Updated: 12/8/2013

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Introduction
  • A seronegative spondyloarthropathy characterized by:
    • urethritis
    • conjunctivitis or uveitis
    • arthritis
  • Epidemiology
    • incidence
      • rare
    • demographics
      • occurs most commonly in young man (<40 years of age)
      • rarely occurs in children, but sometimes appears in adolescents
    • location
      • arthritis
        • may be unilateral or bilateral
        • may affect one or multiple joints
  • Pathophysiology
    • associated infections
      • mycoplasma
      • yersinia
      • salmonella
      • shigella
      • chlamydia
      • campylobacter
  • Genetics
    • may be genetic component making certain individuals more susceptible
  • Prognosis
    • most cases resolve within weeks, but can last up to months
    • recurrence occurs in up to half of cases over period of several years
Presentation
  • Symptoms
    • urinary discomfort or pain
      • usually appears within days or weeks of infection
    • inflammation or dryness of the eye
    • joint pain
      • may develop within weeks of initial infection and urinary symptoms
    • other non-specific pain symptoms including
      • heel pain (Achilles tendon pain)
      • low back pain
  • Physical exam
    • nongonococcal urethritis
    • conjunctivitis or uveitis
    • arthritis
    • skin lesions on palms/soles
      • may resemble psoriasis
      • genital skin lesions
    • low-grade fever
Imaging
  • Radiographs
    • may identify arthritis of the joints
Studies
  • Diagnosis is based primarily on symptoms and presentation
  • Labs
    • HLA-B27 positive in 75% of cases
    • CRP elevated
    • ESR elevated
  • Urinalysis
    • may identify signs of active infection
Treatment
  • Nonoperative
    • antibiotics, symptomatic treatment, observation
      • indications
        • standard of treatment in most cases
      • medications
        • direct antibiotics at underlying infection
          • azithromycin and doxycycline indicated for Chlamydia
        • NSAIDs for pain and inflammation
    • systemic steroids
      • indications
        • severe or recalcitrant cases
Complications
  • Aortic insufficiency
  • Arrhythmia
 

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