Ophthalmologic Manifestations of Reactive Arthritis Workup

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

Laboratory Studies

  • Cultures
    • If urethritis or cervicitis is present, cultures should be obtained. Smears of urethral discharge may be sent for antichlamydial staining by direct immunofluorescent antibody, enzyme immunosorbent assay, culture, or nucleic acid probe. A Giemsa stain or a Wright stain may reveal the classic gram-negative intracellular diplococci associated with gonorrhea. Many patients may experience simultaneous sexually transmitted diseases, particularly chlamydia and gonorrhea.
    • Results of routine urine cultures are negative.
    • Stool cultures can be helpful for enteric pathogens.
  • Venereal Disease Research Laboratory (VDRL) test and fluorescent treponemal antibody absorption (FTA-ABS) test: Perform serologic testing to rule out syphilis that may be associated with chlamydial infection.
  • Synovial fluid aspirates and synovial biopsy samples show a nonspecific mixed inflammatory reaction. Rarely, gonococcus may be recovered.
  • The erythrocyte sedimentation rate and the C-reactive protein level may be elevated.
  • Rheumatoid factor and antinuclear antibodies are negative.
  • HLA-B27
    • HLA-B27 antigen testing is not diagnostic but may be useful.
    • The HLA-B27 test is moderately expensive and should not be ordered indiscriminately as a screen for all patients with uveitis. Instead, this test should be ordered for patients suspected of having ocular disease associated with one of the seronegative spondyloarthropathies.
    • A complete histocompatibility panel, which includes multiple loci and alleles, is not necessary. This test can be exorbitantly expensive, and it is not useful in the workup of patients with uveitis.
  • A tuberculin skin test may be appropriate in certain individuals, particularly those with demographics strongly suggestive of infectious tuberculosis (TB). TB is far more likely to occur in immigrants from Southeast Asia, Africa, and other endemic regions. Caution must be taken not to interpret a positive skin test as diagnostic of tuberculous uveitis, particularly in individuals who have been given the bacille Calmette-Guérin (BCG) vaccine.
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Imaging Studies

  • Radiologic examination demonstrates various arthritic changes.
    • Changes in the sacroiliac joint are present in as many as 32% of patients.
    • Specifically ordering a radiograph of the sacroiliac joint is best. This radiograph provides a more sensitive tunnel view compared to a routine film of the lumbosacral spine.
    • Films of the foot may be useful, revealing changes consistent with chronic plantar fasciitis or Achilles tendonitis.
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Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  2. Kozeis N, Trachana M, Tyradellis S. Keratitis in reactive arthritis (Reiter syndrome) in childhood. Cornea. Aug 2011;30(8):924-5. [Medline].

  3. Rudwaleit M, Braun J, Sieper J. Treatment of reactive arthritis: a practical guide. BioDrugs. Jan 2000;13(1):21-8. [Medline].

  4. Amor B. Reiter's syndrome. Diagnosis and clinical features. Rheum Dis Clin North Am. Nov 1998;24(4):677-95, vii. [Medline].

  5. Banares A, Hernandez-Garcia C, Fernandez-Gutierrez B, Jover JA. Eye involvement in the spondyloarthropathies. Rheum Dis Clin North Am. Nov 1998;24(4):771-84, ix. [Medline].

  6. Kohnke SJ. Reactive arthritis. A clinical approach. Orthop Nurs. Jul-Aug 2004;23(4):274-80. [Medline].

  7. Lee DA, Barker SM, Su WP, Allen GL, Liesegang TJ, Ilstrup DM. The clinical diagnosis of Reiter's syndrome. Ophthalmic and nonophthalmic aspects. Ophthalmology. Mar 1986;93(3):350-6. [Medline].

  8. Mahoney BP. Rheumatologic disease and associated ocular manifestations. J Am Optom Assoc. Jun 1993;64(6):403-15. [Medline].

  9. Ostler HB. Oculogenital disease. Surv Ophthalmol. Jan-Feb 1976;20(4):233-46. [Medline].

 
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