- Associated with STI – most commonly chlamydia – and typically affects men aged 20-40.
- Associated with GI infection:
- Less common than STI involvement
- Could be salmonella, shingella, Yersinia, or campylobacter
- Acute, asymmetrical, polyarthritis
- The classic triad of:
- Conjunctivitis – can’t see
- Non specific urethritis – can’t pee
- Acute arthritis – can’t bend the knee
- May be an oligoarthritis
- Tends to affect the large joints, particularly the ankle and knee. May sometimes involve the feet.
- May sometimes involve:
- Keratinous brown plaques on soles and palms
- Mouth ulcers
- Weight loss
- Pustular vesicles (rare) – sometimes look like those seen in psoriasis
- CNS involvement (rare)
- Cardiovascular involvement (rare)
- Can vary from a very mild arthritis, to a serious multi-systemic condition.
- Presents 1-4 weeks after the initial infection
- High degree of clinical suspiscion:
- STI / GI infection
- Acute onset polyarthritis of lower limbs and feet
- Stool sample / culture
- Test for chlamydial / other STI infection
- Rest / splint affected joints
- Up to 50% will resolve within 4 months
- Use NSAID’s and Steroid injections if necessary
- These only provide symptomatic releif
- In some cases, may be chronic. This can result in deformity. In some patients, it may also relapse and remit. In these individuals, consider:
- Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
- Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
- Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy