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Question 12#

A 20-year-old man complains of arthritis and eye irritation. He has a history of burning on urination. On examination, there is a joint effusion of the right knee and a rash of the glans penis. Which of the following is correct? 

A. Neisseria gonorrhoeae is likely to be cultured from the glans penis
B. The patient is likely to be rheumatoid factor-positive
C. An infectious process of the GI tract may precipitate this disease
D. An ANA is very likely to be positive
E. Creatine kinase (CK) will be elevated

Correct Answer is C

Comment:

 Reactive arthritis (Reiter syndrome) is a reactive polyarthritis that develops several weeks after an infection such as nongonococcal urethritis (NGU) or gastrointestinal infection caused by Yersinia enterocolitica, Campylobacter jejuni, or Salmonella or Shigella species. Reiter syndrome is characterized as a triad of oligoarticular arthritis, conjunctivitis, and urethritis. The disease is most common among young men and is associated with the histocompatibility antigen, HLA-B27. Circinate balanitis is a painless red rash on the glans penis that occurs in 25% to 40% of patients. Other clinical features may include keratodermia blennorrhagicum (a rash on the palms and soles indistinguishable from papular psoriasis) and spondylitis. ANA and rheumatoid factor are usually negative. CPK would be elevated in polymyositis or dermatomyositis but not in reactive arthritis. Gonorrhea rarely precipitates Reiter syndrome, and a negative urethral culture would be expected.