Box 1 Clinical manifestations of reactive arthritis

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Most commonly present with oligoarthritis, but can also present with polyarthritis or monoarthritis Axial

Frequently involved Sacroiliac joints Lumbar spine Occasionally involved Thoracic spine (usually seen in chronic ReA) Cervical spine (usually seen in chronic ReA) Cartilagenous joints (symphysis pubis, sternoclavicular joints) Peripheral

Frequently involved Large joints of the lower extremities (especially knees) Dactylitis (sausage digit) Very specific for a spondyloarthropathy

Enthesitis Hallmark feature

Transitional zone where collagenous structures, such as tendons and ligaments, insert into bone Inflammation causes collagen fibers to undergo metaplasia forming fibrous bone Chronic enthesitis leads to radiographic findings Plantar or Achilles spurs Periostitis

Nonmarginal syndesmophytes Syndesmoses of the sacroiliac joints


Oral ulcers (generally painless) Sterile dysuria


Keratoderma blennorrhagicum Pustular or plaquelike rash on the soles or palms Grossly and histologically indistinguishable from pustular psoriasis May also involve Nails (onycholysis, subungual keratosis, nail pits) Scalp


Circinate balanitis Erythema or plaquelike lesions on the shaft or glans of penis



Typically during acute stages only Anterior uveitis (iritis)

Often recurrent Rarely described

Scleritis, pars planitis, iridocyclitis, and others


Aortic regurgitation Pericarditis Valvular pathologies detected [28]. Both Ct and Cpn, however, have occasionally been demonstrated in the synovial tissue of patients with other types of arthritis or even asymptomatic individuals [38,39]. These findings are discussed in more detail in the pathophysiology section.

It has been suggested that individuals with postchlamydial ReA display different clinical features than those with nonchlamydial ReA. Specifically, postchlamydial individuals more often develop a monoarthritis or oligoar-thritis with predominant lower extremity involvement, sacroiliitis, urethritis, a longer period between inciting infection and arthritis, and lower C-reactive protein levels [40].


In 1944, Shigella was the first bacteria to be directly implicated as a cause of ReA [41]. Shigella, however, is the least common of the gastrointestinal-inducing organisms that are associated with ReA in developed countries [42]. This is in large part caused by the rarity of this organism in these communities. All four of the species of Shigella (S flexneri, S dysenteriae, S son-nei, and S boydii) can cause ReA. Previous data suggested that S flexneri and S dysenteriae are the most common causes, and S sonnei is a rare cause worldwide [42,43]. A study in 2005 from Finland, however, revealed cases of ReA to S sonnei, S flexneri, and S dysenteriae, with S sonnei being the most common cause [44]. The overall attack rate in this study was 7%.

Humans are the only known host for Shigella, so this makes the use of animal models impossible. Interestingly, Shigella is phylogenetically indistinguishable from Escherichia coli. S flexneri shares all but 175 of 3235 open reading frames with two strains of E coli [42]. Despite these similarities, they behave very differently. Shigella has the ability to invade human

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Thank you for deciding to learn more about the disorder, Osteoarthritis. Inside these pages, you will learn what it is, who is most at risk for developing it, what causes it, and some treatment plans to help those that do have it feel better. While there is no definitive “cure” for Osteoarthritis, there are ways in which individuals can improve their quality of life and change the discomfort level to one that can be tolerated on a daily basis.

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