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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.
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Constitutional: fatigue, malaise, fever, weight loss.
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Arthritis: usually acute, asymmetric, oligoarticular, involving predominantly lower extremities; sacroiliitis may occur.
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Enthesitis: inflammation at insertion of tendons and ligaments into bone; dactylitis or “sausage digit,” plantar fasciitis, and Achilles tendinitis are common.
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Ocular features: conjunctivitis, usually minimal; uveitis, keratitis, and optic neuritis rarely present.
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Urethritis: discharge intermittent and may be asymptomatic.
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Other urogenital manifestations: prostatitis, cervicitis, salpingitis.
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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.
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Uncommon manifestations: pleuropericarditis, aortic regurgitation, neurologic manifestations, secondary amyloidosis.
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Reactive arthritis is associated with and may be the presenting sign and symptom of HIV.