Review Question - QID 107415

This clinical presentation is most consistent with reactive arthritis, likely due to Chlamydia infection. Therefore, nucleic acid amplification testing for Chlamydia trachomatis should be performed.

Chlamydia infection is a common cause of reactive arthritis (formerly known as Reiter’s syndrome). The classic triad of symptoms are urethritis, conjunctivitis, and asymmetric non-infectious arthritis. Associated skin findings include circinate balanitis, a dry annular rash involving the glans and shaft of the penis, and keratoderma blenorrhagica, hyperkeratotic, sometimes pustular skin lesions involving the palms and soles. Suspected patients should be tested for Chlamydia via nucleic acid amplification testing. Infected patients can be treated with rifampin and doxycycline or azithromycin.

Incorrect Answers:
Answer 1: Rheumatoid factor is associated with rheumatoid arthritis.
Answer 2: Anti-cyclic citrullinated peptide antibodies are also associated with rheumatoid arthritis and more specific than rheumatoid factor.
Answer 3: Antinuclear antibody assay is a non-specific test, associated with systemic lupus erythematosus, scleroderma, Sjogren’s syndrome, and mixed connective tissue disease.
Answer 4: While HLA-B27 positivity may predispose to reactive arthritis, it is not the best answer choice since it will not influence the management of this patient.

Bullet Summary:
The classic triad of symptoms of Reiter's syndrome is urethritis, conjunctivitis, and asymmetric non-infectious arthritis.