Average age 18–40 years. The male:female ratio following enteric infection is 1:1; however, genitourinary-acquired reactive arthritis is predominantly seen in young males. In a majority of cases, history will elicit symptoms of genitourinary or enteric infection 1–4 weeks prior to onset of other features.
Constitutional: fatigue, malaise, fever, weight loss.
Arthritis: usually acute, asymmetric, oligoarticular, involving predominantly lower extremities; sacroiliitis may occur.
Enthesitis: inflammation at insertion of tendons and ligaments into bone; dactylitis or “sausage digit,” plantar fasciitis, and Achilles tendinitis are common.
Ocular features: conjunctivitis, usually minimal; uveitis, keratitis, and optic neuritis rarely present.
Urethritis: discharge intermittent and may be asymptomatic.
Other urogenital manifestations: prostatitis, cervicitis, salpingitis.
Mucocutaneous lesions: painless lesions on glans penis (circinate balanitis) and oral mucosa in approximately a third of pts; keratoderma blennorrhagica: cutaneous vesicles that become hyperkeratotic, most common on soles and palms.
Uncommon manifestations: pleuropericarditis, aortic regurgitation, neurologic manifestations, secondary amyloidosis.
Reactive arthritis is associated with and may be the presenting sign and symptom of HIV.