Question:
A 28 year old male presents with asymmetric oligoarthritis involving the knees and ankles, along with a history of dysuria and diarrhea 3 weeks ago. On examination, he has conjunctival infection, painless shallow oral ulcers also. Which of the following findings is most commonly associated with this condition?
A 28 year old male presents with asymmetric oligoarthritis involving the knees and ankles, along with a history of dysuria and diarrhea 3 weeks ago. On examination, he has conjunctival infection, painless shallow oral ulcers also. Which of the following findings is most commonly associated with this condition?
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The extra-articular manifestations of Reactive Arthritis are high-yield: Conjunctivitis/anterior uveitis, Circinate balanitis, Keratoderma blennorrhagicum, and Dactylitis ("sausage digits"). Always look for a precipitating GI or GU infection 1-4 weeks prior to joint symptoms.
Updated On: Sep 3, 2026
- Malar rash
- Tophus formation
- Keratoderma blennorrhagicum
- Erythema marginatum
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The Correct Option is C
Solution and Explanation
Concept:
The patient presents with the classic triad of Reactive Arthritis (formerly Reiter's syndrome): non-gonococcal urethritis (dysuria), conjunctivitis, and asymmetric oligoarthritis (knees, ankles), following a gastrointestinal infection (diarrhea 3 weeks ago).
Reactive arthritis is a seronegative spondyloarthropathy strongly associated with HLA-B27.
Explanation:
• Reactive arthritis is an autoimmune condition that develops in response to an infection in another part of the body, most commonly urogenital (Chlamydia trachomatis) or enteric (Salmonella, Shigella, Yersinia, Campylobacter).
• The disease is characterized by the classic triad ("can't see, can't pee, can't climb a tree") alongside various mucocutaneous manifestations.
• Keratoderma blennorrhagicum (Option C): This is a highly characteristic dermatological finding in reactive arthritis. It presents as hyperkeratotic, vesicular, or pustular lesions, most commonly on the palms and soles, visually and histologically resembling pustular psoriasis.
• Other mucocutaneous findings include Circinate balanitis (painless serpiginous lesions on the glans penis) and painless shallow oral ulcers.
• Option (A), Malar rash, is seen in SLE.
• Option (B), Tophus formation, is the hallmark of chronic tophaceous gout.
• Option (D), Erythema marginatum, is a classic major Jones criterion for Acute Rheumatic Fever, which typically presents with migratory polyarthritis after a streptococcal pharyngitis, not an enteric or chlamydial infection.
Final answer:
Keratoderma blennorrhagicum is the classic skin lesion associated with Reactive Arthritis.
The patient presents with the classic triad of Reactive Arthritis (formerly Reiter's syndrome): non-gonococcal urethritis (dysuria), conjunctivitis, and asymmetric oligoarthritis (knees, ankles), following a gastrointestinal infection (diarrhea 3 weeks ago).
Reactive arthritis is a seronegative spondyloarthropathy strongly associated with HLA-B27.
Explanation:
• Reactive arthritis is an autoimmune condition that develops in response to an infection in another part of the body, most commonly urogenital (Chlamydia trachomatis) or enteric (Salmonella, Shigella, Yersinia, Campylobacter).
• The disease is characterized by the classic triad ("can't see, can't pee, can't climb a tree") alongside various mucocutaneous manifestations.
• Keratoderma blennorrhagicum (Option C): This is a highly characteristic dermatological finding in reactive arthritis. It presents as hyperkeratotic, vesicular, or pustular lesions, most commonly on the palms and soles, visually and histologically resembling pustular psoriasis.
• Other mucocutaneous findings include Circinate balanitis (painless serpiginous lesions on the glans penis) and painless shallow oral ulcers.
• Option (A), Malar rash, is seen in SLE.
• Option (B), Tophus formation, is the hallmark of chronic tophaceous gout.
• Option (D), Erythema marginatum, is a classic major Jones criterion for Acute Rheumatic Fever, which typically presents with migratory polyarthritis after a streptococcal pharyngitis, not an enteric or chlamydial infection.
Final answer:
Keratoderma blennorrhagicum is the classic skin lesion associated with Reactive Arthritis.
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