A 27-year-old male had burning micturition and urethral discharge. After 4 weeks he developed joint pains involving both the knees and ankles, redness of the eye and skin lesion. The most probable clinical dignosis is
Reactive ahritis, formerly known as Reiter's syndrome, is a form of inflammatory ahritis that develops in response to an infection in another pa of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease.By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. The ahritis often is coupled with other characteristic symptoms; this was previously referred to as Reiter's syndrome, Reiter's disease or Reiter's ahritis. The term "reactive ahritis" is preferred and increasingly used as a substitute for this designation because Hans Conrad Julius Reiter was not the first to describe the syndrome, his conclusions regarding its pathogenesis were incorrect, and because he committed war crimes as a Nazi at Buchenwald concentration camp during World War II. The manifestations of reactive ahritis include the following triad of symptoms: an inflammatory ahritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Ahritis occurring alone following sexual exposure or enteric infection is also known as reactive ahritis. Patients can also present with mucocutaneous lesions, as well as psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagicum. Enthesitis can involve the Achilles tendon resulting in heel pain. Not all affected persons have all the manifestations. The clinical pattern of reactive ahritis commonly consists of an inflammation of fewer than five joints which often includes the knee or sacroiliac joint. The ahritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or "migratory" (new joints become inflamed after the initially inflamed site has already improved). Reactive ahritis is an RF-seronegative, HLA-B27-linked ahritis] often precipitated by genitourinary or gastrointestinal infections. The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis),however, it also can happen after group A streptococcal infections. Ref Harrison20th edition pg 1123
Psoriasis vulgaris
Reiter's syndrome
Behcet's syndrome
Sarcoidosis
Fungal infections, Scabies, Pediculosis