What is the role of radiography in the workup of reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Radiologic examination may demonstrate various arthritic changes. These changes tend to be asymmetric and oligoarticular and are more common in the lower extremities. However, radiologic signs are present in only 40-70% of cases, and they may be completely absent even in instances of severe disease. Early in the disease process, radiography often reveals no abnormalities at all.

In more advanced or long-term ReA, periosteal reaction and proliferation at sites of tendon insertion are visible. Exuberant plantar spurs are a common sign in long-term ReA. Changes consistent with chronic plantar fasciitis or Achilles tendinitis may be seen. In the hands and feet, marginal erosions with adjacent bone proliferation occur. The erosions typically have indistinct margins and are surrounded by periosteal new bone and periostitis (see the images below).

Radiograph of feet of 27-year-old man shows erosio Radiograph of feet of 27-year-old man shows erosions in all left metatarsophalangeal (MTP) joints with subluxation and valgus deformity of most toes. Smaller erosions are also visible in fourth and fifth MTP joints of right foot.
Lateral radiograph of foot reveals calcaneal spur Lateral radiograph of foot reveals calcaneal spur and enthesitis.
Radiograph of both hands shows small erosive chang Radiograph of both hands shows small erosive changes in both first metacarpal heads associated with minimal subluxation. Bone density is normal.

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