Reactive arthritis - Nail and Distal Digit
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Synopsis
Reactive arthritis may rarely occur in children; it is termed epidemic or post-dysenteric. In adults, it is termed epidemic or venereal. It was initially described after infections with specific bacteria: Chlamydia trachomatis, Shigella, Salmonella, Yersinia, and Campylobacter. However, recent studies have implicated Clostridioides difficile, Giardia, and other atypical infections as triggers for ReA. Chlamydia trachomatis is the most common trigger and it may be asymptomatic in 10% of patients. It is unclear how infections trigger the disease. When reactive arthritis is secondary to a gastrointestinal infection, it affects both sexes equally. However, reactive arthritis secondary to C trachomatis infection is more common in men. Those patients who are positive for human immunodeficiency virus (HIV) or human leukocyte antigen (HLA)-B27 typically have more severe arthritis.
Nail involvement affects 20%-30% of patients with reactive arthritis. Changes resemble those of nail psoriasis including onycholysis, nail pitting, subungual hyperkeratosis, and pustules affecting the nail folds. Paronychia is also common. Other reported findings are ridging, splitting, elkonyxis (loss of nail plate substance above the lunula only), and brown-red discoloration.
For most patients, reactive arthritis is a self-limited disease and they recover completely within 2-6 months. A chronic arthritis may persist in a minority, usually in association with HLA-B27 phenotype. Other patients can develop recurrent episodes of reactive arthritis after encountering the same organism.
Codes
ICD10CM:M02.30 – Reiter's disease, unspecified site
SNOMEDCT:
67224007 – Reactive arthritis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Pustular psoriasis with psoriatic arthritis can appear similar.
- Bacterial paronychia
- Drug-induced paronychia
- Trachyonychia
- Chronic paronychia
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Management Pearls
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Therapy
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Last Reviewed:10/17/2017
Last Updated:10/16/2022
Last Updated:10/16/2022
Patient Information for Reactive arthritis - Nail and Distal Digit
Overview
Reactive arthritis (formerly called Reiter syndrome) is a type of arthritis triggered by infection. The infection causes an autoimmune reaction of arthritic joint pain, stiffness, and inflammation. The joints often affected are your knees, ankles, and joints in your upper extremities. The arthritis may also occur along the spine and lower back. A small number of patients also have inflammation in the urethra, eyes, and skin.Reactive arthritis is a rare condition that usually goes away on its own in as few as 2-6 months. Less commonly, it can persist beyond 6 months (referred to as chronic reactive arthritis). It can also recur. Foodborne illnesses and sexually transmitted chlamydial infections are both common precursors to reactive arthritis.
Who’s At Risk
Reactive arthritis most commonly affects young adults (aged 20-40). Women and men develop reactive arthritis to foodborne infections at about the same rate, but men have a higher chance of developing reactive arthritis due to sexually transmitted bacteria. A family history of reactive arthritis also increases the likelihood of developing reactive arthritis.The following bacteria have been known to cause reactive arthritis:
- Chlamydia
- Salmonella
- Yersinia
- Campylobacter
- Shigella
- Clostridioides difficile
- Giardia
Signs & Symptoms
The symptoms of reactive arthritis typically begin 1-4 weeks after the initial infection. They may include:- Joint pain and swelling
- Eye inflammation or pink eye
- Increased frequency and discomfort during urination
- Swollen toes and fingers (sausage digits)
- Fever, fatigue, and weight loss
- Changes in fingernails and toenails (ridging, peeling, discoloration)
- Some people have changes in bowel movements, such as diarrhea or constipation
Self-Care Guidelines
These measures can be taken to reduce your risk of developing an infection that could lead to reactive arthritis:- Store food at its proper temperature and cook it properly
- Use condoms to lower your risk of sexually transmitted infections
These measures can be taken to manage symptoms:
- Talk to your doctor about following an anti-inflammatory diet
- Exercise regularly, preferably with activities easy on the joints (swimming, walking, bicycling)
- Do stretching exercises to maintain joint movement and range of motion
When to Seek Medical Care
Contact your health care provider if you have joint pain or swelling for longer than a week.Treatments
If your reactive arthritis is caused by a bacterial infection that is still active, your health care provider may prescribe an antibiotic.To relieve the symptoms of arthritis, the health care provider may recommend:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve inflammation, such as ibuprofen
- Corticosteroid injections into joints to reduce inflammation
- Some types of rheumatoid arthritis drugs help to reduce pain
- Physical therapy to increase strength of joints, joint flexibility, and range of motion
Reactive arthritis - Nail and Distal Digit
See also in: Overview,Anogenital