Dermatologic Manifestations of Reactive Arthritis Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: Apr 16, 2012
 

Laboratory Studies

No laboratory or imaging finding is diagnostic of reactive arthritis. The diagnosis is based on clinical data.

Although a positive HLA-B27 result is not specific of the disease, haplotyping can be used to diagnose reactive arthritis.

Microbiologic examination of smears, immunofluorescence results, and cultures of the urethral secretion must be considered.

Microbiologic studies of urine and stool are less helpful; nevertheless, in the dysenteric form, stool culture for enteric pathogens (eg, Salmonella, Shigella, and Yersinia species) should be considered.

Aspirates of joint fluid usually are sterile.

A Japanese man with reactive arthritis was negative for HLA-B27 and other HLA-B27 cross-reactive major histocompatibility complex (MHC) class I antigens, but he was positive for human leukocyte antigen B51 (HLA-B51).[27] The laboratory examination findings showed significant elevation of serum levels of immunoglobulin G (IgG) and IgA antichlamydial antibodies.

A combination of Chlamydia infection and HLA-B51 presence was suggested to play a role in the pathogenesis of reactive arthritis in this patient. The US Preventive Services Task Force guidelines for screening for chlamydial infections were updated in 2007.[28]

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Imaging Studies

Radiologic signs are present in only 40% of the cases. These signs can be completely absent regardless of the severity.

Whole-body scintigraphy is a sensible diagnostic tool for use in screening for enthesopathy and arthropathy.[29]

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Other Tests

The incidence of reactive arthritis is high among patients with AIDS, and HIV testing is mandatory in patients in whom reactive arthritis is newly diagnosed, even if they do not have the risk factors.

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Histologic Findings

Histopathologic changes are not different from the histopathologic picture of a psoriasis vulgaris. Acanthosis, with elongation of the rete ridges, psoriasiform hyperplasia, subcorneal abscesses, and spongiform pustules, are observed. The upper dermis shows a mixed inflammatory infiltrate with neutrophils.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Jorge Romaní, MD  Assistant Professor, Department of Dermatology, Hospital De Palamós Faculty of Medicine, Spain

Disclosure: Nothing to disclose.

Lluís Puig, MD, PhD  Program Director, Assistant Professor, Department of Dermatology, Hospital De La Santa Creu I Sant Pau, Universitat Autónoma De Barcelona

Lluís Puig, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, European Academy of Dermatology and Venereology, and International Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Robin Travers, MD  Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

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