Diferencia entre revisiones de «Reiter syndrome»
(Text replacement - "==Diagnosis==" to "==Evaluation==") |
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{{Differntial Diagnosis Oligoarthritis}} | {{Differntial Diagnosis Oligoarthritis}} | ||
== | ==Evaluation== | ||
*Primarily a clinical diagnosis, no definitive test | *Primarily a clinical diagnosis, no definitive test | ||
*More likely if there is the presence of: | *More likely if there is the presence of: | ||
Revisión del 07:41 25 jul 2016
Background
- Seronegative spondyloarthropathy that manifests as an acute, asymmetric, oligoarthritis (LE>UE) that occurs 2-6 weeks after infection
- Classic triad: urethritis, conjunctivitis, and arthritis ("Can't pee, can't see, can't climb a tree")
Clinical Features
- Preceding Infection
- Urethritis: generally caused by Chlamydia or Ureaplasma
- Enteritis: generally caused by Salmonella or Shigella
- Preceding infection may be clinically silent
- Musculoskeletal symptoms
- Arthritis: oligoarthritis, usually in the lower extremities
- Enthesitis (pain at insertion sites)
- Dactylitis (sausage digits)
- Low back pain
- Extraarticular symptoms
- Conjunctivitis (less frequently uveitis, keratitis)
- GU symptoms
- Oral lesions
- Cutaneous and nail changes
Differential Diagnosis
Oligoarthritis
- Ankylosing spondylitis
- Gonococcal arthritis
- Lyme disease
- Psoriatic arthritis
- Reactive arthritis
- Rheumatic fever
- Rheumatoid arthritis
- Systemic lupus erythematosus
Evaluation
- Primarily a clinical diagnosis, no definitive test
- More likely if there is the presence of:
- Characteristic musculoskeletal findings
- Presence of preceding illness
- Lack of more likely cause of arthritis
Management
- Treat inciting infection
- Symptomatic treatment of arthritis
- NSAIDs are first line (naproxen, diclofenac, indomethacin)
- Intraarticular and systemic steroids for NSAID refractory
Disposition
- Referral to a rheumatologist