Reactive Arthritis — SCE Dermatology MCQ

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HardConnective Tissue & VasculitisReactive ArthritisSCE Dermatology

Three weeks after urethritis, a man develops asymmetric oligoarthritis, sterile conjunctivitis, shallow serpiginous balanitis and hyperkeratotic plaques on his soles. Which unifying diagnosis is most likely?

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Correct answer: B — Reactive arthritis following genitourinary infection

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

E is correct. The timing after urethritis, asymmetric lower-limb oligoarthritis, conjunctivitis, circinate balanitis and keratoderma blennorrhagicum form the classic reactive-arthritis phenotype. The trigger is often Chlamydia trachomatis, although microbiological testing and treatment of active infection and partners remain separate from treatment of post-infectious arthritis. Secondary syphilis can be palmoplantar but does not characteristically produce this timed triad. Behcet disease causes recurrent painful ulcers and uveitis; disseminated gonococcal infection produces tenosynovitis and sparse pustules during active bacteraemia; psoriasis alone does not explain urethritis and conjunctivitis. The original stem only implied arthritis; this version states the defining feature explicitly.

Reference: NICE NG65 spondyloarthritis recommendations: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations