General
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• Aseptic arthritis triggered by infective agent located outside the joint (Am Fam Physician 1999;60:499, UpToDate )
• Also called reactive arthritis

Clinical features
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• Patients present with asymmetric oligoarthritis
• Articular and extraarticular manifestations are similar regardless of organisms causing this disorder
• Synovitis of digital tendon sheath produces sausage fingers or toes, causes spurs
• Triad of arthritis, uveitis/conjunctivitis, non-gonococcal urethritis/cervicitis is not always present
• 80% are HLA-B27 positive

Epidemiology
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• Typically affects men or women in 20-30's

Sites
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• Affects ankles, knees, feet

Etiology
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• Occurs after GI infections (Salmonella, Shigella, Campylobacter, Yersinia), Chlamydia, Escherichia coli, Clostridium difficile, Chlamydia pneumoniae

Case reports
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• 35 year old Nigerian man with fever, dysentery, dysuria and joint pains (Afr Health Sci 2004;4:136)
• 36 year old man with progressive myelopathy (J Clin Neurol 2007;3:215)
• 46 year old HIV+ man with Reiter's syndrome (Braz J Infect Dis 2002;6:40)

Treatment
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• Doxycycline

Clinical images
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Onychodystrophy

Swollen "sausage" toe / inflamed ankle

Radiograph: periosteal reaction at plantar fascia insertion

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