Rathod Tushar, Chandanwale Ajay, Chavan Shital, Shah Munjal
Department of Orthopedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India.
J Nat Sci Biol Med. 2011 Jul;2(2):216-8. doi: 10.4103/0976-9668.92312.
Reactive arthritis (ReA) is an immune mediated disease, clinically associated with oligoarthritis of the lower limbs and sometimes with urethritis and conjunctivitis. In our case, a 24-year-old male presented with severe mutilating arthritis involving both upper and lower extremities in contrast to conventional Reiter's syndrome which presents with asymmetric oligoarthritis. He had multiple well-defined, irregular, erythematous, hyperkeratotic, scaly and itchy plaques, not easily distinguishable from pustular psoriasis. The patient also gave history of circinate balanitis and urethritis. He was started on methotrexate (7.5 mg/week, later escalated to 15 mg/week with 15 mg/day folinic acid supplementation) to which he responded. But when he stopped it on his own, the symptoms recurred. Hence, methotrexate was restarted, but still the patient suffers from fixed flexion deformities in affected joints. Histopathological examination of skin lesions is also suggestive of ReA. Thus, this case report suggests that diagnosis of Reiter's should be considered in symmetrical, mutilating polyarthritis patients with typical skin lesions.
反应性关节炎（ReA）是一种免疫介导的疾病，临床上与下肢少关节炎相关，有时还伴有尿道炎和结膜炎。在我们的病例中，一名24岁男性表现为累及上下肢的严重致残性关节炎，这与表现为不对称少关节炎的传统赖特综合征不同。他有多个边界清晰、不规则、红斑、角化过度、鳞屑状且瘙痒的斑块，不易与脓疱型银屑病区分。患者还自述有环状龟头炎和尿道炎病史。开始给他使用甲氨蝶呤（7.5毫克/周，后来增至15毫克/周，并补充15毫克/天的亚叶酸），他对此有反应。但当他自行停药后，症状复发。因此，重新开始使用甲氨蝶呤，但患者受累关节仍存在固定性屈曲畸形。皮肤病变的组织病理学检查也提示为反应性关节炎。因此，本病例报告表明，对于有典型皮肤病变的对称性、致残性多关节炎患者，应考虑赖特综合征的诊断。
