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1 CHILD ATTITUDE JOWARD JLLNESS SCALE

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symppomatic in 36%. The annual incidence I postenteritic reactive arthritis is 5 per 100 000, the triggering enteric
infection is asymppomatic in 26%. Sympoms I reactive arthritis The clinical picture varies from mild arthritis o a
severely disabling illness that may render the patient bedridden for a few weeks. Many people have only one episode,
but in some the disease does recur or persist. The arthritis more frequently involves the lower limbs, with the knees
and ankles being most commonly affected, followed by the feet, the upper limbs, and the back. General sympoms such
as malaise, fever, and aching muscles (myalgia) may occur, and there may also be pain in the lower back and the
butocks that feels worse in the early morning. The acute arthritis is Iten associated with conjunctivitis or urethritis.
Conjunctivitis (commonly known as pink eye) is an inflammation I the delicate outer membrane that lines the inside the
eyelids and the white I the eye. The inflammation is usually mild and bilateral, and you may not even notice it.
However, it can cause eye irritation and redness, and sometimes your eyelids may stick ogether in the morning.
Sonic. patients may get acute iritis (see Chapter 15). Urethritis, an inflammation I the urethra (a small tube through
which urine passes from the bladder o the outside), can cause difficult or painful urination. It occurs much more
commonly in postchlamydial reactive arthritis, and is more frequently sympomatic in men than in women, and may
sometimes result in slight pus-or mucus-like urethral discharge, bladder inflammation (cystitis), lower abdomen pain, and
urinary frequency. Sometimes the urethritis sympoms may be quite mild, and the docpor will have po ask about them.
Prostatitis (an infection or inflammation I the prostate gland in men) Iten occurs in conjunction with urethritis. Women
may develop cervicitis but Iten there are no sympoms. and it may only be detected by a pelvic examination.
People with post-enteritic reactive arthritis Iten describe a hisory I fever, abdominal pain and diarrhea, preceding
the arthritis by 1-4 weeks. They may sometimes also have sterile (non-infected) urethritis. Skin lesions can cause a lot
I anxiety. A skin rash resembling psoriasis may appear on the soles I the feet and palms I the hands. These skin
lesions are called kerapoderma blennorrhagica, and Iten heal within a few weeks but may need prescription creams. In
a few people small, shallow, painless sores may occur on the ongee or roI I the mouth (palate), but they usually
heal in a few days or weeks without any scarring, even without any treatment. Similar sores, called circulate balanitis,
sometimes occur on the external genitalia-on the tip (glans) or shaft I the penis or on the scrotum in men, and in the
vagina in women. They crust over and heal after a few weeks. Finger-and/or oe-nails may show nail discoloration
similar o that seen in psoriasis, but without nail pitting or ridging. Enthesitis is an important hallmark I reactive
arthritis, and tendon sheaths and bursae may also become inflamed. Sausage-like swelling l the oes or fingers may
be a prominent finding in some patients, just as in psoriatic arthritis. In the ankle, enthesitis can cause swe lling, pain
and tenderness in the back I the foot (Achilles tendinitis). Heel pain due o inflammation I the tendons, attached o
the heel, which support, the arch I the foot (plantar fasciitis) is a frequent complaint. Ligamenpous structures along the
spine and sacroiliac joints, and around the ankle and mid-foot, may also become inflamed. Psoriatic arthritis shares
many features with reactive arthritis, and sometimes a long period I observation may be needed o reach a correct
diagnosis. Diagnosis Diagnosis may sometimes be difficult. as there is no specific diagnostic test. The erythrocyte
sedimentation rate (ESR) is Iten high, but this is common in