What are the signs and symptoms of human leukocyte antigen (HLA) B27–associated reactive arthritis?

Updated: Oct 30, 2018
  • Author: Anna Luisa Di Lorenzo, MBBCh; Chief Editor: Andrew A Dahl, MD, FACS  more...
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The syndrome usually begins with urethritis followed by conjunctivitis and rheumatological findings. Arthritis begins within 1 month of infection in 80% of patients. It is usually acute, asymmetric, and oligoarticular and predominantly involves the joints of the lower extremities (eg, knees, ankles, feet, wrists). The arthritis is usually quite painful. Dactylitis or sausage digit is a diffuse swelling of a solitary finger or toe. This is a distinct feature of both reactive arthritis and psoriatic arthritis. Plantar fasciitis and Achilles tendonitis also are common. Sacroiliitis is present in as many as 70% of patients. The conjunctivitis is usually minimal and lasts for only a few days or weeks. It is mucopurulent and papillary. See the image depicted below.

Reactive arthritis. Involvement of knee (left) and Reactive arthritis. Involvement of knee (left) and conjunctivitis (right). Courtesy of Paul Dieppe, BSc, MD, FRCP, FFPHM.

Punctate and subepithelial keratitis may occur rarely, leading to permanent corneal scars. Acute nongranulomatous iritis recurs frequently in this condition. It may become bilateral and chronic and may result in blindness. Mucocutaneous lesions are common and appear in the mouth and palate and on the glans penis and palms and soles.

Two such conditions are considered to be major diagnostic criteria for reactive arthritis, according to the American Rheumatological Association (ARA) guidelines: (1) keratoderma blennorrhagicum, a scaly, erythematous, irritating disorder of the palms and soles of the feet, and (2) circinate balanitis, a persistent, scaly, erythematous circumferential rash of the distal penis. Keratoderma blennorrhagicum may resemble pustular psoriasis, which can make it difficult to distinguish between these two seronegative arthropathies. Minor diagnostic criteria of reactive arthritis include sacroiliitis, plantar fasciitis, Achilles tendonitis, nail bed pitting, palatal ulcers, and tongue ulcers.

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