Review Question - QID 103007

This patient is presenting with urethritis (pain with urination), conjunctivitis, and asymmetric joint pain without an effusion concerning for reactive arthritis.

Reactive arthritis is an autoimmune response to infection that classically involves a triad of noninfectious urethritis, arthritis, and conjunctivitis. This classic triad is actually only seen in approximately one-third of patients with reactive arthritis. The disease is associated with preceding gastrointestinal infection with organisms such as Salmonella, Shigella, Yersinia, or Campylobacter as well as preceding genitourinary infection with the most common causative organism being Chlamydia. Diagnosis is primarily based on history and clinical presentation. Treatment involves treating any underlying infections and NSAIDs for symptom control.

Figure A is the physical exam finding of conjunctivitis.

Incorrect Answers:
Answer 1: Osteoarthritis presents with joint pain typically in an older/obese patient with a cold and painful joint. Pain is typically worse with exertion and relieved by rest.

Answer 3: Rheumatoid arthritis typically presents in a middle-aged woman with symmetric arthralgias that are worse in the morning and improve throughout the day along with other systemic manifestations (such as malaise and low-grade fevers).

Answer 4: Septic arthritis presents with a red, hot, inflamed, and exquisitely tender joint. It must be aspirated followed by antibiotics and surgical washout.

Answer 5: Stress fracture presents with focal bone pain/tenderness in a patient who overexerts oneself (such as someone in the military in basic training). Radiographs may demonstrate a hair-line fracture or may be normal. Treatment involves rest and non-weight bearing status.

Bullet Summary:
Reactive arthritis presents with urethritis, uveitis, and arthritis.