Pathophysiology
1) a type of spondyloarthropathy 2) marked by arthritis nongonococcal urethritis or cervicitis, and conjunctivitis
Signs and Symptoms
1) arthritis resembles rheumatoid arthritis 2) dysuria, urinary frequency, urethral discharge 3) keratoderma blennorrhagicaum (type of pustular psoriasis) over soles, palms, and torso (50%) 4) usually remits over 12 months 5) low back pain (20%) 6) joints most affected are knees, ankles, and feet (usually asymmetrically) 7) if toes or fingers are affected, tendon synovitis resembles “sausage digits” 8) pain over nonarticular bony areas 9) painless mouth ulcers 10) heel pain 11) fevers
Characteristic Test Findings
Laboratory – 1) increased sed rate 2) increased C-reactive protein 3) negative for rheumatoid factor Joint aspiration – 4) accumulating evidence that bacteria persist at sites of primary infection (previously thought to be negative) Radiology – 5) periosteal reactions, especially at the calcaneus with formation of heel spurs 6) bony fusion across joints
Associated Conditions
1) HLA-B27 is present in 90% of cases 2) strong association with HLA-B51 3) progressive arthritis, including ankylosing spondylitis (20%) 4) AIDS 5) increased incidence of cerebral vasculitis 6) strong association with previous gastrointestinal and genitourinary infections, especially Yersinia, Cyclospora, Salmonella, Shigella, Campylobacter, Helicobater, and Chlamydia trachomatis 8) dilation of ascending aorta
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