Keratoderma blennorrhagicum of the plantar surface Figure 3. Keratoderma blennorrhagicum of the plantar surface Keratoderma blennorrhagicum classically is found on the plantar surface of the feet, but palms and other areas may also be involved Figure 4. Keratoderma blennorrhagicum begins as small vesicles on an erythematous base that soon rupture and form lesions with varying degrees of crusting, exudation, and erosion. Thick yellow scale and hyperkeratosis is common, and pustules are often present. Figure 4.
|Published (Last):||2 June 2017|
|PDF File Size:||18.11 Mb|
|ePub File Size:||20.89 Mb|
|Price:||Free* [*Free Regsitration Required]|
The classical presentation of the syndrome starts with urinary symptoms such as burning pain on urination dysuria or an increased frequency of urination. It presents with monoarthritis affecting the large joints such as the knees and sacroiliac spine causing pain and swelling. An asymmetrical inflammatory arthritis of interphalangeal joints may be present but with relative sparing of small joints such as the wrist and hand. Patient can have enthesitis presenting as heel pain, Achilles tendinitis or plantar fasciitis , along with balanitis circinata circinate balanitis , which involves penile lesions present in roughly 20 to 40 percent of the men with the disease.
A small percentage of men and women develop small hard nodules called keratoderma blennorrhagicum on the soles of the feet and, less commonly, on the palms of the hands or elsewhere. The presence of keratoderma blennorrhagica is diagnostic of reactive arthritis in the absence of the classical triad. Subcutaneous nodules are also a feature of this disease. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision.
Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go. Dactylitis , or "sausage digit", a diffuse swelling of a solitary finger or toe, is a distinctive feature of reactive arthritis and other peripheral spondylarthritides but can also be seen in polyarticular gout and sarcoidosis. Mucocutaneous lesions can be present. Common findings include oral ulcers that come and go.
In some cases, these ulcers are painless and go unnoticed. In the oral cavity , the patients may suffer from recurrent aphthous stomatitis , geographic tongue and migratory stomatitis in higher prevalence than the general population. About 10 percent of people with reactive arthritis, especially those with a prolonged course of the disease, will develop cardiac manifestations, including aortic regurgitation and pericarditis. Reactive arthritis has been described as a precursor of other joint conditions, including ankylosing spondylitis.
See also: List of human leukocyte antigen alleles associated with cutaneous conditions Reactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence of enthesitis as the basic pathologic lesion  and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis. Other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum , Salmonella spp.
Chlamydia trachomatis is the most common cause of reactive arthritis following urethritis. Ureaplasma and mycoplasma are rare causes. There is some circumstantial evidence for other organisms causing the disease, but the details are unclear.
The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that reactive arthritis is caused either by an autoimmune response involving cross-reactivity of bacterial antigens with joint tissues or by bacterial antigens that have somehow become deposited in the joints. Diagnosis[ edit ] There are few clinical symptoms, but the clinical picture is dominated by arthritis in one or more joints, resulting in pain, swelling, redness, and heat sensation in the affected areas.
The urethra , cervix and the throat may be swabbed in an attempt to culture the causative organisms. Cultures may also be carried out on urine and stool samples or on fluid obtained by arthrocentesis.
Tests for C-reactive protein and erythrocyte sedimentation rate are non-specific tests that can be done to corroborate the diagnosis of the syndrome. A blood test for the genetic marker HLA-B27 may also be performed. About 75 percent of all the patients with reactive arthritis have this gene. Diagnostic criteria[ edit ] Although there are no definitive criteria to diagnose the existence of reactive arthritis, the American College of Rheumatology has published sensitivity and specificity guidelines.
fiessinger leroy reiter
Publicitй Syndrome de Fiessinger-Leroy-Reiter Le syndrome oculo-urйthro-synovial, encore appelй arthrite rйactive, est une maladie systйmique qui accompagne parfois la spondylarthrite ankylosante. Les infections gйnitales а Chlamydia trachomatis sont le plus souvent en cause. Elle touche gйnйralement symйtriquement plusieurs articulations mais quelquefois une seule , essentiellement les grosses articulations du membre infйrieur et celles des orteils. Certains patients se plaignent de lombalgies, surtout dans les formes graves. Certains autres prйsentent des enthйsopathie. Un syndrome dysentйrique ou diarrhйe. Quelques lйsions de la peau et des muqueuses, et plus spйcifiquement de la bouche, se rencontrent chez certains malades.
Syndrome de Reiter ou Syndrome de Fiessinger-Leroy-Reiter ou syndrome oculo-urétro-synovial O.U.S