Reactive Arthritis (Reiter Syndrome)

Behcet disease

FIGURE 3.34 Psoriatic arthritis. "Sausage finger deformity" of the distal interphalangeal joint. Note onycholysis.

FIGURE 3.35 Psoriatic arthritis ("arthritis mutilans"). This patient has severe psoriatic arthritis with marked deformities and subluxations of the small bones of the hands. Note also the characteristic onycholysis on the nails.

<bold>FIG. 129.1.</bold> Psoriatic arthritis in a patient with human immunodeficiency virus disease.

<bold>FIG. 63.2.</bold> Anteroposterior radiograph of the upper pelvis and lumbar spine. Both sacroiliac joints (<italic>large arrows</bold>) are fused (grade IV sacroiliitis), and there are bilateral, symmetric syndesmophytes (<italic>small arrow</bold>), resulting in the typical "bamboo" appearance of ankylosing spondylitis.

<bold>FIG. 63.3.</bold> Lateral radiograph of the lumbar spine in ankylosing spondylitis with "shiny corners" or Romanus lesions (<italic>large arrows</bold>) due to marginal erosions of verte al bodies and typical marginal syndesmophytes (<italic>small arrows</bold>).

<bold>FIG. 63.4.</bold> Lateral radiograph of the cervical spine in ankylosing spondylitis. Bony fusion of apophyseal joint between C2 and C3 (<italic>large arrow</bold>) and all other apophyseal joints below this level also are fused. A marginal syndesmophyte is also shown (<italic>small arrow</bold>).

<bold>FIG. 65.2.</bold> Asymmetric polyarthritis resembling rheumatoid arthritis in a patient with psoriasis.

<bold>FIG. 65.3.</bold> Long-standing psoriatic arthritis with a symmetric distribution. This patient had a "claw deformity" due to bony ankylosis of the proximal and distal interphalangeal joints.

<bold>FIG. 65.4.</bold> Psoriatic arthritis involving the metacarpophalangeal and proximal interphalangeal joints of the index finger with an associated flexor tenosynovitis. This combination gives rise to the "sausage" digit.

Reiter syndrome: hand and ankle acute arthritis in 19 yo man with chlamydia infection

Reiter syndrome: balanitis and elbow effusion (arthritis) in 19 yo man with chlamydia infection

<bold>FIG. 65.7.</bold> Family study in which psoriasis, ulcerative colitis, and ankylosing spondylitis showed a "clustering" phenomenon. Patients DB and FB have psoriasis in addition to ankylosing spondylitis.

<bold>FIG. 65.9.</bold> "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.

<bold>FIG. 65.10.</bold> Bony ankylosis of distal interphalangeal joints in a patient with psoriatic arthritis.

<bold>FIG. 65.11.</bold> Complete destruction of middle proximal interphalangeal joint. Also note bony ankylosis of corresponding distal interphalangeal joint.

<bold>FIG. 65.15.</bold> Psoriatic arthritis with axial involvement. The patient was HLA-B27^﹢ and had no radiologic evidence of sacroiliitis, but atypical syndesmophytes are observed.

Balanitis in Reiter syndrome

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

<bold>Fig B 10-12. Ankylosing spondylitis.</bold> Bilateral symmetric obliteration of the sacroiliac joints with prominent syndesmophytes in the lower lumbar spine.

Figure 6-200 <bold>ANKYLOSING SPONDYLITIS: SACROILIAC JOINTS. Bone Window CT, Axial Sacrum.</bold> Note the widening of the left sacroiliac joint resulting from erosions along the articular surfaces of the ilium and sacrum (<italic>arrow</bold>). <bold><italic>COMMENT:</bold></bold> The early changes associated with the inflammatory arthropathies affecting the sacroiliac joints are better evaluated using CT because of its superior sensitivity over plain film radiography. CT is the imaging modality of choice for evalua...

Figure 10-140 <bold>ANKYLOSING SPONDYLITIS: LUMBAR SPINE. A and B. Bamboo Spine.</bold> Note that complete interbody ankylosis by marginal syndesmophytes produces this distinctive undulating spinal contour.

Figure 10-154 <bold>SKELETAL DISTRIBUTION OF PSORIATIC ARTHRITIS.</bold>

<bold>FIG. 33.8.</bold>Behçet disease. Painful vulvar ulcer in a woman who also had oral ulcers of a similar appearance. Serologic and microbiologic studies for other potential pathogens were negative. (From Wilkinson, Stone. Atlas of vulvar disease. Philadelphia: Lippincott, Williams and Wilkins, with permission.)

<bold><italic>Figure 12.11</bold></bold>. Technique for sacroiliac compression test. Excellent first-line test to assess for ankylosing spondylitis.

Fig. 6. Anteroposterior view of the lumbar spine in a patient with psoriatic arthritis. There is paravertebral ossification with bulky bridging syndesmophytes in a bilateral, asymmetric distribution. Contrast this to the symmetric pattern in Figure 5.

<bold>FIGURE 26-56. Ankylosing spondylitis.</bold> The vertebrae have been cut longitudinally. The vertebral bodies are square and have lost most of their trabecular bone, owing to osteoporosis from disuse. Bone bridges fuse one vertebral body to the next across the intervertebral disks. Portions of the intervertebral disk are replaced by bone marrow. Bony bridges also fuse the posterior elements <bold><i>(ankylosis)</i></bold>.

Reiter's syndrome. Keratoderma blennorrhagicum. Scaly, red-brown, inflammatory, pustular, psoriasislike lesions are present on the soles. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Reiter's syndrome. In circinate balanitis, psoriasiform lesions occur on the glans penis and the scrotum. From Goodheart HP. Goodheart's Photoguide to Common Skin Disorders: Diagnosis and Management, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2009.

Serpiginous ulcer of penis in patient with mouth and eye findings. Likely Behcet disease.

Necrotic oral and lip ulceration HSV negative; eye and genital findings led to diagnosis of Behcet syndrome