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I found this intersting Clinical Vignete
A 27-year-old white male presents with a 3-week history of several swollen and painful toes and knees. He has a
past history of conjunctivitis. He also describes some low back stiffness that is more severe in the morning. Which
of the following is the most likely diagnosis?
A. Gout
B. Lyme disease
C. Reiter's syndrome
D. Rheumatoid arthritis
E. Septic arthritis
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The correct answer is C. This is a case of Reiter's syndrome.
Patients typically present with the acute onset of arthritis (usually asymmetric and additive), with involvement of new joints occurring over a period of a few days to 2 weeks. Joints of the lower extremities are the most commonly involved, but wrists and fingers can also be
affected. Dactylitis (sausage digit), a diffuse swelling of a solitary finger or toe, is a distinctive feature of Reiter's arthritis and psoriatic arthritis. Tendonitis and fasciitis are common. Spinal pain and low back pain are common. Conjunctivitis, urethritis, diarrhea, and skin lesions are also associated with Reiter's syndrome. Up to 75% of
patients are HLA-B27 positive.
Microorganisms which can trigger Reiter's syndrome include Shigella spp.,
Salmonella spp., Yersinia spp., Campylobacter jejuni, and Chlamydia trachomatis.
Most patients are younger males.
Gout (choice A) usually presents as an explosive attack of acute, very painful, monarticular inflammatory arthritis. Hyperuricemia is the cardinal feature and prerequisite for gout. The first metatarsophalangeal joint is
involved in over 50% of first attacks.
Lyme disease (choice B), caused by Borrelia burgdorferi, presents with a red macule or papule at the site of the tick bite. This lesion, called erythema chronicum migrans, slowly expands to form a large annular lesion with a red border and central clearing. The lesion is warm, but usually not painful. The patient also has severe headache, stiff neck, chills, arthralgias, and profound malaise and fatigue. Untreated infection is associated with development of arthritis. The large joints (e.g., knees) are usually involved with the arthritis lasting for weeks to months.
Rheumatoid arthritis (choice D) begins insidiously with fatigue, anorexia, generalized weakness, and vague musculoskeletal symptoms leading up to the appearance of synovitis. Pain in the affected joints, aggravated by
movement, is the most common manifestation of established rheumatoid arthritis. Generalized stiffness is frequent and is usually greatest after periods of inactivity. Morning stiffness of greater than 1 hour in duration is
very characteristic. Rheumatoid arthritis is more common in females. The metacarpophalangeal and proximal interphalangeal joints of the hands are characteristically involved.
Septic arthritis (choice E) is caused by a variety of microorganisms, including Neisseria gonorrhoeae and Staphylococcus aureus. Hematogenous spread is the most common route in all age groups. 90% of patients present with involvement of a single joint, usually the knee. The usual presentation is moderate-to-severe pain, effusion, muscle spasm, and decreased range of motion. Peripheral leukocytosis and a left shift are common. Disseminated gonococcal infections present as fever, chills, rash, and articular symptoms. Papules progressing to hemorrhagic pustules develop on the trunk and extensor surfaces of the distal extremities. Migratory arthritis and tenosynovitis of multiple joints is common.
BY THE WAY I HAVE A QUESTION FOR THE ONES WHO ALREADY HAVE TAKEN THE TEST.
I'VE HEARD IS NO LONGER REITER ARTHRITIS/ REITER SYNDROME
IS NOW CALLED REACTIVE ARTHRITIS .
I WOULD APPRECIATE ANY FEEDBACK!
A 27-year-old white male presents with a 3-week history of several swollen and painful toes and knees. He has a
past history of conjunctivitis. He also describes some low back stiffness that is more severe in the morning. Which
of the following is the most likely diagnosis?
A. Gout
B. Lyme disease
C. Reiter's syndrome
D. Rheumatoid arthritis
E. Septic arthritis
🙄
🙄
🙄
The correct answer is C. This is a case of Reiter's syndrome.
Patients typically present with the acute onset of arthritis (usually asymmetric and additive), with involvement of new joints occurring over a period of a few days to 2 weeks. Joints of the lower extremities are the most commonly involved, but wrists and fingers can also be
affected. Dactylitis (sausage digit), a diffuse swelling of a solitary finger or toe, is a distinctive feature of Reiter's arthritis and psoriatic arthritis. Tendonitis and fasciitis are common. Spinal pain and low back pain are common. Conjunctivitis, urethritis, diarrhea, and skin lesions are also associated with Reiter's syndrome. Up to 75% of
patients are HLA-B27 positive.
Microorganisms which can trigger Reiter's syndrome include Shigella spp.,
Salmonella spp., Yersinia spp., Campylobacter jejuni, and Chlamydia trachomatis.
Most patients are younger males.
Gout (choice A) usually presents as an explosive attack of acute, very painful, monarticular inflammatory arthritis. Hyperuricemia is the cardinal feature and prerequisite for gout. The first metatarsophalangeal joint is
involved in over 50% of first attacks.
Lyme disease (choice B), caused by Borrelia burgdorferi, presents with a red macule or papule at the site of the tick bite. This lesion, called erythema chronicum migrans, slowly expands to form a large annular lesion with a red border and central clearing. The lesion is warm, but usually not painful. The patient also has severe headache, stiff neck, chills, arthralgias, and profound malaise and fatigue. Untreated infection is associated with development of arthritis. The large joints (e.g., knees) are usually involved with the arthritis lasting for weeks to months.
Rheumatoid arthritis (choice D) begins insidiously with fatigue, anorexia, generalized weakness, and vague musculoskeletal symptoms leading up to the appearance of synovitis. Pain in the affected joints, aggravated by
movement, is the most common manifestation of established rheumatoid arthritis. Generalized stiffness is frequent and is usually greatest after periods of inactivity. Morning stiffness of greater than 1 hour in duration is
very characteristic. Rheumatoid arthritis is more common in females. The metacarpophalangeal and proximal interphalangeal joints of the hands are characteristically involved.
Septic arthritis (choice E) is caused by a variety of microorganisms, including Neisseria gonorrhoeae and Staphylococcus aureus. Hematogenous spread is the most common route in all age groups. 90% of patients present with involvement of a single joint, usually the knee. The usual presentation is moderate-to-severe pain, effusion, muscle spasm, and decreased range of motion. Peripheral leukocytosis and a left shift are common. Disseminated gonococcal infections present as fever, chills, rash, and articular symptoms. Papules progressing to hemorrhagic pustules develop on the trunk and extensor surfaces of the distal extremities. Migratory arthritis and tenosynovitis of multiple joints is common.
BY THE WAY I HAVE A QUESTION FOR THE ONES WHO ALREADY HAVE TAKEN THE TEST.
I'VE HEARD IS NO LONGER REITER ARTHRITIS/ REITER SYNDROME
IS NOW CALLED REACTIVE ARTHRITIS .
I WOULD APPRECIATE ANY FEEDBACK!
