Reactive Arthritis vs. Disseminated Gonococcus
Ruddy: Kelleys Textbook of Rheumatology, 6th ed. Chapter 70, pp 1055-64; Ch 96, pp 1478-81.
Li F et al. Molecular detection of bacterial DNA in venereal-associated arthritis. Arth Rheum 39(6); 950-9..
Liebling MR, Arkfeld DG, Michelini GA, et al: Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction.
Arthritis Rheum 37:702, 1994.
• Classic triad for reactive arthritis is urethritis, conjunctivitis, and arthritis following a diarrheal
infection; don’t forget, though, about other manifestations like enthesopathy, sacroileitis, circinate
balanitis, and keratoderma blenorrhagica
• DGI joint fluid culture has a yield of only 50%, but culture of all sites has a combined yield of 80%
• Only 25% of cases of DGI have associated genitourinary symptoms
1. What do I need to know about reactive arthritis?
• One of the HLA-B27 seronegative spondyloarthropathies (the others are ankylosing spondylitis, psoriatic
arthritis, and IBD-associated)
• If youre a lumper, put it in the bag with Reiters syndrome and undifferentiated spondyloarthropathy; if
youre a splitter, they are 3 different diseases
• Classic triad of urethritis, conjunctivitis or uveitis, and arthritis
▪ The arthritis is usually asymmetric, mono/oligoarticular, lower extremities
▪ Remember that the hallmark of this family of disease is enthesopathy (inflammation of insertion
of tendons) which can cause sausage digits, tenderness at the Achilles insertion, chest pain from
sternoclavicular inflammation, etc
▪ These patients may have the classic inflammatory low back pain and evidence of sacroileitis that
we usually associate with ankylosing spondylitis
▪ Other associated features: circinate balanitis in men, keratoderma blenorrhagica, conduction
system abnormalities or aortic insufficiency
▪ Associated with HIV infection, even in non-HLA-B27 patients
• Follows an infection (either urethritis