Introduction: Severe keratoderma blenorrhagicum (KB) is a rare cutaneous manifestation of reactive arthritis (ReA) which can be indistinguishable from psoriasis, making the diagnosis challenging. This is a case of reactive arthritis in a 33-year-old female presenting with disabling, painful oligoarthritis which was accompanied by generalized pustular and scaly rashes simulating psoriasis. Case: A 33-year-old female, Filipino, single with no known co-morbidities presented with disabling, painful oligoarthritis which was accompanied by generalized pustular and scaly rashes of two weeks duration. Her symptoms were preceded a few days earlier with a transient episode of conjunctivitis. She also reported having recently received treatment for “urinary tract infection”. There were generalized hyperkeratotic papules with areas of desquamation overlying erythematous skin involving the scalp, hairline, trunk, and extremities including palms and soles, with onycholysis on all digits. The right wrist and both ankles were warm, swollen and tender, with dactylitis involving most toes. Dermatology consult concurred with the diagnosis of keratoderma blenorrhagicum associated with reactive arthritis, over psoriasis or psoriatic arthritis, and she was started on prednisone 60 mg/day; methotrexate (MTX) 20 mg/week and folic acid were added a week later. With dramatic resolution of both skin and joint involvement, prednisone was tapered to 10 mg/day over the next three weeks and MTX was maintained at 15 mg/week, with no rebound nor recurrence of symptoms. Conclusion Severe KB is a rare cutaneous manifestation of ReA which can be indistinguishable from psoriasis. The acute onset of symptoms, recent history of eye inflammation and genitourinary tract infection strongly favored ReA over psoriasis. A further hallmark of KB is the presence of sterile pustules on the palms and soles. Histologically, KB has more numerous pustules and massive hyperkeratosis compared to psoriasis. Moreover, the dramatic response to systemic steroids, without rebound nor recurrence upon steroid taper or discontinuation favors KB over psoriasis.
Arthritis, Reactive

Reactive arthritis and erythema are uncommon presentations of tuberculosis (TB). Reactive arthritis in tuberculosis (TB) is known as Poncet’s disease, a rare aseptic form of arthritis observed in patients with active TB. We report a case of Poncet’s disease in a 20-year old man whose reactive arthritis overshadowed other clinical symptoms of TB resulting in delayed diagnosis and treatment. Although a conclusive diagnosis of Poncet’s disease is not possible, reactive immunologic reactions such as reactive arthritis and erythema nodosum even without respiratory symptoms should raise suspicion on possible TB. Thus, taking a thorough medical history as well as performing relevant examinations and investigations for possible TB will help expedite the diagnostic process.
Arthritis, Reactive ; Tuberculosis ; Rheumatology

Reiter's syndrome is associated with a classic triad of arthritis, conjunctivitis, urethritis, and is the most common type of reactive arthritis. This syndrome is a one type of seronegative arthropathy, requiring differential diagnosis with psoriatic arthritis and ankylosing spondylitis, since it is associated with psoriasis-like skin lesion, sacroilitis, spondylitis. The arthritis of Reiter's syndrome is known to be acute, short-lived, and transient, but with subsequent attacks, it is more likely that it will lead to permanent joint damage or disability. We recently have experienced one case of Reiter's syndrome with severe joint destruction and significant functional disability, so here we report one case with review of literature.
Arthritis ; Arthritis, Psoriatic ; Arthritis, Reactive ; Conjunctivitis ; Diagnosis, Differential ; Joints* ; Skin ; Spondylitis ; Spondylitis, Ankylosing ; Urethritis

OBJECTIVE: To investigate the long-term efficacy of rehabilitation following arthroscopic synovectomy in patients with rheumatoid arthritis treated with biologic agents. METHODS: Arthroscopic synovectomy was performed in 29 joints of 17 patients, which were divided into two groups. Group 1 included arthroscopic synovectomy plus rehabilitation for 19 joints in 10 patients, and group 2 included arthroscopic synovectomy without rehabilitation for 10 joints in 7 patients. The Disease Activity Score C-reactive protein (DAS28-CRP), Health Assessment Questionnaire-Disability Index (HAQ-DI), and Functional Independence Measure (FIM) values (motor subscale) at 9.7 years after arthroscopic synovectomy were evaluated to identify the clinical factors related to outcomes. RESULTS: The increase in FIM score was significant in group 1 (p=0.05). HAQ-DI at 9 years was significantly decreased in group 1 (p=0.02). Therefore, arthroscopic synovectomy with rehabilitation was significant in improving FIM and HAQ-DI scores over a long period. Multiple regression analysis of FIM scores at 9 years indicated that rehabilitation (p=0.03) and disease duration (p=0.02) were significantly related to outcomes. FIM score at 9 years was significantly negatively correlated with disease duration (p=0.01, r=−0.58, Y=88.89–0.21X). CONCLUSION: Rehabilitation following arthroscopic synovectomy was effective in achieving high FIM scores over time in patients with rheumatoid arthritis.
Arthritis, Rheumatoid* ; Biological Factors* ; C-Reactive Protein ; Humans ; Joints ; Rehabilitation*

No abstract available.
Arthritis, Rheumatoid ; Blood Sedimentation ; C-Reactive Protein ; Erythrocytes

OBJECTIVE: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). METHODS: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. RESULTS: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. CONCLUSION: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.
Achilles Tendon ; Arthritis, Psoriatic ; Arthritis, Reactive ; Blood Sedimentation ; Bursitis ; C-Reactive Protein ; Fascia ; Humans ; Rheumatic Diseases* ; Spondylarthropathies* ; Spondylitis ; Tendons ; Ultrasonography

PURPOSE: We evaluated the clinical and radiological results of arthroscopic ankle fusion using 2 medial screws which had advantages of less morbidity, early weight-bearing and high union rate. MATERIAL AND METHODS: From April, 2002 to March, 2004, 8 patients who had ankle osteoarthritis were treated by ankle fusion using 2 medial screws under arthroscopy; five patients with post-traumatic osteoarthritis, two with post-infectious arthritis and one with paralytic foot. There were 5 male and 3 female. Average age was 67 years old ranging from 57 to 71 years. We evaluated them clinically preoperative and postoperative using AOFAS score, VAS pain scale and patient's satisfaction. In regard to radiological fusion, we checked them by simple AP, lateral and mortise view. Follow up period was average 11 months (range, 6~24 months). RESULTS: All ankles were successfully fused with 2 medial screws under arthroscopy. The mean time of fusion was 10.5 weeks (range, 8~14 weeks). Patient's satisfaction checked at 6 months after operation had favorable results (excellent and good 75%). One case had pain on medial malleolar area because of screw's protrusion. CONCLUSION: Arthroscopic ankle fusion using 2 medial screws was good modality of ankle fusion with less morbidity and early weight-bearing in some cases of ankle arthritis.
Aged ; Ankle* ; Arthritis ; Arthritis, Reactive ; Arthroscopy ; Female ; Follow-Up Studies ; Foot ; Humans ; Male ; Osteoarthritis ; Weight-Bearing

Since 1897 when Poncet first described polyarthritis in the acute stage of extra-articular tuberculosis, Poncet's disease has been considered a reactive arthritis to Mycobacterium tuberculosis. It is characterized by polyarthritis without evidence of direct mycobacterial involvement in patients with active tuberculosis, and eventually resolves without residual joint damage. Even though Poncet's disease is uncommon, the distinction between Poncet's disease and other arthritis, including tuberculous arthritis is clinically important. We report the second case of Poncet's disease diagnosed in a patient with pulmonary tuberculosis in Korea and review the relevant literature.
Arthritis ; Arthritis, Reactive ; Humans ; Joints ; Korea ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Pulmonary

Reactive arthritis occurs after a preceding infection such as urogenital or gastroenteral tract infection. Trichomoniasis, due to Trichomonas vasinalis infection, is one of the most common causes of vaginitis. Reactive arthritis associated with trichomoniasis is uncommon and there has been no report in Korea. We present a 28 year-old woman who had oligoarthritis after Trichomonas vaginalis infection. The arthritis subsided with treatment of the Trichomoniasis with metronidazole and non-steroidal anti-inflammatory drug.
Adult ; Arthritis ; Arthritis, Reactive* ; Female ; Humans ; Korea ; Metronidazole ; Trichomonas Infections ; Trichomonas vaginalis* ; Trichomonas* ; Vaginitis

We report a patient with reactive arthritis induced by recent streptococcal infection. A 27 year man had suffered from fever, sore throat and pain on left sternoclavicular joint. Arthritis occurred two days after tonsillitis and involved left sternoclavicular joint. Left sternoclavicular joint showed redness, swelling and tenderness. There were no growth of microorganism in blood cultures, no evidence of group Abeta-streptococcus in throat cultures, but antistreptolysin-O (ASO) and c-reactive protein (CRP) serum titers were elevated in sequential monitoring. Bone scan showed focal hot uptake at left sternoclavicular joint and Gallium scan showed diffuse inflammation at left sternoclavicular joint and soft tissue biopsy around sternoclavicular joint showed mild chronic inflammation. We suspected septic arthritis and prescribed empirical antibiotics but his symptoms were wax and wane. From the poor responsiveness to antibiotics, sustained high titers of ASO and recent history of tonsillitis, we confirmed poststreptococcal reactive arthritis, and attempted high-dose anti-inflammatory drug (aspirin 6 gram). Left sternoclavicular and shoulder pain improved.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Arthritis, Reactive* ; Biopsy ; C-Reactive Protein ; Fever ; Gallium ; Humans ; Inflammation ; Palatine Tonsil ; Pharyngitis ; Pharynx ; Shoulder Pain ; Sternoclavicular Joint* ; Streptococcal Infections ; Tonsillitis