings: urethritis, conjunctivitis, fever weakness, weight loss, erythema nodosum
  • Skin findings in 5% patients: psoriasiform lesions similar to psoriasis
    • Keratoderma blenorrhagicum: thick plaques with pustules and erythema on plantar surfaces
    • Circinate balanitis: circinate erythematous lesions on glans penis (almost pathognomonic)
• Classic triad: urethritis, arthritis, conjunctivitis
• Treatment: treatment of any triggering infection (doxycycline 100 mg bid × 14 days); arthritic symptoms may treat with biologic agent, methotrexate, cyclosporine, acitretin or NSAID; cutaneous lesions with highpotency topical corticosteroid